Helping elderly patients with a smooth transition

Quick Notes:

  • Long-term care hospitals provide comfortable units that feel just like “home.”

  • These hospitals are inspiring others to follow in their footsteps to improve patient care.

When someone is nearing the end of their life, it’s best to make them feel as comfortable as possible. Many of these individuals might be scared about what’s ahead, and they’re too sick to go home. They’re too ill for most nursing homes. Luckily, the Hospital for Special Care in New Britain, Connecticut, has opened a long-term-care observation unit to help make these patients feel like they’re right at home for the rest of their lives.

Long-term care hospital

New Britain’s Hospital for Special Care is a long-term care hospital (L.T.C.H.) or long-term acute care hospital. Elderly patients are transferred here when an ordinary hospital has discharged them from its facility. They’re too sick to go home or stay at a nursing home, but they don’t qualify for an ordinary hospital. Understandably, this would be a confusing, heartbreaking time for patients and their families. But the L.T.C.H. is designed to make their transition as comfortable as possible.

The unit, which hosts up to 10 patients at a time, is a close observation unit where visitors can always hear the steady ping of pulse monitors and ventilators. The unit includes curtained cubicles that feature windows, soothing artwork, and calming, caring nursing staff.

The reality is that many of these patients won’t be discharged to go home. Their health won’t improve, and that can be a scary thought for some patients and their families. But the L.T.C.H. is designed to gently help patients feel comfortable during the long-term care.

“It’s truly a hidden segment, even to most people in health care,” said Dr. Anil Makam, hospitalist and researcher at the University of California, San Francisco. Health care professionals are praising the Hospital for Special Care for its innovative care towards patients. But to the hospital staff, the focus is always on the patients.

About the patients

Patients improve their health while staying at the L.T.C.H., but it’s a gradual process. For example, one woman with severe emphysema had been staying at the hospital since January 2019. “She’s off the vent, but she’s very tenuous, in and out, in and out,” said Dr. John Votto, the hospital’s pulmonologist and former chief executive.

Another patient had been staying at the hospital’s care unit for about a month, trying to recover from a brain hemorrhage and spinal cord injuries after falling down a set of stairs in his home. While he finally came off his ventilator, Votto commented that he would most likely need it again. He said, “Setbacks are very common.”

In fact, it’s difficult to express a true recovery rate. Makam commented, “True recovery rates – getting back to thinking clearly and functioning well – may be lower.” On average, patients spend two-thirds of their remaining lives in an institution. Makam added, “A little over a third of people never make it home. They go back and forth between the L.T.C.H. and hospitals and nursing facilities, and they die in one of them.”

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Many times, patients can feel a deeper sense of being alone. They feel trapped. Their families feel anxious and stressed, which is why New Britain’s Hospital for Special Care has worked diligently to make its special care unit feel as close to home as possible for these patients.

Inspiring other hospitals

Today, the Hospital for Special Care isn’t the only facility to feature an L.T.C.H. unit. Close to 400 hospitals across the United States provide daily physician visits, high nurse-to-patient ratios, and intensive therapy. In 2017, the units accounted for about 174,000 hospital stays. Votto hopes every patient realizes their situation, commenting, “You’re at a level of illness where there’s not a lot of good outcomes, no matter what.”

But people remain hopeful. They think to themselves, “Maybe I’ll be one of the 20 percent to go home.” Maybe they will, and we hope they are. But just in case they aren’t, the L.T.C.H. is always prepared to make them feel like they’re home until their time comes to leave.

A deeper dive – Related reading from the 101:

The medical field has changed progressively over the last five years. Learn how “millennial” doctors are making innovative changes to patient care.

More people are focusing on how to prepare themselves for death. Learn about the popular “deathcare” trend, which positively prepares individuals for their end-of-life care.