LTAC vs Hospital - what's the diff?

  1. 1
    I am a senior nursing student in my last semester. I drew a facility for clinicals and transition that at first had me pretty disappointed as it is LTAC. After orientation though, I am kind of pumped, as it sounds like I will get the opportunity to do a lot of things we students don't often get to do - lots of wound care, trach care, replacing of lines and catheters, lots of assessments etc. They say the average patient stays about 30 days and then is released to SNF, hospice or home. Some have been there much longer and some are comfort care only. Everyone there seemed very enthused about this place and about teaching students. They average a 7:1 ratio for RNs to patients but seem to have a really good support staff and very low turnover.

    I have been shying away from the idea of LTAC as a job, but if my preceptorship is going to be full of so much experience, I am wondering some things - if there is this much experience to be had, why do hospitals not want to hire LTAC after a year or two? What is the pay of LTAC compared to hospital pay rates? What is the job satisfaction? They had employee satisfaction scores posted from last year (exactly a year ago in fact) and this facility's were actually quite low, which seemed to be directly contradictory to what those who came to see us in orientation seemed to feel. I am wondering if the floor nurses have a different opinion or if this would be a result of all ancillary staff and not just the nurses?

    This facility keeps lights off in the hallways to save money, which is pretty icky - very dark and dreary in there. I just don't know what to think. Anecdotal reports from prior students who got this facility for transition are overall quite positive. It does sound like we will get the opportunity to gain some confidence-building skills, which is great. I am just a little confused about some of the contradictory information and about what the challenges of LTAC tend to be and what makes it so different from acute hospital experience. Any insight?
    Carlalily likes this.
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  4. 1
    LTAC patients are too involved for LTC- a LOT of complex medical issues; many take vents and dialysis patients, as well as complicated decubs/wounds, rehab patients with extensive medical issues, etc. You can get a LOT of good experience. If you can't see during the day, they need to turn the lights on (a lot of places dim the lights at night). I worked at one for about 6 months (then relocated out of town), and liked the place....this was back in the mid 90s.

    They don't qualify for acute care anymore because of the chronic nature of their problems, but many are still very involved. You should get some good skill practice
    not.done.yet likes this.
  5. 2
    Hummm....LTAC....Where do I begin??? Ok....LTAC. Long Term Acute Care. These facilities are licensed as acute care facilities but do not have "emergency departments". per say, although some still do carry a "walk in" status for emergency preparedness. They can perform simple surgical procedures (endoscopes) but lack the anesthesia support for complex procedures. They have 24/7 MD support, pharmacies on site as well as radiology. These are ACUTE patients that have "RUN OUT" of acute days.

    These are medically complex patients with complicated hospitals stays and require complex acute care. The LTACS I am familiar with have ICU's and accept ventilated patients including post open hearts that still have PA-lines, A-lines and drips. These patients sre usually full codes with treatment goal of rehab and then home. They have 24/7 in house respiratory therapy, run their own codes and have radiology available 24/7. These patients are also on telemetry and recieve interventions for their symptoms and arrythmias. These patients are acutely or critically ill but no longer have "acute care days" that pay for them to stay in the hospital.....it used to be called when a patient goes on an "outlyer"....out of days and the hospital just sucked up the cost of the lower reinbursement but the patietn still requireing the higher level of care.... Now they just discharge them to the LTAC.

    Although they are licensed as ACUTE CARE they are not reimbursed as well as acute care. This is one of the ongoing debates about adding another tier of payment through medicare/insurance as these patiens require a high level of care. You will see many things there that you might not see in a hospital unless you changed specialties. In one intensive care there were 8 beds and in those 8 beds were 6 vents 4 PA lines 7 A-lines multiple drips (dopamine, neo,dobutamine, epi, TPN,heparin,and cardizem) and a halo traction. 4 open hearts, 1 MVA quadraplegic, 2 head bleeds and an ALS patient.

    Traches, vents, complex wounds and chest tubes are common. SO, they take care of the same patients, all complex....collected from many facilities...all in one building........with less money.

    Working in an LTAC will give you an enormous amount of experience. Hospitals actually don't realize what the LTAC does. I admit I didn't until a friend became a director and I went to work for her as a supervisor. What I learned shocked me ......I had NO idea these kind of facilities existed.....until I work for one. If you work in one be prepared to do a little teaching when applying to hospital acute care just because they simply aren't really aware what an LTAC does. All they know is that when they need to get rid of the financial burden of complex medical cared for patient......they go to the LTAC...... END of story.

