Your Guide to Post-COVID Patient Types and Recovery: Differences Between PICS and Long-Haulers

<p>Based on continued evaluation of the patients suffering from and recovering from COVID-19, a new subset of patients is emerging, formally called &ldquo;post-COVID". These patients experience long-lasting symptoms and typically fit into one of two categories:</p>
<ol>
<li>The sickest COVID patients who spent considerable time in the hospital (often the intensive care unit) and often developed <strong>post-intensive care syndrome (PICS)</strong> due to their extended hospital care</li>
<li>The COVID patients who did not require hospitalization originally but continue to experience symptoms, are becoming known in medical and recovering COVID communities as <strong>long-haulers</strong></li>
</ol>
<p><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/covid-long-haulers-blog.jpg?sfvrsn=9c7d94ea_2" data-displaymode="Original" title="COVID PICS Patients are the sickest COVID patients who spent considerable time in the hospital (often the intensive care unit) and often developed post-intensive care syndrome (PICS) due to their extended hospital care. Vs COVID Long-Haulers who are The COVID patients who did not require hospitalization originally but continue to experience symptoms, are becoming known in medical and recovering COVID communities as long-haulers." /></p>
<p><strong>This guide explores some of the more common experiences of long-haulers, the need for research, the clinical conditions of PICS patients, and the positive role long-term acute care hospitals play in the care of PICS patients.</strong></p>
<p><strong>Post-COVID PICS Patients</strong></p>
<p>Patients who spend considerable time in an ICU are at risk of developing post-intensive care syndrome (PICS), which can have a long-lasting impact on patient well-being.</p>
<p>PICS has long been a known diagnosis for patients facing complex and prolonged medical treatment. According to the Cleveland Clinic, PICS is a result of a combination of factors, including receiving care in the ICU for serious medical conditions including respiratory failure or sepsis, the use of life-sustaining equipment such as ventilators, and the use of certain medications. Additionally, PICS can bring on ICU-acquired weakness, cognitive or brain dysfunction and other mental health disorders.</p>
<p>Hospitalized COVID-19 patients are receiving life-saving care in an ICU for much longer than the average stay of three to four days and are often reliant on a ventilator, both of which puts them at high risk.</p>
<p>Post ICU/CCU-level patients such as these often require the specialized, interdisciplinary care that is only available in LTAC hospitals. This is because these patients are significantly sicker &ndash; with a much higher case mix index &ndash; and benefit from care provided by a team who specializes in the care of medically complex patients and customized care pathways.</p>
<p><img src="https://www.kindredhealthcare.com/images/default-source/default-album/covid-long-haulers-blog2.jpg?sfvrsn=ee7d94ea_0" data-displaymode="Original" alt="Approximately 10% of people who were sick with COVID experience prolonged symptoms beyond three weeks. " title="Approximately 10% of people who were sick with COVID experience prolonged symptoms beyond three weeks." /></p>
<p><strong>Who Are COVID Long-Haulers?</strong></p>
<p>For those less severe COVID patients &ndash; the long-haulers &ndash; it is becoming clear that they may develop symptoms as a result of the SARs-CoV-2 infection. They have persistent myriad chronic symptoms that may continue for weeks and months after the patient has been declared virus-free.&nbsp;</p>
<p>According to a recent study in JAMA, approximately 10% of people who were sick with COVID experience prolonged symptoms beyond three weeks.</p>
<p>Jessica Dine, MD, a pulmonary specialist at the University of Pennsylvania, Perelman School of Medicine, noted that &ldquo;most of the patients I see who are suffering from [this], were not hospitalized.&rdquo; She noted that they were quite ill with COVID symptoms, but remained at home.<sup>1</sup>&nbsp;Another observational study from the United Kingdom also recognized that those post-COVID patients reporting a &ldquo;prolonged and debilitating course of illness&rdquo; were never admitted to a hospital.<sup>2</sup>&nbsp;It is important to note that these patients are very different from PICS patients, who spent considerable time in an ICU during their COVID treatment.</p>
