Complex Care Hospitals, an Integral Part of a Community's Health Care Continuum
No matter the cause, a hospital stay may be a significant event in a person’s life. Patients and their family members face many decisions when it’s time to leave the community hospital. Some patients may be able to return home, and their decisions may involve rental or purchase of durable medical equipment, or nursing care in the home. Other patients with additional recovery needs may require a referral to a rehabilitation hospital or a skilled nursing facility that provides extended care for chronic conditions.
There are patients, however, whose serious illness or injury may have stabilized, but still requires a continuation of the critical care services provided by one of the community’s vital acute care hospitals. Physicians treating medically complex patients may determine that the seriousness of their conditions requires acute care services like those available in the intensive care unit of the community hospital. In this case, the physician may refer the patient to a specialty acute care hospital known as a "complex care hospital." Like community hospitals, complex care facilities are typically equipped with the same advanced technologies and staffed with a similar array of physicians, nurses and healthcare specialists.
The strength of a complex care hospital is its focus on providing a combination of critical care services and intensive therapeutic services, unlike rehabilitation hospitals and nursing centers that are not equipped to provide comprehensive medical services in a critical care setting.
In this way, complex care hospitals add an important level of care to the commu nity’s health care infrastructure. In a sense, this level of care is an extension of the typical services available in a community hospital, such as:
- Physician interaction with daily on-site assessment
- Significant ancillary services required by complex, acute medical and therapeutic needs – such as a full-service laboratory, radiology, rehabilitation gym and more
- Clinically competent care providers with advanced assessment and intervention skills
- A patient-centered, outcome-focused interdisciplinary approach led by a physician and a team of therapists and specialists that includes intensive care management to move the patient efficiently through the continuum of care
- Education for the patient and his or her family to manage ongoing health care needs
In short, complex care hospitals are specifically designed to treat patients who need several services at once – patients with multiple active health problems that require early and aggressive intervention in a critical care setting.
These accommodations are met by what Brian Callister, M.D., describes as a "true trans-disciplinary blend of services." These include critical care facilities, rehabilitation services, nutrition and dietary services and many others.
But don’t confuse complex care hospitals with chronic care or subacute facilities such as nursing homes. Unlike chronic care facilities, complex care hospitals treat critically ill patients in a very intensive way. They use specialized and individualized treatment programs similar to those found in short-term hospitals, and they work toward medical recovery, which means returning home. These treatment programs are generally not available, nor appropriate, in chronic care facilities.
Complex care hospitals also differ from nursing home or subacute programs in that the patients are usually much more ill (often critically ill) and require more intensive therapeutic programs and critical care medical intervention than are available in typical subacute facilities.
A complex care hospital may be licensed as a long term acute care hospital, but Callister cautions against assuming complex care hospitals specialize only in long-term patients. The average stay is actually only about 25 days.
What are the characteristics of a complex care hospital?
The Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) included several distinct provisions for long term acute care-licensed hospitals, which include complex care hospitals. These include:
- Active physician involvement. Physicians are actively involved with patients during their treatments. Onsite availability is also critical.
- Patient review process. Patients are screened before admission and regularly throughout their stays to ensure the appropriateness the level of care.
- Interdisciplinary medical teams. Interdisciplinary treatment teams of health care professionals, including physicians, prepare and carry out individualized treatment plans for each patient.
What services do complex care hospitals provide?
In a sense, complex care hospitals are an extension of the critical care services found in community hospitals. This includes physicians, specialists, speech, respiratory and occupational therapists, an advanced nursing staff, wound care specialists, rehabilitation equipment, diagnostic services, and case management professionals. Complex care hospitals often offer some specialized programs, such as respiratory therapy and ventilator weaning, chronic and acute dialysis, and traumatic brain injury.
What kind of conditions do complex care hospitals handle?
Complex care hospitals are equipped to treat patients with critical care needs, such as: multiple-system failure, brain and spinal cord injury (including trauma or stroke), cardiopulmonary failure, ventilator dependence, acute renal failure, complex pulmonary diseases, and many more. To treat such medically complex diagnoses, complex care hospitals coordinate care with a variety of medical specialists in areas including infectious diseases, wound management, oncology, neurologic diseases, trauma and stroke, post-operative complications, and restorative care such as physical rehabilitation and occupational therapy.
How to choose a complex care hospital
The best way to determine if a complex care hospital is right for you or your loved one is often to visit the facility. Any reputable complex care hospital will understand your concerns and willingly address any questions you may have.
While you’re there, take the time to visit with the physicians, nurses, therapists and other staff members.
Be sure to talk to your doctor, and weigh your options. Just like any healthcare provider, a complex care hospital has its own unique personality. Another helpful resource for patients and family members seeking more information about complex care services in their area is the Acute Long Term Hospital Association, or ALTHA. The hospital search tool on ALTHA’s website can be accessed at http://www.altha.org/