    NOW........ for the other side of the experience......comming from acute care I was shocked at the acuity of the patient and the amount of nurses (and lack therof) that cared for these patients. The LTAC I knew is NOTROIOUS in the area for being cheap to the staff, sick patients and no help. Saftey can be an issue. In that ICU of eight patients there would be at the most on days 3 nurses....the other shifts were 2 nurses and sometimes and aide. The patient assignments were 7-10 patients to one nurse with an aide per nurse and sometimes and extra aide for the floor. The work load is heavy....really heavy. The LTAC I speak of wouldn't even allow disposable coffee cups because of the "waste" and the staff would wash out dinner cups for water cups for later for the patient. Staff provided their own coffee and cups and there were NO snacks kept on the floor.......they were signed out by the supervisor and there had better be a good reason.

    There is a high turn over rate and a constant in flow/outflow of staff with little to no resources available and administration oblivious to everything but the bottom line.....money. Which by the way you aren't making....they do pay less than hospitals. Actually, reflecting on it, it isn't any different that acute care there is just less staff around to help.

    Pay attention when there as a student. Keep your ears and eyes open to what's going on around you. Grasp EVERY opportunity to learn and do because you are right.......that's the place to get overdosed on it. BUt whether to work there later? I think you'd get valuable experience......and if you can't get an acute care position or don't want to, I'd go to the ICU or telemetry. YOu'd be more marketable later and they'd be willing to train....but never tell them this is a stepping stone....they'd dump you in a heart beat.

    YOu are going to learn alot....you can PM me if you have any other questons........Good luck:heartbeat
    Last edit by Esme12 on Sep 3, '11
    not.done.yet and maelstrom143 like this.
  6. 2
    Quote from Esme12
    Hummm....LTAC....Where do I begin??? Ok....LTAC. Long Term Acute Care. These facilities are licensed as acute care facilities but do not have "emergency departments". per say, although some still do carry a "walk in" status for emergency preparedness. They can perform simple surgical procedures (endoscopes) but lack the anesthesia support for complex procedures. They have 24/7 MD support, pharmacies on site as well as radiology. These are ACUTE patients that have "RUN OUT" of acute days.

    These are medically complex patients with complicated hospitals stays and require complex acute care. The LTACS I am familiar with have ICU's and accept ventilated patients including post open hearts that still have PA-lines, A-lines and drips. These patients sre usually full codes with treatment goal of rehab and then home. They have 24/7 in house respiratory therapy, run their own codes and have radiology available 24/7. These patients are also on telemetry and recieve interventions for their symptoms and arrythmias. These patients are acutely or critically ill but no longer have "acute care days" that pay for them to stay in the hospital.....it used to be called when a patient goes on an "outlyer"....out of days and the hospital just sucked up the cost of the lower reinbursement but the patietn still requireing the higher level of care.... Now they just discharge them to LTACS.

    Although they are licensed as ACUTE CARE they are not reimbursed as well as acute care. This is one of the ongoing debates about adding another tier of payment through medicare/insurance as these patiens require a high level of care. You will see many things there that you might not see in a hospital unless you changed specialties. In one intensive care there were 8 beds and in those 8 beds were 6 vents 4 PA lines 7 A-lines multiple drips (dopamine, neo,dobutamine, epi, TPN,heparin,and cardizem) and a halo traction. 4 open hearts, 1 MVA quadraplegic, 2 head bleeds and an ALS patient.

    Traches, vents, complex wounds and chest tubes are common. SO, they take care of the same patients, all complex....collected from many facilities...all in one building........with less money.

    Working in an LTAC will give you an enormous amount of experience. Hospitals actually don't realize what the LTAC does. I admit I didn't until a friend became a director and I went to work for her as a supervisor. What I learned shocked me ......I had NO idea these kind of facilities existed.....until I work for one. If you work in one be prepared to do a little teaching when applying to hospital acute care just because they simply aren't really aware what an LTAC does. All they know is that when they need to get rid of the financial burden of complex medical cared for patient......they go to the LTAC. END.

