A long-term acute care hospital (LTCH) provides hospital-level care and daily physician rounding for patients who are still seriously ill after intensive care. A skilled nursing facility (SNF) offers nursing support and therapy at a lower level. Inpatient rehabilitation delivers intensive daily therapy. The difference comes down to how much medical care each setting provides.
If a loved one is leaving the intensive care unit, a case manager may hand you a list of places and ask where you want the patient to go. Most families have never heard of these options before that day. The table below shows how the three settings differ.
| LTCH | Skilled nursing facility | Inpatient rehabilitation | |
|---|---|---|---|
| Level of care | Hospital level | Nursing home level | Hospital level |
| Physician presence | Daily | Visits on a set schedule- typically weekly or monthly | Rehabilitation physician leads care |
| Rehab therapy intensity | As the patient tolerates. Focus is on medical stability | Light to moderate | At least three hours a day |
| Typical stay | 25 days | Several weeks | Usually a few weeks |
| Best suited to | Still medically unstable | Medically stable, needs nursing | Medically stable, can do therapy |
What is a long-term acute care hospital (LTACH)?
A long-term acute care hospital is a licensed hospital that treats patients who still need hospital-level care for a long time. Medicare uses the term long-term care hospital, or LTCH, for the same type of facility. The two terms describe the same thing.
Families almost always ask the same first question: what is long-term acute care, and how is it different from a regular hospital stay? The answer is time and intensity. An LTCH treats the same level of illness, for longer a longer period of time
An LTCH is held to the same hospital standards as the acute care hospital.. Doctors are on-site around the clock. Nurses care for fewer patients than they would in a nursing home. Most patients arrive straight from an intensive care unit.
Patients treated in a long-term acute care hospital often need:
- Â Â Help coming off a ventilator or breathing machine
- Â Â Treatment for serious or repeated infections
- Â Â Care for complex wounds that are not closing
- Â Â Dialysis alongside other active medical problems
-   Continued medical management after an organ transplant or heart surgery
- Â Â Management of several serious conditions at the same time
Medicare publishes its own plain-language guide,What are Long-Term Care Hospitals?, and the formal definition sits in the CMS long-term care hospital payment rules. You can also read how this level of care works on the RML page explaining what a long-term acute care hospital is.
What is inpatient rehabilitation?
Inpatient rehabilitation is a hospital program built around intensive therapy, at least three hours a day for at least five days a week.
Inpatient rehab units, sometimes called acute rehab, treat patients after a stroke, brain injury, spinal cord injury, or major joint surgery. A rehab doctor leads the team. The goal is to build strength fast enough for the patient to go home.
Acute rehab vs. subacute rehab is the other comparison families are asked to make. Acute rehab delivers roughly three hours of therapy a day in a hospital setting. Subacute rehab delivers one to two hours a day, usually inside a skilled nursing facility, for patients who cannot yet tolerate a full therapy schedule.
RML provides hospital-level care for patients recovering from stroke and other neurologic events through its stroke and neurologic recovery program.
LTACH vs. SNF vs. rehab: how do they compare?
The three settings are separated by one question: how much active medical treatment does the patient still need every day?
| Patient situation | Setting usually recommended |
|---|---|
| Still on a ventilator or being weaned from one | Long-term acute care hospital |
| Needs daily physician oversight and complex treatment | Long-term acute care hospital |
| Medically stable, needs nursing care and light therapy | Skilled nursing facility |
| Medically stable, can tolerate about three hours of therapy | Inpatient rehabilitation |
| Needs help with bathing and dressing, no skilled care | Custodial nursing home care |
The comparison families run into most often is skilled nursing facility vs rehab, because from the outside those two settings look alike. The difference is therapy load. Rehab expects about three hours a day. Skilled nursing works at a gentler pace.
A patient can move through more than one of these settings. Many people spend time in a long-term acute care hospital, then move to inpatient rehab, then finish healing at home with outpatient therapy.
How long does a stay in each setting last?
Medicare defines a long-term acute care hospital by an average patient stay of more than 25 days, which makes it the longest of the three settings.
Skilled nursing stays vary a lot. Medicare covers up to 100 days per benefit period, but many patients stay well under that, because coverage lasts only while skilled care is still needed. Rehab stays are the shortest, often a few weeks, because therapy is intensive and progress is meant to come fast.
In every setting, the length of a stay comes down to medical progress, not a fixed date. The care team reviews the plan often and keeps the family posted as goals are met.
Does Medicare cover long-term acute care?
Yes. Medicare Part A covers a stay in a long-term acute care hospital the same way it covers a stay in any other acute care hospital.