<p>According to the patient-driven <a href="https://www.wearebodypolitic.com/bodytype/2020/8/16/covid-19-support-group-long-haul" target="_blank">Body Politic COVID-19 Support Group</a>, long-hauler symptoms &ldquo;include (but are by no means limited to) fevers that last for months, impaired short-term memory, poor proprioception (sense of body movement and position), brain fog, heat intolerance, orthostatic intolerance (difficulty standing), dramatic changes to blood pressure and heart rate, muscle pain, menstrual changes, tinnitus, persistent nausea, weight loss, hair loss, and newfound food sensitivities.&rdquo;<sup>3</sup> They note that these symptoms often persist for a month or more, may flare up unpredictably in different combinations, and can be debilitating enough to prevent the reestablishment of employment or household responsibilities.&nbsp;&nbsp;</p>
<p><strong>Challenges with Lack of Long-Haulers Research</strong></p>
<p>Our understanding of SARS-CoV-2 is still in its relative infancy. Consequently, there is a notable lack of validated research on the virulence of SARS-CoV-2 and how to prevent or provide long-term interventions for long-haulers.</p>
<p>In March 2020, Body Politic started the COVID-19 Support Group after its founder and key members became ill and discovered the lack of online content or resources for people suffering from COVID. In response, they launched a patient-driven survey with 640 respondents. They are now conducting a second, patient-reported survey to help understand long-term post-COVID symptoms and experiences.</p>
<p><em><a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30701-5/fulltext" target="_blank">The Lancet</a>&nbsp;</em>recently noted that the main limitation of current research is data reporting/fragmentation, a high risk of bias and no external validation. Specifically, the authors urged strong research to understand long-haulers, highlighting that &ldquo;participation of an international and interdisciplinary group of researchers is essential.&rdquo;</p>
<p><strong>Path Ahead</strong></p>
<p>Long-term acute care hospitals have the clinical expertise and a strong and lengthy history of providing vital intensive medical care and therapies often necessary to successfully support PICS&rsquo; patient recovery. These competencies include rehabilitative therapies to recover strengths and abilities, cognitive rehabilitation, and pulmonary rehabilitation to increase lung function.</p>
<p>LTAC hospitals deliver care for the most difficult-to-treat, critically ill and medically complex patients &ndash; such as patients with respiratory failure, septicemia, traumatic injuries, wounds or other severe illnesses complicated by multiple chronic conditions, many of which have been symptoms of post-COVID recovery.</p>
<p>On the contrary, due to the limited research on the prolonged treatment for long-haulers, a definitive and validated care path is not known at this time. By recognizing that most long-haulers do not access acute level care at a typical hospital, a specialized rehabilitation hospital or long-term acute care hospital, it is probable that acute medical and rehabilitation interventions may help COVID patients more fully recover and support longer-term stability and recovery.</p>
<p><strong>How Kindred Can Help</strong></p>
<p>Kindred&rsquo;s long-term acute care hospitals provide high-quality COVID and post-COVID interdisciplinary medical and rehabilitative care that supports a more complete recovery and return to independence.</p>
<p>Data demonstrates that during the pandemic, Kindred&rsquo;s LTAC hospitals cared for significantly sicker patients (higher case mix index), discharged a greater percentage of patients back to their home or community, and reduced rehospitalizations (during the LTACH stay) of Medicare patients to less than 7%.</p>
<p>The teams of skilled and caring clinicians in Kindred&rsquo;s long-term acute care hospitals can be the right partner for you in caring for your patients who have been in an ICU or a critical care unit, or who are chronically ill and readmit to the hospital frequently. Kindred has proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways. Kindred also has decades of experience treating post-intensive care syndrome (PICS).</p>
<p>Many Kindred hospitals have or are in the process of achieving disease-specific certification from The Joint Commission in key conditions such as respiratory failure and sepsis.</p>
<p><strong>If you have a post-COVID patient, or other patients in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine whether an LTAC stay is appropriate for your patient. If you are unsure of who your Kindred representative is, please feel free to contact us and speak with a Registered Nurse who can assist.</strong></p>
