These wise words by Confucius profoundly affected my life. This passionate urge to do what I love helped me get my first job as a speech-language pathologist in the long-term acute care hospital setting (LTACH, pronounced as L-tack) where I have been happily practicing for the past four years.
Okay, let’s rewind the story a little bit. In 2009, at the age of 21, I left my home in Mumbai, India, to come to the United States and pursue my dream of becoming an ASHA-certified speech-language pathologist. After completing my master’s in communication disorders in 2011, I got a clinical fellowship at a hospital in Dallas, where I lived.
Woo-hoo! My dream of working as an SLP in an acute care hospital was coming true, albeit with one difference—the position was for an LTACH SLP. If you have no idea what this setting is all about or you want to know more, you’re not alone! Read on to find out…
What are LTACHs?
ASHA defines LTACHS as “facilities that specialize in the treatment of patients with serious medical conditions that require extended acute care on an ongoing basis.” These patients have complex and often chronic critical illnesses and multiple co-morbidities that cannot usually be treated at an alternate level of care.
LTACH patients stay an average of 25 to 30 days with the goal of optimizing the patient’s ability to live independently and quality of living, or to achieve the highest level of wellness possible and then move on to the next level of care.
Which patients get admitted to LTACHs?
The types of patients typically seen in LTACHs include those requiring:
- Intensive respiratory care/pulmonary rehab.
- Inpatient dialysis for chronic renal failure.
- Multiple IV medications or transfusions.
- Complex wound care/management for burns.
- Treatment following neurological conditions and/or trauma.
What is the role of the LTACH SLP?
SLPs provide a wide range of skilled services to individuals in LTACHs. A sizable number of patients have trachs and/or are ventilator-dependent. The SLP works with them to improve their swallow function and tolerance for speaking valves. A considerable portion of my caseload consists of patients with dysphagia.
My skilled services and recommendations can significantly affect a patient’s nutrition or hydration status and overall recovery. LTACH SLPs also work with the patients, family and staff on ways to optimize speech, language and/or cognition in patients with a variety of complex medical conditions.
Is the LTACH the right setting for you?
Below are the four reasons I love being an LTACH SLP. If any of these resonates with you, the LTACH setting might be right for you, too.
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- Experience: I’ve worked in a challenging environment from day one of my clinical fellowship: There are trachs/vents, speaking valves, suctioning, lots of secretions, complex medical diagnoses (many I had not previously heard of), multiple co-morbidities (not for the faint-hearted!), videofluoroscopic studies and more. Working with the unique and varied LTACH caseload helps me grow tremendously as a medical SLP and provides me with invaluable experience.
- Confidence: I am often consulted regarding all kinds of decisions, including, but not limited to, a patient’s nutrition/hydration, speaking-valve tolerance, trach/vent weaning goals, palliative care recommendations, feeding tube concerns, cognitive status, discharge planning, etc. As I’ve learned how to become an effective member of each of these teams and watched patients improve, I’ve developed much-needed confidence in my clinical decision-making skills.
- Competence: With increased experience, confidence and the development of not just clinical skills, but also skills such as critical thinking, problem solving, team membership and communication, comes competence. Being competent does not mean knowing everything and doing everything right. A crucial lesson I learnt in the LTACH setting is that it is okay to not know everything. However, we owe it to our patients to acknowledge this, step out of our comfort zones and do what it takes to become competent clinicians.
- Satisfaction: The greatest thing I achieved by working in the LTACH setting is immense satisfaction. With the average 25-day length of stay for patients, the LTACH setting strikes the perfect balance between diagnostic and therapeutic skills. Watching someone go from being critically ill to going home independently is a joy I can’t express in words. I find it gratifying and fulfilling.
I sincerely hope my experiences help you gain some insight working in an LTACH hospital setting. I also hope it motivates some of you to try working in one of these settings. If you have any questions or comments, please get in touch.
Here’s hoping all of you choose to do what you love and never have to work a day in your life.
Rinki Varindani Desai, MS,CCC-SLP, specializes in the rehabilitation of speech, cognitive-linguistic and swallowing disorders in adults. She created and administers the Medical SLP Facebook forum. She’s an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders. Follow her medical SLP-related updates on Facebook, Twitter or her website or email at email@example.com.