Project start: 9/01/2022
Each year, long-term acute care hospitals (LTACHs) care for over 100,000 individuals with complex and serious illness requiring prolonged inpatient care for weeks or months following a short stay hospitalization. Patients cared for in LTACHs are typically older, disproportionately from underserved backgrounds (e.g., Black and dual Medicare-Medicaid enrolled), and have substantial multimorbidity. Individuals transferred to LTACHs have prognoses similar to patients with metastatic cancer, with a median survival of only eight months, and often spend most of their remaining life in a hospital or long-term care facility. Given substantial morbidity and mortality, most individuals cared for in LTACHs qualify for and could benefit from specialty palliative care consultation, which in other settings has been shown to improve quality of life and end-of-life experiences, decrease burdensome care, and significantly lower costs by reducing unwanted care. Despite these benefits, only about one-third of LTACHs nationwide self-reported having a palliative care program, and little is known about the structure and characteristics of these programs, including about their staffing.
The purpose of this project is to evaluate the scope of palliative care programs and staffing models in LTACHs. This project will also determine whether palliative care staffing and services vary by LTACH characteristics, such as ownership type, size, and region. This research will complement our prior research on the configuration of palliative care teams in short-term acute care hospitals, filling an important knowledge gap to help expand and inform optimal design and implementation of palliative care services in LTACHs.
We will prospectively survey LTACHs who are members of the National Association of Long Term Hospitals (NALTH), the premier association representing LTACHs in the United States, to characterize specialty palliative care programs and staffing models, including the discipline, training, and roles of the palliative care workforce.
This project aims to answer four questions:
- What is the staffing of specialty palliative care programs in LTACHs, including total full-time equivalent staff by discipline (i.e., social workers, physicians, etc.) and their training?
- What is the structure of specialty palliative care programs in LTACHs, including their financing, availability (i.e., on-site vs telehealth), and services provided (i.e., symptom management, psychology care, bereavement care)?
- Does palliative care staffing vary by characteristics such as LTACH ownership type, bed size, chain affiliation, region, and location (freestanding vs. located within a hospital)?
- Do palliative care services vary by characteristics such as LTACH ownership type, bed size, chain affiliation, region, location (freestanding vs. located within a hospital)?
For more information, contact Joanne Spetz or Anil Makam.