<hr />
<p>References</p>
<ol>
<li>Rubin R. <em>As Their Numbers Grow, COVID-19 &ldquo;Long Haulers&rdquo; Stump Experts.</em> JAMA. Published online September 23, 2020. doi:10.1001/jama.2020.17709</li>
<li>Rayner C, Lokugamage AU, Molokhia M. <em>COVID-19: prolonged and relapsing course of illness has implications for returning workers<br />
</em>https://blogs.bmj.com/bmj/2020/06/23/covid-19-prolonged-andrelapsing-course-of-illness-has-implications-for-returning-workers</li>
<li>https://www.wearebodypolitic.com/bodytype/2020/8/16/covid-19-support-group-long-haul, Body Politic COVID-19 Support Group, August 18, 2020
</li>
</ol>

Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positivity Impact COVID-19 Response

<p>Patients experiencing prolonged hospital stays due to COVID-19 and related complications often require continued care in an intensive care unit (ICU), inpatient rehabilitation facility (IRF) and/or long-term acute care hospital (LTACH).</p>
<p>An American Hospital Association case study recently looked into how partnerships with post-acute care settings are continuing to positively impact the healthcare industry&rsquo;s response to COVID-19.</p>
<p><a href="https://www.aha.org/system/files/media/file/2020/08/aha-cs-kindred-health-0820%20%28006%29.pdf " target="_blank"><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-case-study-icon.jpg?sfvrsn=b1ab97ea_2" class="float-right" data-displaymode="Original" alt="Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positivity Impact COVID-19 Response" title="Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positivity Impact COVID-19 Response" /></a></p>
<p>&ldquo;Inpatient rehabilitation hospitals and long-term care hospitals are key partners for general acute-care hospitals discharging patients with, and recovering from, COVID-19. In particular, as communities and hospitals struggled to meet ICU capacity needs, these hospitals stepped forward to take care of COVID-19-positive patients and others to help provide beds for more COVID-19-positive patients,&rdquo; the case study noted.</p>
<p>The study looked at one Kindred hospital, Kindred Hospital Clear Lake, outlining how the care management strategy began to relieve area general acute-care hospital partners by accepting their non-COVID patients, but grew to encompass much more. This hospital, along with many other Kindred LTACHs and IRFs, expanded services to take care of recovering patients who no longer demonstrated symptoms of the virus but were being impacted by a multitude of long-lasting side effects.</p>
<p>Further, with waivers recently implemented to expand the use of IRFs and LTACHs to treat patients who had COVID-19, inpatient rehabilitation and LTAC hospitals are uniquely equipped to take sicker patients who have advanced and complex needs. LTAC hospitals deliver care for the most difficult-to-treat, critically ill and medically complex patients &ndash; such as patients with respiratory failure, septicemia, traumatic injuries, wounds or other severe illnesses complicated by multiple chronic conditions, many of which are symptoms of post-COVID recovery. Read our latest white paper, <a data-category="Hospital" data-action="Click-Button" data-label="Blog-Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positivity Impact COVID-19 Response" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/kindred-how-ltac-hospitals-help-post-covid-patients.pdf?sfvrsn=dbab89ea_2" title="Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients" target="_blank">&ldquo;How LTAC Hospitals Help Post-COVID Patients&rdquo;</a>&nbsp;to learn more.</p>
<p><a href="https://www.aha.org/system/files/media/file/2020/08/aha-cs-kindred-health-0820%20%28006%29.pdf " target="_blank">Read the full case study</a></p>

Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positively Impact COVID-19 Response

<p>Patients experiencing prolonged hospital stays due to COVID-19 and related complications often require continued care in an intensive care unit (ICU), inpatient rehabilitation facility (IRF) and/or long-term acute care hospital (LTACH).</p>
<p>An American Hospital Association case study recently looked into how partnerships with post-acute care settings are continuing to positively impact the healthcare industry&rsquo;s response to COVID-19.</p>
