What is Long Term Acute Care?

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    I have an interview at a long term acute care facility next week and am looking to get some information about this area of nursing. As a new graduate, I know that I may have to take whatever I can get in this economy and I am very fortunate to already have a job offer in a nursing home as well.

    What I am looking to get some advice or information about is whether or not a long term acute care facility would give me better experience than a nursing home. When I say better I basically mean that I would like to work in an ICU or ER one day and also keep my options open to become a CRNA.

    Would long term acute care provide me with the chance to develop skills and become comfortable with procedures that would make myself more attractive to hiring managers in ICU/ER?

    If anyone has any experience in this area or advice please speak up, I am excited about this opportunity but also a little stressed about making this decision.

    Thanks!

    Spartan05
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  3. 14 Comments so far...

  4. 2
    Here's a link that may help; when I worked in CCU we'd sometimes d/c patients to this facility http://www.cshnc.com/.

    The "What We Do" link has a good summary. If the place you're considering is similar, it would be a great stepping stone to a critical care unit. Good luck!
    VickyRN and Spartan05 like this.
  5. 1
    LTACHs serve patients with complex medical needs requiring long-term hospitalization in an acute setting. Many LTACH patients are admitted directly from short-stay hospital intensive care units with respiratory/ventilator-dependent or other complex medical conditions.

    http://www.cga.ct.gov/2004/rpt/2004-R-0966.htm

    In my area we have Vencor and Kindred.
    I would think that the experience in a long care acute care hosp will be more beneficial to your ultimate goal. I have friends that worked at this type of facility and they learn about vents and even medication drips. Some Facilities have ICUs within the unit for even sicker patients.
    Good Luck
    Spartan05 likes this.
  6. 2
    Lately I think our floor is an LTAC...



    But hey at least you always know the person, since they have been there for months.

    Tait
    imaRN08 and Spartan05 like this.
  7. 0
    LTAC stands for long term acute care and that's exactly what it is. Worked in one for 4 years. Had lots of complex medical problems. These folks were released from the hospital but needed much more care than an LTC or home health could provide. They can stay as long as 60 days which can be regenerated for future stays and then have 20 lifetime reserve days which are a 1 time deal. Can stay as long as 80 days and many of them stay even longer. You name it, you'll see it. And the LTAC I worked in had it's own ICU.
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    It is mostly Nursing Home type patients that are admitted to the hospital, but require a LONG stay. Not a 3 day in and out admission. The patients are typically elderly, total care, and have a lot going on medically. Too much medical stuff to keep them in a nursing home, but not not quite enough going on to keep them on a med/surg floor.

    Think 85 year old who just had major surgery and will have a long recovery but STABLE, and will be on multiple IV meds, O2, have a foley, dressing changes, is diabetic with readings all over the place, and has a fever. A bit too much for LTC, but too stable for med/surg.
  9. 0
    Quote from GooeyRN
    It is mostly Nursing Home type patients that are admitted to the hospital, but require a LONG stay. Not a 3 day in and out admission. The patients are typically elderly, total care, and have a lot going on medically. Too much medical stuff to keep them in a nursing home, but not not quite enough going on to keep them on a med/surg floor.

    Think 85 year old who just had major surgery and will have a long recovery but STABLE, and will be on multiple IV meds, O2, have a foley, dressing changes, is diabetic with readings all over the place, and has a fever. A bit too much for LTC, but too stable for med/surg.

    Sounds like you just described my Transitional Care Unit...
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    You get a lot of vents, work with a lot of respiratory therapists so it's good for pulmonary background and the vent experience might make you more attractive for ICU at some other time. You get to see weans that take months (from the vent), going to different types of trachs, decannulated, the journey from life support to talking back and feeding their own selves is pretty amazing.

    Also you can get a bit of palliative care experience, as they don't all get better. Some get a lot worse. You have a lot of foleys, rectal tubes, picc lines, central lines, dobhoff and ng tubes, and PEG feeding tubes with various pumps. Very fun, so you do get used to dealing with a lot of stuff hooked up to your patient.

    You see more wounds than you can shake a stick at, and get much better with dressing changes. Lots of ostomies as well. Since the patients are more like residents with their long stays, you get to develop your psychosocial skills in dealing with them and their families. Oh, and there is also physical therapy, occupational therapy, speech therapy, and in most places their own wound care nurse. So you have a lot of interdisciplinary stuff going on as well. The workload resembles, ratio-wise in my facility anyhow, a good hospital medical floor ratio. Like I'm used to 4 and can do four. Sometimes it's two, or three, and if everything including a weather disaster happens it can be five. I don't like five but I can do it once in a long while. If you do the ICU rooms it's probably a 2 patient assignment.

    All in all I think the biggest challenge with my facility for new grads, would be that they mostly hired experienced nurses with ICU experience and we have this laid back attitude that can get a new grad in trouble if they adopt it while trying to be like their preceptor. So it's good for experience, but insist on something more akin to an apprenticeship than an orientation- like, could you please do 90 days or so, with varying workloads, consistent preceptorship, and I think the new grads should work some shifts opposite what they normally work, if possible, to get a feel for the "other side."

    /ramble off.
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    I worked in a LTAC before working in an ICU, and I felt it helped me a lot. You get all sorts of experience with vents, lines, and all sorts of other things. I was told (and agree with, at least in our unit) when I was interviewed that the acuity of an LTAC was in between an ICU and an ICU stepdown (progressive).
  12. 0
    I work in a long term acute care facility for severely disabled children. I wouldn't say it's equivalent to ICU step down but we do take a lot of post-ops. All our kids are profoundly mentally and physically disabled, more than half are gastrostomy fed, almost none can walk, none can speak and they all require extensive physiotherapy, occupational and speech therapy and their medication conditions managed (a lot of the kids have poor chests due to risk of aspiration and the fact that a lot have squashed lungs due to spinal and other deformities.

    For the most part, however, my job is personal care, feeding and providing basic therapies e.g. getting the kids in their standing frames or on their prone boards, trying to mentally engage them, provide comfort (both physical comfort and emotional comfort etc.)


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