Because an LTACH counts as a hospital, the usual Part An inpatient benefit applies. Each benefit period covers up to 90 days of hospital care, plus 60 lifetime reserve days if they are needed. A doctor must confirm that the patient needs care only a hospital can give.
Skilled nursing coverage works differently. Medicare first requires a hospital stay of at least three days in a row. Days 1 through 20 are paid in full. Days 21 through 100 carry a daily share of the cost that Medicare sets each year. After day 100, coverage ends for that benefit period.
Medicare sets out these rules in its guide to skilled nursing facility care, which is worth reading before you choose.
Medicaid and private plans follow their own rules. RML nurse liaisons confirm coverage with families before a patient is admitted, so no one faces the paperwork alone.
How do families choose the right setting?
The deciding factor is how much medical care the patient still needs each day, not how much therapy the family hopes for.
Ask the discharge planner these questions before you choose:- What level of care does the patient need right now? Ask whether the need is hospital level or nursing level.
- Who oversees care, and how often? Ask whether a physician is on site around the clock or visits on a schedule.
- How much therapy can the patient tolerate today? A patient who cannot sit up for an hour will not manage three hours of therapy.
- What has to improve before the next step? Knowing the goal helps you track progress week by week.
- What does insurance cover, and for how long? Ask for this in writing so there are no surprises later.
- How far is it from my family? Regular visits matter to recovery, so travel time is a real factor.
Write the answers down. These choices are often made fast, and notes help you weigh the options fairly.
Where RML fits
RML Specialty Hospital is a not-for-profit long-term acute care hospital with campuses in Chicago and Hinsdale, Illinois.
Founded in 1987, RML treats patients who come from intensive care units across the Chicago area and DuPage County and still need hospital-level care. Doctors are on site 24 hours a day. Nurse liaisons guide families from the first phone call through admission.
More than 65 hospitals across Illinois, Indiana, and Wisconsin refer patients to RML’s two campuses. RML is the largest ventilator weaning hospital in the United States and is also recognized for wound care, stroke recovery, organ transplant recovery, and ventricular assist device support.
You can review the full range of care and services offered at RML, find contact details for the Chicago and Hinsdale locations, or learn what to expect through the admissions process for families.
Frequently asked questions
What is the difference between an LTACH and a skilled nursing facility?
A long-term acute care hospital (LTACH) is a licensed hospital with doctors on site around the clock for patients who still need active medical care. A skilled nursing facility provides nursing and therapy to patients who are stable but not yet ready to go home.
What is a long-term acute care facility?
A long-term acute care facility is a hospital that treats seriously ill patients over a long period, usually more than 25 days. Medicare also calls it a long-term care hospital. Most patients come straight from an intensive care unit and still need hospital-level care.
How long can you stay in a skilled nursing facility?
Medicare covers up to 100 days in a skilled nursing facility per benefit period. The first 20 days are paid in full, and days 21 through 100 carry a daily share of the cost. Coverage lasts only while the patient still needs skilled care and is making progress.
Does Medicaid cover long-term acute care hospitals?
Medicaid coverage for long-term acute care hospitals is set by each state and varies by plan. In Illinois, Medicaid does cover needed hospital care for eligible patients. RML confirms coverage with each family before a patient is admitted, so costs are clear up front.
What is an LTACH?
LTACH stands for long-term acute care hospital. It is a licensed hospital that treats patients who still need daily medical care after intensive care, usually for more than 25 days. Medicare uses the term LTCH, or long-term care hospital, for the same kind of facility.
What is the difference between acute rehab and subacute rehab?
Acute rehab gives about three hours of therapy a day in a hospital, for patients who can handle that pace. Subacute rehab gives about one to two hours a day, usually in a skilled nursing facility, for patients who need a slower start.
Is an LTACH the same as a nursing home?
No. An LTACH is a licensed hospital with doctors on site daily and nurses trained in critical care. A nursing home is a place to live with help for daily needs. The two meet very different needs and follow different rules.
Getting help in Chicago and the western suburbs
Families looking for long-term acute care in Chicago or the western suburbs often start with no warning and very little time. RML Specialty Hospital is a long-term acute care hospital in Chicago and Hinsdale, Illinois, and takes referrals from hospitals across the region.
Chicago campus: 3435 West Van Buren Street, Chicago, Illinois 60624. General information: 773-826-6300. Admissions: 773-826-6400.
Hinsdale campus: 5601 South County Line Road, Hinsdale, Illinois 60521. General information: 630-286-4000.
Every situation is different. Talk with the treating physician and discharge planner about which setting matches your loved one’s medical needs right now.