<p><a href="https://www.aha.org/system/files/media/file/2020/08/aha-cs-kindred-health-0820%20%28006%29.pdf " target="_blank"><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-case-study-icon.jpg?sfvrsn=b1ab97ea_2" class="float-right" data-displaymode="Original" alt="Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positivity Impact COVID-19 Response" title="Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positivity Impact COVID-19 Response" /></a></p>
<p>&ldquo;Inpatient rehabilitation hospitals and long-term care hospitals are key partners for general acute-care hospitals discharging patients with, and recovering from, COVID-19. In particular, as communities and hospitals struggled to meet ICU capacity needs, these hospitals stepped forward to take care of COVID-19-positive patients and others to help provide beds for more COVID-19-positive patients,&rdquo; the case study noted.</p>
<p>The study looked at one Kindred hospital, Kindred Hospital Clear Lake, outlining how the care management strategy began to relieve area general acute-care hospital partners by accepting their non-COVID patients, but grew to encompass much more. This hospital, along with many other Kindred LTACHs and IRFs, expanded services to take care of recovering patients who no longer demonstrated symptoms of the virus but were being impacted by a multitude of long-lasting side effects.</p>
<p>Further, with waivers recently implemented to expand the use of IRFs and LTACHs to treat patients who had COVID-19, inpatient rehabilitation and LTAC hospitals are uniquely equipped to take sicker patients who have advanced and complex needs. LTAC hospitals deliver care for the most difficult-to-treat, critically ill and medically complex patients &ndash; such as patients with respiratory failure, septicemia, traumatic injuries, wounds or other severe illnesses complicated by multiple chronic conditions, many of which are symptoms of post-COVID recovery. Read our latest white paper, <a data-category="Hospital" data-action="Click-Button" data-label="Blog-Case Study: Partnerships with Post-Acute Care Hospitals Continue to Positivity Impact COVID-19 Response" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/kindred-how-ltac-hospitals-help-post-covid-patients.pdf?sfvrsn=dbab89ea_2" title="Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients" target="_blank">&ldquo;How LTAC Hospitals Help Post-COVID Patients&rdquo;</a>&nbsp;to learn more.</p>
<p><a href="https://www.aha.org/system/files/media/file/2020/08/aha-cs-kindred-health-0820%20%28006%29.pdf " target="_blank">Read the full case study</a></p>

The Growing Importance of Advanced Hospital‑Level Infection Control: 5 Differing Standards in Post-Acute Care Protocols

<div class="right-align">
<a class="btn btn-blue _gt" data-category="Hospital" data-action="Click-Button" data-label="Blog-The Growing Importance of Advanced Hospital‑Level Infection Control" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/hd-infection-control-whitepaper.pdf?sfvrsn=9e3396ea_2" title="The Growing Importance of Advanced Hospital‑Level Infection Control" target="_blank">Download this article as a PDF</a></div>
<br />
<img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-infection-control-blog-graphics-1.jpg?sfvrsn=f53396ea_2" data-displaymode="Original" alt="This guide highlights five standards maintained by long-term acute care hospitals to combat infection and protect the most vulnerable of patients, as well as the benefits of these hospital-based standards compared to other levels of care." title="This guide highlights five standards maintained by long-term acute care hospitals to combat infection and protect the most vulnerable of patients, as well as the benefits of these hospital-based standards compared to other levels of care." /><br />
<br />
<p>The pandemic has pushed infection control standards to the forefront as patients and providers are counting on advanced protocols to reduce viral spread and prevent further outbreaks. Now more than ever, it&rsquo;s important for patients to be treated in a care setting that is not only best suited to their medical needs but also upholds the highest federally and clinically-recognized health and safety requirements.</p>
<p>Though all post-acute settings provide value to their most appropriate patient type(s), they are not all created equal.<sup>1</sup> This guide highlights five standards maintained by long-term acute care hospitals to combat infection and protect the most vulnerable of patients, as well as the benefits of these hospital-based standards compared to other levels of care.</p>
<p><strong>Levels of Care: Comparing Infection Protocols</strong></p>