    NOW........ for the other side of the experience......comming from acute care I was shocked at the acuity of the patient and the amount of nurses (and lack therof) that cared for these patients. The LTAC I knew is NOTROIOUS in the area for being cheap to the staff, sick patients and no help. Saftey can be an issue. In that ICU of eight patients there would be at the most on days 3 nurses....the other shifts were 2 nurses and sometimes and aide. The patient assignments were 7-10 patients to one nurse with an aide per nurse and sometimes and extra aide for the floor. The work load is heavy....really heavy. The LTAC I speak of wouldn't even allow disposable coffee cups because of the "waste" and the staff would wash out dinner cups for water cups for later for the patient. Staff provided their own coffee and cups and there were NO snacks kept on the floor.......they were signed out by the supervisor and there had better be a good reason.

    There is a high turn over rate and a constant in flow/outflow of staff with little to no resources available and administration oblivious to everything but the bottom line.....money. Which actually isn't any different that acute care there is just less staff around to help.

    Pay attention when there as a student. Keep your ears and eyes open to what's going on around you. Grasp EVERY opportunity to learn and do because you are right.......that's the place to get overdosed on it. BUt whether to work there later? I think you'd get valuable experience......and if you can't get an acute care I'd go to the ICU or telemetry. YOu'd be more marketable later and they'd be willing to train....but never tell them this is a stepping stone....they'd dump you in a heart beat.

    YOu are going to learn alot....you can PM me if you have any other questons........Good luck:heartbeat
    This really sums up the world of LTAC very well. I think it's an amazing learning experience for a student, given that you're not worried about drawing a salary. One thing I would like to add is that they have a lot of problems keeping up a consistant census, and cancel nurses off the schedule at the drop of a hat. One month I was cancelled three times, which, if you keep in mind that these are 12-hour shifts, means I lost an entire week of pay that I couldn't cover, even with PTO, because by that time I had been cancelled so many times that I had blown through all of my PTO to cover that lost income and had nothing left...for vacation or sick time, which I really, desperately needed.

    Wish you the best, I think you will get a lot out of the experience.
    not.done.yet and Esme12 like this.
  7. 2
    Thank you SO MUCH for the well thought out and positive responses! I am really excited by the learning opportunity and have kind of gone from feeling like I lost out to feeling like I lucked out! Should be an educational semester!
    Esme12 and xtxrn like this.
  8. 1
    Quote from not.done.yet
    Thank you SO MUCH for the well thought out and positive responses! I am really excited by the learning opportunity and have kind of gone from feeling like I lost out to feeling like I lucked out! Should be an educational semester!

    YOu're welcome.......update us an let us know how you are doing....or leave me a visitor message. I'll be looking forward to it...:heartbeat
    not.done.yet likes this.
  9. 1
    You just make me smile. Thank you for the mentorship - I will definitely be taking you up on it!
    Esme12 likes this.
  10. 2
    I work in an LTAC and we see it all! We have ICU, TCU (transitional care unit-vent pts. are here) and med-surg. We do vent weaning, low tolerance rehab, wound care, IV Abx, and much more. We can do trachs at bedside and endoscopy. Dr. are on site, respiratory, pharmacy and radiology is also on site. We have a chaplain, pet therapy, dialysis, and OT/PT. Many pts. are total care with complex problems. We see a lot of respiratory pts. (more of these than any other), osteomylitis, post-CABG, complications from gastric bypass, diabetes, diabetic foot ulcers, wounds that won't heal, malnutrition,post-MVA, post-stoke, neuro and tons of other stuff. A lot of the resp. pts. have other other issues too, like lung CA. Some go home on hospice, some are comfort only, some are full codes. We all are to be ACLS, which is provided inhouse. I haven't taken it yet, but I have only been here a few mo. They will schedule me in soon. You will really hone your assessment skills and learn a lot. These pts can do downhill at the drop of a hat and it happens FAST.
    I was really excited when I got the position here. For me it has a stressful run due to a lack of staffing. We use a lot of agency/travel nurses to fill in the blanks and CNA's aren't always there to help. When we do get them they are assigned to a hall, yielding 18 pts. a piece. Some are GREAT and others aren't. So a lot falls on nurses, getting vitals, turned every 2 hrs., toileting and such. It can very rewarding. Seeing a pt. go from ICU to the end of the hall in med-surg is awesome. Also, having a pt. on a vent who we thought wasn't going to make it, talk to me 2 weeks later about how they can't wait to see their family is awesome. We just had a new grad leave our unit to go to ICU at a local hospital. He hadn't been with us a yr. and they snatched him up. In our area, you can get a job anywhere with this experience. We have a reputation for being a difficult place to work, yet we are respected because they know what we do.
    KimberlyRN89 and not.done.yet like this.


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