Context
Virtually every patient in a long-term acute care hospital (LTACH) has a serious illness and thus, potentially eligible for palliative care (PC).

Objectives
To evaluate the scope, structure, and staffing of PC programs in LTACHs

Methods
Descriptive cross-sectional survey of LTACH leaders affiliated with the National Association of Long Term Hospitals (NALTH) linked with publicly available hospital data to determine presence, structure, and staffing of PC service, and perceptions among leaders of LTACHs without PC services.

Results
Among 42 respondent LTACHs (50.6%) , 24 (57%) reported having a PC program. LTACHs with versus without PC were more often part of a healthcare system (75% vs 59%) but not an LTACH chain (38% vs 53%) . Most externally contracted PC services (75%) , provided in-person consultation at least most weekdays (82%) , were financed by professional billing (71%) and/or hospital support (64%) , and were well regarded. The most common staffing discipline was physicians (55%) ; 10% met the interdisciplinary team definition. Half (55%) reported seeing fewer than 50% of patients perceived to benefit from PC; 36% reported interest in PC training for their staff. Among the 18 LTACHs without PC, most (78%) perceived that PC was beneficial, and recognized recruiting staff, financing, and LTACH/host hospital leadership as barriers.

Conclusions
Independently owned, non-profit LTACHs embedded within healthcare systems more often reported having PC services, with variability in structure and opportunities for further expansion and training. Despite positive regard for PC, barriers of staffing and financing will need to be overcome to establish PC services in LTACHs.