<p>As healthcare leaders continue to make bold changes to protect the health and safety of patients during this time, long-term acute care hospitals have quickly adapted to meet the advanced needs of the critically ill and medically complex &ndash; including those recovering from COVID-19. When patients are stabilized in the acute care setting, it is important for providers to be aware of the infection prevention protocols of various post-acute care settings that optimize long-term patient recovery.</p>
<img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-infection-control-blog-graphics–2.jpg?sfvrsn=f13396ea_2" data-displaymode="Original" alt="LTACHS Require Daily Physician Oversight, 24/7 RN Presence, Dedicated Infection Control Personnel " title="LTACHS Require Daily Physician Oversight, 24/7 RN Presence, Dedicated Infection Control Personnel " /><br />
<br />
<p><strong>#1.&nbsp;Certifications</strong></p>
<p>Many of the certifications set forth by federal programs and agencies are the foundational pieces that ensure of patient care are consistently met, including in the areas of quality and safety. Long-term acute care hospitals are required to adhere to a set of stringent operational guidelines, which ultimately benefit all patients who receive care in these settings:</p>
<ul>
<li><strong>LTAC hospitals are licensed as general acute care hospitals, and must comply with the same health and safety requirements. </strong>Through their conditions of participation (CoPs) guidelines, the Centers for Medicare and Medicaid Services (CMS) sets the infection control standards expected of LTAC facilities in order to participate in the Medicare program.<sup>2</sup></li>
<li><strong>LTAC hospitals must also meet state licensure requirements </strong>to ensure they are able to effectively manage the extensive care needs of critically ill, medically complex patients who require a longer recovery period.</li>
</ul>
<p><strong>All Kindred LTAC hospitals have achieved or are in process of achieving accreditation by The Joint Commission for disease-specific certification in Respiratory Failure and Sepsis. </strong>A gold<strong> </strong>standard in the acute care industry, the Joint Commission disease-specific<strong> </strong>certification &ldquo;demonstrates commitment to a higher standard<strong> </strong>of service&rdquo; and &ldquo;strengthens community confidence in quality and<strong> </strong>safety of care.&rdquo;&nbsp;<sup>3</sup></p>
<p><strong><strong>#</strong>2.&nbsp;Staffing</strong></p>
<p>Appropriate staffing, including physician involvement and nursing expertise, is key to overseeing a medically complex patient population. LTAC hospitals are provided the staffing resources necessary to provide 24/7 care under the guidelines set forth by CMS, as well as additional guidelines established at the facility level to ensure there are personnel fully dedicated to infection control. Here are some of the key benefits of these advanced staffing guidelines:</p>
<ul>
<li><strong>Through the CMS Medicare program, LTAC hospitals require daily physician oversight and a 24/7 RN presence. </strong>Other post-acute settings, like skilled nursing facilities (SNFs), set minimum requirements to eight hours of RN coverage daily, LPN/LVN 24-hour presence, and a physician visit during the first 30 days, with one visit every subsequent 60 days.</li>
<li><strong>LTAC hospitals feature hospital-level infection prevention and control overseen by an Infection&nbsp;</strong><strong>Control Nurse. </strong>Other post-acute settings typically employ a part-time infection preventionist to manage infection control.</li>
<li><strong>In addition to the physician-led interdisciplinary care, </strong>patients at LTAC hospitals also have immediate access to credentialed, infectious disease physicians and other medical sub-specialists.</li>
</ul>
<p><strong><strong>#</strong>3.&nbsp;Employee Protection</strong></p>
<p>As the recommendations for personal protective equipment (PPE) continue to ramp up based on the care setting, LTAC hospitals can rely on their long-standing practices of infectious disease control and treatment, infection prevention and promotion of safety at the highest level.</p>
<p>Additionally, LTAC hospitals participate in ongoing education regarding preventing and minimizing the spread of viruses and infections. For example:</p>
<ul>
<li><strong>Competencies and special employee training are built in at LTAC hospitals </strong>to address myriad multi-drug resistant organisms, viruses and infections in order to prevent or minimize their spread.</li>
