The evidence behind the standard.

Survival, Function, and Cognition After LTACH Hospitalization

This 2024 study in JAMA Network Open followed middle-aged and older adults after a stay in a long-term acute care hospital, a setting that serves more than 70,000 Medicare beneficiaries each year. The researchers linked the nationally representative Health and Retirement Study to Medicare claims, identifying 396 participants over age 50 who were admitted to an LTACH between 2003 and 2016, with a median age of 75. Half had experienced a prolonged ICU stay, and 41 percent had received mechanical ventilation. Within two and a half years of the LTACH admission, four in five had died or were living with severe impairment, defined as dependence in two or more activities of daily living or dementia. Health before the illness mattered: participants with a better survival prognosis and better function and cognition before the hospitalization had more favorable outcomes. The authors conclude that a patient's pre-hospitalization health can guide patients, families, and clinicians in decisions about prolonged acute care.

Time in Prior Hospital Stay and Ventilator Patient Outcomes in LTACHs

Focusing on one of the LTACH's most clinically demanding populations — patients requiring prolonged mechanical ventilation — this study examined how the timing of transfer from an acute care hospital affects outcomes in the LTACH setting. The research addresses a question that every LTACH clinical leader navigates in the context of admission decisions: who should be transferred, and when. The findings contribute evidence to decisions that are currently made largely on clinical judgment and that have significant implications for both patient outcomes and facility financial performance.

Patient Outcomes and Lessons Learned From Treating COVID-19 at an LTACH

This single-center retrospective study documented the characteristics, clinical management, and outcomes of patients treated for severe COVID-19 at an LTACH in the northeastern United States — and compared them to the facility's pre-pandemic medically complex patient population. The study illustrates the LTACH's role as a flexible, high-acuity resource in healthcare system surge management, and offers operational and clinical lessons relevant to any LTACH leader navigating a system-level crisis. The interdisciplinary care approach described reflects the kind of coordinated leadership that the CLLP's patient experience and clinical operations domains develop.

Palliative Care Services in Long-Term Acute Care Hospitals: A National Survey Study

This 2025 survey went directly to LTACH leaders to map how palliative care actually operates inside these facilities. Among responding hospitals, 57% reported having a palliative care program, but the more useful finding for executives is why the others didn't: leaders named difficulty recruiting staff, financing, limited leadership support, and uncertainty about the benefit as the main barriers. Hospitals with a program were more often embedded within a larger health system that supplied leadership and financial backing.

Nursing Staff Turnover and Care Quality in Hospital Units

This peer-reviewed study examined the relationship between nurse staffing levels, collective staff turnover, and care quality across hospital units — finding that nurse turnover negatively affects care quality for intensive care units and medical-surgical units, with the impact more substantial in higher-acuity settings. For LTACH leaders — who manage both high-acuity clinical environments and chronic workforce instability — the findings quantify what experienced operators already know: turnover is not just a human resources problem. It is a patient safety problem. Increased staffing levels are identified as an effective countermeasure, but the study acknowledges the operational constraints that make this solution more complex in practice.