Indian healthcare needs to refocus on long term acute care

Dr Vijay Janagama, Head-Concept and Clinical Excellence, HCAH SuVitas highlights the role of Long Term Acute Care (LTAC) in lifting the pressure off the secondary and tertiary care sectors

India is not really ageing ‘healthy’. India is home to nearly 138 million elderly persons. With increasing age and longevity, the risk of chronic diseases like pulmonary and heart diseases isseeing a steep hike. Reports indicate, 10–20 per cent of patients recovering from critical illness worldwide experience persistent organ failures, necessitating complex care for a prolonged period of time. Indian healthcare, which is already struggling with insufficient hospital beds, dismal number of ICU facilities etc. will be highly ill-equipped to address the chronic care needs of the growing ageing population.It’s high time we realised the role of Long Term Acute Care (LTAC) to lift the pressure off the secondary and tertiary care sectors, thus realising continued acute level care for optimum outcomes to both the patients and providers.

Need and benefits of LTAC

Long Term Acute Care is a specialised multidisciplinary care for ICU or Post Operative Care patients who require long term supervised care. Many stroke, head injuries, spinal cord injuries and other major medical/surgical illness require long term acute care beyond the normal length of stay in an ICU/hospital. These critically ill patients often need attention of several specialistsin a day and will also need many critical care services like prolonged mechanical ventilation, intravenous antibiotics, complex wound care etc.

LTAC is designed for critical/postoperative patients who can’t afford long term stay in tertiary care setting but want to still benefit from the acute care services and personalised attention within an out-of-the-hospital setting. LTAC can reduce hospital readmissions by 26-44 per cent and generally cost 25-34 per cent lesser than traditional hospitals (per-patient-day costs). LTAC also reduces the risks of hospital acquired infections, enhances early integrated recovery and improves overall emotional wellbeing of the patients (since they get to be with their family unlike in an ICU).

Difference between LTAC and Long Term Care (LTC)

LTAC hospitals, which are certified medical institutions, provide intensive medical care for patients with critical conditions for an average length of stay of 25 days or above. Once the patients are declared fully stable, they are either shifted to home or to a rehabilitation facility for regaining complete functionality.

In contrast to this, LTC centers needn’t be or function as part of certified hospitals. It is typically considered as custodial care administered to patients who need extended care for activities of daily living (ADL) and to manage their health (relatively less critical) conditions. LTC comprises of round-the-clock nursing care, medical supervision, rehabilitation therapies like physiotherapy, respiratory therapy, occupational therapy, nutrition therapy etc.Patients often stay for an indefinite period of time at LTC facilities.Unlike LTAC which offers care to a very high acuity, complex care needing patient population, LTC in practical terms is considered as institutionalized care offered to elderly population for their long term, overall wellbeing.

How Indian healthcare will be benefited by LTAC?

Long Term Acute Care provides interdisciplinary acute care to meet the unique needs of patients struggling with chronic illnesses in the country. Patients who are denied of extended acute care due to the insufficient capacity of hospitals will find LTAC a welcoming relief. Hospitals can efficiently plan their acute care services by working closely with LTACs. Intensivists can identify patients who will need extended ICU care within first few days of starting critical care treatment. For instance, clinicians could think of LTAC for patients when tracheostomy is first considered. These patients mostly report higher case mix index (more than onecomorbidity) than traditional hospital patients. Consequently, the care requirements of these patients will be more complex, necessitating the need to transition to specialised units of care with a particular competency for recovery. As soon as it is determined that the patient needs prolonged acute care, hospitals can initiate transition to a trusted LTAC partner, thus efficiently realizing continuum of acute care. Efficient partnership between hospitals and LTACs help in effective utilization of acute care facilities in hospitals and reducing readmissions. This is a much-needed strategy to level the largely unmet needs of the healthcare system of a fast-ageing country like ours.