<li><strong>Many LTAC hospitals systems, like Kindred, have a well</strong><strong>‑</strong><strong>established and robust PPE supply chain </strong>with standard best practices to react to a full range of infections and communicable diseases.</li>
</ul>
<p><strong><strong>#</strong>4.&nbsp;Patient Safety</strong></p>
<p>In addition to well-established PPE best practices and infection control training resources available for employees, LTAC hospitals also have additional guidelines in place to protect the patient. From ensuring air quality to full service testing areas, LTAC hospitals are engineered with patient safety top of mind. Some of these standards often unseen in other care settings include:</p>
<ul>
<li><strong>Protocols to isolate infected patients, negative pressure rooms (which are specially engineered to isolate patients with airborne contagious diseases), dedicated teams that monitor for outbreaks and multiple levels of protective gear.</strong></li>
<li><strong>On-site laboratories, dialysis, radiology, intensive care units, surgical suites and negative pressure isolation rooms that enable LTAC hospitals to meet a full range of patient needs without relying on outpatient services. </strong>Patients who access these services within an LTACH can minimize their risk of additional exposure and spread.</li>
<li><strong>LTAC hospital licensing requires hospital-quality air filtration systems. </strong>Care settings such as skilled nursing facilities (SNFs) have the same air handling/ HVAC quality as the average residential home.</li>
</ul>
<p><strong><strong>#</strong>5.&nbsp;Advanced Clinical Expertise</strong></p>
<p>LTAC hospital professionals are leading industry experts in ventilator care, with best-in-class capabilities in weaning the most challenging ventilator-dependent patients, all while remaining committed to the safety of patients, employees and caregivers. Kindred LTAC hospitals specifically partner with agencies and organizations that help further its clinical expertise in infection control through several initiatives:</p>
<ul>
<li><strong>Kindred has been recognized for its leading antimicrobial stewardship and infection prevention efforts, </strong>part of a larger CDC-recognized initiative to improve how antibiotics are prescribed to prevent infection and combat antibiotic resistance.<sup>4</sup></li>
<li><strong>Kindred regularly cooperates with state, local and federal agencies, </strong>including public health departments, to study and better understand how all healthcare providers can help combat multi-drug resistant organisms and prevent disease spread.</li>
</ul>
<p><strong>How Kindred Hospitals Can Help</strong></p>
<p>We are recognized for our infection prevention efforts and our robust PPE supply chain program. Coupled with our dedication to getting every Kindred LTACH certified by The Joint Commission in Respiratory Failure and Sepsis, these infection protocols enhance our care for the complex medical needs of many post-intensive care patients, and specifically post-COVID patients.</p>
<p>Kindred Hospitals provide expert care in the treatment and rehabilitation of medically complex and post-ICU patients that require continued services in an acute hospital setting, which may include continued intensive care and specialized rehabilitation.</p>
<p>Our interdisciplinary team of clinicians in our long-term acute care hospitals can meet the needs of your patients who have been in an ICU, critical care unit or who are chronically ill and readmit to the hospital frequently. We have proven success in treating patients suffering from pulmonary disease and respiratory failure, with a long track record of liberating patients from mechanical ventilation and artificial airways.</p>
<p><strong>If you have a post-COVID patient, or other patients in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine the most appropriate care setting for your patient&rsquo;s next stage of treatment. If you are unsure of who your Kindred representative is, please feel free to contact us via <a href="https://www.kindredhealthcare.com/our-services/transitional-care-hospitals/healthcare-professionals" target="_blank">recoveratkindred.com</a>&nbsp;and speak with a Registered Nurse who can assist.</strong>&nbsp;</p>
<hr />
<p>References</p>
<ol>
<li><span style="font-size: 12px;"><em>www.aha.org/lettercomment/2020-06-24-ahaletter-resetting-impact-act-next-covid-19-relief-package</em></span></li>
<li><span style="font-size: 12px;"><em>https://www.cms.gov/Regulations-andGuidance/Legislation/CFCsAndCoPs/Hospitals</em></span></li>
<li><span style="font-size: 12px;"><em>https://www.jointcommission.org/en/accreditation-and-certification/become-accredited/why-achieve-accreditation</em></span></li>
