The evolution of care for the chronically critically ill patient.

The post acute health care system has evolved its infrastructure to accommodate the growing complex medical patient population, a direct result of the expanded capability in supporting critically ill patients in the ICU setting. When patients fail to wean from mechanical ventilation in the ICU, there is often less emphasis on continuing these efforts, and patients appear better served in specialized units dedicated to weaning patients from mechanical ventilation. Long-term acute care hospitals also provide an ideal environment to support patient care for other complex medical illnesses, including populations with oncologic, cardiovascular, and infectious disease. The LTAC hospital seems best adapted to this role. Its infrastructure includes significant physician support and the blending of immediate and long-term care services and provides an ideal opportunity to serve this resource-intensive group. An emphasis on the transition from acute illness to recovery serves to define the role and mission of this important entity and highlights the specialized nature of the LTAC hospital.