A long-term acute care hospital (LTACH) is a hospital that treats patients who are still seriously ill but no longer need the full resources of an intensive care unit, and who are expected to need hospital level care for an extended time. Medicare uses the term long-term care hospital (LTCH). To qualify, a hospital must generally have an average Medicare inpatient length of stay greater than 25 days, which is far longer than at a typical acute care hospital.
This guide is general information, not medical advice. The care team and discharge planners can explain what fits a specific patient.
What an LTACH does
An LTACH provides daily physician oversight, 24-hour nursing, respiratory therapy, wound care, pharmacy services, lab work and imaging. Many also offer physical, occupational and speech therapy. The difference from a general hospital is the focus: LTACHs are organized around patients whose recovery is expected to take weeks rather than days.
Typical patients
Patients in an LTACH usually have one or more complex medical needs, such as:
- Prolonged mechanical ventilation, including patients being weaned off a ventilator after a long ICU stay
- Complex wounds, such as severe pressure injuries or surgical wounds that need specialized care
- Multiple organ problems, for example a combination of respiratory failure, kidney problems and heart conditions
- Long courses of IV therapy, such as antibiotics for a serious infection
How patients get to an LTACH
Most patients are transferred directly from a hospital ICU or step-down unit. When a patient's condition has stabilized enough to leave intensive care but they still need hospital level care, the hospital's case managers may recommend an LTACH. The LTACH reviews the patient's records to confirm they meet its admission criteria, and insurers often require approval before transfer.
Medicare payment rules shape this pathway. CMS pays an LTACH its full LTCH rate mainly for patients who spent at least 3 days in an ICU during the prior hospital stay or who need prolonged mechanical ventilation. Other patients can still be admitted, but the hospital is paid a lower rate, so LTACHs tend to focus on the most medically complex cases.
LTCH vs IRF vs SNF
| Long-term care hospital (LTCH) | Inpatient rehabilitation facility (IRF) | Skilled nursing facility (SNF) | |
|---|---|---|---|
| Main purpose | Extended hospital level medical care | Intensive rehabilitation therapy | Skilled nursing and therapy after a hospital stay |
| Typical patient | Medically complex, may be on a ventilator | Medically stable, can take part in intensive therapy | Needs daily skilled care but not hospital level care |
| Physician involvement | Daily physician oversight is common | Rehabilitation physician with regular face-to-face visits | Physician oversight with less frequent visits |
| Medicare rule | Average length of stay greater than 25 days | Intensive therapy expectation and 60 percent condition rule | Generally a qualifying 3-day inpatient stay |
| Medicare part | Part A hospital benefit | Part A hospital benefit | Part A skilled nursing benefit |
Some patients move through more than one setting, for example from an LTACH to an inpatient rehabilitation hospital once they can tolerate intensive therapy, and then home.
The hospital-within-hospital model
Some LTACHs are freestanding buildings. Others operate as a hospital within a hospital, meaning the LTACH occupies space, such as one or more floors, inside or on the campus of another hospital. Even in that setup, the LTACH is a separate hospital with its own license, leadership and medical staff, and CMS has rules intended to keep the two hospitals separately organized. For families, this can mean a transfer simply involves moving to another floor, but billing, staff and policies will change.
Medicare coverage in general terms
Medicare Part A covers medically necessary care in an LTACH under the same inpatient hospital benefit used for general hospitals. Days spent in an LTACH count toward your benefit period, and deductibles and coinsurance apply under the usual Part A rules. If you transfer directly from an acute care hospital within the same benefit period, you generally do not pay a second deductible. Because LTACH stays are long, coinsurance for extended days and lifetime reserve days can become relevant, so ask the facility and Medicare.gov about current amounts.
Medicare Advantage and private plans also cover LTACH care, usually with prior authorization and network rules. If costs are a concern, see Hospital Financial Assistance and How to Read a Hospital Bill.
How to evaluate an LTACH
Choices may be limited, but it is still worth comparing options:
- Medicare.gov Care Compare. CMS publishes LTCH quality measures that may include discharge to community, ventilator liberation (how often patients are weaned off the ventilator), pressure injuries, falls with major injury, readmissions and healthcare-associated infections such as central line and catheter associated infections.
- Experience with the patient's needs. Ask how many ventilator or complex wound patients the facility cares for.
- Staffing. Ask about physician visit frequency, respiratory therapist coverage and nurse staffing on each shift.
Browse long-term care hospitals by state or find hospitals near me. For a wider overview, read Types of Hospitals.
Questions for families
- Why does the care team recommend an LTACH instead of another setting?
- What are the goals for this stay, and how will progress be measured?
- How often will a physician see the patient, and which specialists are available?
- What is the plan for ventilator weaning or wound healing, if relevant?
- How will the team communicate with family, and how often are care conferences held?
- What are the visiting hours? See Hospital Visiting Hours and Rules.