<li><em><span style="font-size: 12px;">https://www.cdc.gov/antibiotic-use/core-elements/index.html</span></em></li>
</ol>

Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients

<div class="right-align">
<a class="btn btn-blue _gt" data-category="Hospital" data-action="Click-Button" data-label="Blog-Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/kindred-how-ltac-hospitals-help-post-covid-patients.pdf?sfvrsn=dbab89ea_2" title="Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients" target="_blank">Download this article as a PDF</a></div>
<br />
<p>The latest research findings are honing in on the clinical conditions associated with COVID-19, along with the specific care pathways needed for patients, once stabilized, to fully recover. Specialized care after the initial hospital stay is proving to play a critical role.&nbsp;</p>
<p>Hospitalized COVID-19 patients often experience significant pulmonary complications, including severe pneumonia and acute respiratory distress-like syndrome. Further, many physicians are reporting that patients are developing post-intensive care syndrome (PICS) due to an intensive care unit (ICU) stay measured in weeks rather than days. The virus is also resulting in strokes, and causing sepsis, which can lead to multi-system failure and leave a patient with lasting damage to the lungs and other organs.</p>
<p><strong>This brief details COVID-19 patient care management strategies and research on how the clinical expertise of LTAC hospitals is uniquely suited for post-COVID patients.</strong></p>
<h2><strong>New Research on Care Solutions for Post-COVID Patients: The Role of LTACHs</strong></h2>
<p>A growing body of evidence indicates that the specialized services delivered in long-term acute care hospitals play a unique and positive role in treating patients recovering from COVID-19.</p>
<p>A recent study in the <em>Journal of Rehabilitative Management</em> stated that: &ldquo;Early rehabilitation of the COVID-19 patients can enhance pulmonary, respiratory function, reduce complications, improve function, cognitive impairments and quality of life."<sup>1</sup></p>
<p>Hospitalized COVID-19 patients are receiving life-saving care in an ICU for much longer than the average stay of three to four days and are often reliant on a ventilator, both of which puts them at high risk of developing post-intensive care syndrome (PICS) &ndash; a condition that can include ICU-acquired weakness, cognitive or brain dysfunction and other mental health disorders. Specialized care interventions and rehabilitation are needed to address the short- and medium-term consequences of post-COVID patients experiencing PICS symptoms and recovering from extended mechanical ventilation.<sup>2</sup></p>
<p>Additionally, as published recently in <em>The Boston Globe<sup>3</sup></em>:</p>
<p style="padding: 0 50px;">Many recovering COVID-19 patients need to be weaned off of ventilators and slowly reintroduced to eating on their own. Some also require speech therapy, pulmonary therapy, and dialysis.</p>
<p style="padding: 0 50px;">&hellip;COVID-19 has reminded the world of the importance of facilities that occupy the middle ground of the critical care landscape.</p>
<p style="padding: 0 50px;">&ldquo;In a pandemic, you really do need that kind of intensive care,&rdquo; said Grabowski, who co-authored a paper advocating for the importance of long-term acute care hospitals. "For years, we said, &lsquo;Why do we need long-term care hospitals?&rsquo; And all of a sudden with COVID, we&rsquo;re saying &lsquo;Why don&rsquo;t we have more long-term care hospitals?&rsquo;&rdquo;</p>
<p>Lastly, a recently co-authored a post in <em>Health Affairs</em> highlighted the critical resource that LTAC hospitals can play during the COVID pandemic.<a href="#_ftn4" name="_ftnref4"></a><sup>4</sup> Specifically, the researchers suggest that <strong>the clinical expertise in LTAC hospitals with &ldquo;critical care nurses, respiratory therapists, and intensivists&rdquo; aligns with the ongoing needs of COVID patients. </strong>The experts conclude that, &ldquo;During this unprecedented international crisis, [LTAC hospitals] offer additional opportunities to prepare for and manage the surge of COVID-19 patients experiencing respiratory failure.&rdquo;</p>
<h2><strong>Unique Clinical Presentations Require Specialized Care</strong></h2>
