Long-Term Care
We recommend asking the following questions when a loved one is being considered for transfer to an LTACH:
“What are the outcomes of LTACHs in this area?”
“How many patients are alive one year after admission to this LTACH?”
“How many patients are discharged home from this LTACH one year after admission?”
Not all patients in the ICU will recover enough to return home. Some patients are left so weakened by their critical illness that they are unable to breathe on their own and must rely on a breathing machine. These patients are “ventilator-dependent” and are usually unable to live independently. If they are medically stable, patients can be transferred to a ventilator-weaning facility, called a “long-term acute care hospital” (LTACH). The goal of these hospitals is to get patients strong enough to go home, and they emphasize physical therapy and rehabilitation. About one-third of patients transferred to LTACHs improve enough to get off the breathing machine and return home. Unfortunately, many patients remain ill and debilitated in the year after being transferred to an LTACH.
Other patients are not ventilator-dependent but still too weak and debilitated to return home. Depending on the severity of their weakness, some patients may need to be transferred to a skilled nursing facility, a nursing home, or an inpatient rehabilitation center. These facilities offer different intensities of physical rehabilitation, occupational rehabilitation, and nursing care.
Life After Surviving Critical Illness
We recommend you ask the following questions:
“What level of functioning will my loved one have when they are ready to leave the ICU?”
“What signs or symptoms of depression, anxiety or PTSD should I be aware of?”
“Are you aware of any support groups in the area for ICU survivors?”
With survival rates generally improving in critical illness, there has been an increased focus on how patients do after they leave the ICU. Many patients are still weak and debilitated after they leave the ICU despite daily exercise and rehabilitation, and it can take many days or weeks before they are strong enough to perform even simple tasks like getting out of bed or dressing themselves. Almost half of patients are still unable to function independently a year after their episode of critical illness.
Besides physical weakness, patients who survive their critical illness may have memory problems, and may have symptoms of depression, anxiety or post-traumatic stress disorder (PTSD). Family members of patients may also experience symptoms of psychological distress. While therapies to prevent and treat these symptoms are still being developed, it is important to let the patient’s healthcare provider know if the patient is showing signs of depression, anxiety or PTSD. Many patients and families also find it helpful to attend support groups that focus on survivors of critical illness.
DISCLAIMER
This Intensive Care Unit (ICU) guide for patients and families is intended to provide general information about adult ICUs. The guide is for informational purposes only and is not a substitute for the advice or counsel of one’s personal healthcare provider.
