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June 27, 2014

NYT takes a look inside long-term acute-care hospitals

Daily Briefing

    With the aging population and the increased use of life-prolonging medical treatments, more U.S. patients are entering long-term acute care hospitals where they may live for months or even years, Gina Kolata writes in the New York Times.

    There are 400 long-term acute care hospitals in the United States, and the number of patients in such facilities has more than tripled in the past decade—reaching 380,000 patients, according to one estimate.

    How good are the long-term care services in your state?

    That number is only growing because long-term acute care facilities treat patients who are often sustained by respirators and feeding tubes—sometimes never waking up from comas. One study found about half of patients who enter such facilities die within a year, while the rest remain in custodial care. Just 10% to 15% ever return to an independent life.

    Essentially, long-term acute-care is "where you go when you survive but you don't recover," says Judith Nelson, a critical care specialist at Mount Sinai Hospital. A patient's journey to a long-term acute care facility often begins in an ICU when a physician suggests placing a tube in a patient's throat so they can insert a ventilator, Nelson says. "Once that happens, your future is not bright," she says.

    Physicians need to discuss patients' future

    Few physicians discuss the consequences of inserting a breathing tube or the alternatives, says Shannon Carson, a critical care specialist at the University of North Carolina School of Medicine. As a result, many "misunderstand" and think it could be "a sign of hope."

    "It could be that physicians are not confident in their prognosis and therefore don't want to share it, or it could be that physicians do share it and families don't want to hear it," says Carson, adding, "They are discussing how the patient is doing today, not how they will be doing in six months."

    For some families, the stay at a long-term hospital ends in the painful decision to let go and cease life-saving interventions.

    But Kolata reports, patients at long-term hospitals are not necessarily without happiness. She tells the story of two patients with muscular dystrophy who were recently married in the courtyard of the Hospital for Special Care in Connecticut.

    "It's remarkable," says John Votto, the hospital's CEO. "You are on a ventilator, you can't move, you can't walk, you can't breathe. You and I would say, 'Oh my God, you must have this terrible quality of life.' But they really don't. Honestly, many are quite happy" (Kolata, New York Times, 6/23).

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    1. Current ArticleNYT takes a look inside long-term acute-care hospitals

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