<p>Due to the complex medical needs of post-COVID patients, long-term acute care (LTAC) hospitals are a key care setting. LTAC hospitals deliver care for the most difficult-to-treat, critically ill and medically complex patients &ndash; such as patients with respiratory failure, septicemia, traumatic injuries, wounds or other severe illnesses complicated by multiple chronic conditions, many of which have been symptoms of post-COVID recovery.</p>
<p>These specialty hospitals are unlike other post-acute care settings because they are licensed as a general acute care hospital by the state and certified by the Centers for Medicare &amp; Medicaid Services (CMS) as an LTAC hospital, and accredited by the Joint Commission under acute care standards. Additionally, care is provided in an interdisciplinary fashion, featuring daily physician visits and specialty physicians based on patient needs. Clinicians are specially trained for the critical care setting and are able to support prolonged recovery times.</p>
<h2><strong>LTACH Expertise in Pulmonary Care and Recovery</strong></h2>
<p>A patient&rsquo;s recovery and long-term lung health is directly dependent on the type and intensity of the care they receive. Distinct from all other post-acute settings, LTAC hospital clinicians are highly specialized in their ability to successfully liberate the most challenging ventilator patients, and LTAC hospitals feature hospital-level infection control, negative pressure rooms where needed and on-site laboratories and dialysis.</p>
<h2><strong>How Kindred Hospitals Can Help</strong></h2>
<p>We specialize in the treatment and rehabilitation of the post-intensive care and complex medical patient requiring continued intensive care, including specialized rehabilitation, in an acute hospital setting.</p>
<p>Our team of skilled and caring clinicians in our long-term acute care hospitals can be the right partner for you for your patients who have been in an ICU or a critical care unit, or who are chronically ill and readmit to the hospital frequently. We have proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways.</p>
<p>Many of our hospitals have or are in the process of achieving disease-specific certification from The Joint Commission in key conditions such as respiratory failure and sepsis.</p>
<p>We also have decades of experience treating post-intensive care syndrome (PICS). Under Kindred&rsquo;s expert interdisciplinary care, patients receive targeted services including:</p>
<ul>
<li>Daily physician oversight</li>
<li>Physician specialists</li>
<li>ICU-level care and staffing when necessary</li>
<li>24/7 respiratory therapy coverage</li>
<li>IV pain control management and narcotic/opioid weaning</li>
<li>Early mobilization of both ventilated and spontaneously breathing patients</li>
<li>Antimicrobial management to complete sepsis treatment and prevent antibiotic resistance</li>
<li>Interdisciplinary teams to clarify interventions and monitor progress</li>
<li>A patient-centered, goal-directed care plan addressing function, cognition and medical impairments</li>
<li>Family-focused discharge planning, whether directly to home or to less intense levels of post-acute care</li>
</ul>
<p><strong>If you have a post-COVID patient, or other patients in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine the most appropriate care setting for your patient&rsquo;s next stage of treatment. If you are unsure of who your Kindred representative is, please feel free to <a href="https://www.kindredhealthcare.com/our-services/transitional-care-hospitals/healthcare-professionals" target="_blank">contact us</a>&nbsp;and speak with a Registered Nurse who can assist.</strong></p>
<hr />
<p>References</p>
<ol>
<li><span style="font-size: 12px;">Fary Khan, MBBS, MD, FAFRM (RACP), Bhasker Amatya, DMedSci, MD, MPH, <em>&ldquo;Medical Rehabilitation in Pandemics: Towards a New Perspective,&rdquo;</em> Journal of Rehabilitative Management, Vol. 52, Issue 4, April 9, 2020</span></li>
<li id="ftn2">
<p><span style="font-size: 12px;">Stam HJ, Stucki G, Bickenbach J. Covid-19 and Post Intensive Care Syndrome: A Call for Action. J Rehabil Med. 2020;52(4):jrm00044. Published 2020 Apr 15. doi:10.2340/16501977-2677</span></p>
</li>
<li id="ftn3">
<p><span style="font-size: 12px;">Dasia Moore, "COVID-19 patients are recovering, but with nowhere to go," The Boston Globe, May 19, 2020</span></p>
</li>
<li><span style="font-size: 12px;"><em>&ldquo;How Can We Ramp Up Hospital Capacity To Handle The Surge Of COVID-19 Patients? Long-Term Acute Care Hospitals Can Play A Critical Role,&rdquo;</em> Health Affairs blog, April 13, 2020, DOI: 10.1377/hblog20200410.606195</span></li>
</ol>
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