Journal of Cardiology and Cardiovascular Research

Long term care (LTAC) vs Hospice care and which is best for what patient, medical decision making should be determined on varies factors. The diagnosis of the patient, life expectancy and whether or not the patient has a DNR (do not resuscitate) order or full code order are important factors. Every aspect of the critical and/ or terminal illness should be considered. Emotional and spiritual support of the patient along with the family’s needs should be considered. Knowing the advantages and disadvantages of each option is essential. This article will disclose the pros and cons of each care and include a case report on why the medical decision was made on a specific case and care option.

Long-term care LTC is defined as the health and support services for people of any age group.It is provided by caregivers.People require support and health services, and it's their right to obtain the appropriate care for their well-being.LTAC system is usually suitable for critically ill patients as they need professional care by caregivers.Without LTAC services, a critically ill patient is prone to suffer more and delay recovery [1].The patients experiencing LTAC care are mostly discharged from the intensive care unit (ICU).These patients may not need ICU anymore but require more supervision and maintenance than usual.

What type of patients are observed in LTAC?
Studies and surveys recommend that patients need to stay in an LTAC for around 30 days to Cardiology Graduate of Mount Sinai Hospital Miami Beach Florida and Cardiologist at Private Practice, Howard B Reinfeld and Associates MD, PA and BS Pharmacy, St. John's University, Jamaica, New York, USA be observed for proper care.Typically, patients with prolonged use of ventilators or weaning are seen in LTACs.Patients with ongoing dialysis for chronic renal failure are more likely to be observed in the long-term acute care system.Patients who have undergone complex wounds or burns, several IV medications or transfusions, or require intensive respiratory care should stay in the LTAC to get the appropriate care from the providers.These patients should not leave LTAC until they get recovered [2].Just like every other thing, the LTAC system has strengths and weaknesses.Here are the weaknesses and strengths of the LTAC system.

Weaknesses
The environment and aging of the population Almost 70% of those currently turning 65 need a better LTC system.But it lacks a positive environment because basically, a long-term care facility is a home where a positive environment for the resident, especially for the patient suffering from any severe condition, needs a positive environment that most of us actually lack [2].There is a limited amount of actual care given to the elderly by their friends and family.The elderly community needs special care and services from care providers, and unfortunately, they don't get them.It is proved to be one of the hardest weaknesses of the system.

Low quality of care and cost
The Long-term care settings have changed over time so has the requirement of the care.
The overall factors affect the system, from caring for the vulnerable population to costeffective care, everything is facing lower quality and no efficiency.It is essential to understand the eligibility criteria for services to provide quality at an affordable cost, especially for the elderly [3].The insurance of the elderly should never be compromised, because of the budget, so it is high time to focus on this challenge and convert it into a strength.However, the research shows that the cost of LTAC is generally 25 to 35 percent lower than that of regular hospitals [1].

Staff shortage
It is much needed to get credible and qualified professionals to provide the demanding services.But unfortunately, the shortage of trained staff makes it hard to reach the goal of qualified care providers who understand the need for services of the public and deliver professionally.Employee turnover enforces to hire low qualified personnel in the workforce, which directly affects the LTAC system [3].

Strengths
As far as strengths are concerned, the Longterm care system also holds many positive aspects.LTAC is one of the most appropriate options for patients with critical conditions.These patients are thoroughly monitored in the LTAC system.
Patients who require rehabilitation services, wound care, and pulmonary services should opt for LTAC than regular hospitals [4].Other strengths may include:

Medical support at the LTC facility
One of the most significant pros of an LTC facility is consistent medical care.The public gets constant access to medical care services from minor injuries or major injuries to prescription administration.The 24-hour monitoring services are available to the patient to make the system even more impactful.LTC services ensure the safety of health as a priority [4].

Family concerns
If a family commits to helping their loved one by providing the best care and services, it seems even more effective.From emotional or physical to financial drain, family support and long-term care by professionals always assist.The family of the patient with chronic illness should not take care of their daily needs and go to their jobs and follow routines.It's because the patient is taken care of well in the LTAC by professionals.

Living spaces
The proper living space is provided through the LTC system to manage the housekeeping.It is actually based on the care of the elderly, and in a safe and healthy environment, they get recovered soon from any injury or damage.The constant care with wheelchairs and walkers becomes a positive aspect of the long-term care system [5].

What is hospice care medical decision?
Hospice care (HC) is inter-professional and multidimensional care as it provides a broad range of services.It may include symptom management, pain, psychosocial and spiritual care, and bereavement services.Hospice care is a bit challenging decision to choose as it evokes uncertainty and confusion.This decision is made by the family, patients, and healthcare providers [6].Hospice care essentially focuses on the comfort care and quality of life of the patient with serious terminal illnesses.A patient and their family have a right to the discussion in order to opt for the best hospice care plan with the physician.

When should hospice care start?
Hospice care is often provided to patients with terminal illnesses, for instance, advanced cancer.Any illness with no positive recovery or cure by any advanced treatment may lead a patient to end up acquiring hospice care.When a patient is no longer able to survive more than 6 months, they should be getting hospice care, which is provided for patients' care and comfort [7].Physicians, family, and the patient can have a discussion together to exactly estimate when to start hospice care.However, research has shown that most people and doctors resist getting hospice care soon.It might be due to the indication of giving up on the patient's life.But studies and surveys have shown that hospice care may enhance the quality of life and provide hope to the quality of life at the last stages of advanced illness [8].Therefore, hospice care medical decision lies between the patient and the family.

Advantages of hospice care
Hospice services strengthen patients' quality of life by providing medical care.It is a specialized form of care for patients experiencing life-limiting illnesses or terminal or diseased conditions.Research shows that hospice care possesses interdisciplinary care, which is provided by trained volunteers and professionals.It may involve trained home health aide, case manager nurses, physicians, certified medical social workers, and skilled hospice volunteers in order to fulfill all the health needs of the patients and provide them comfort and care.These types of services are available 24 hours per day, even on holidays and weekends.It shows that patients and their family members feel free to access hospice care whenever they need it [8].One of the most significant advantages of hospice care medical decision is it is not so expensive when it comes to durable medical equipment, medications, or medical supplies.Additionally, Medicaid, Medicare, and private insurance usually balance the expenses for the patients of hospice care.Studies and surveys have analyzed that hospice care is one of the best ways to avoid unnecessary and unwanted medical treatments, hospitalizations, and other medical procedures.However, the goal of hospice care is to fulfill the requirements of the patient's health in order to achieve care goals and provide the best comfort and convenience to the patient [7].

Disadvantages
Everything that comes with advantages has its drawbacks too.One of the most potential drawbacks of hospice care is it restricts several aspects of treatments.It has been analyzed that a hospice asks for a per day charge of money from which all the medical expenses must be paid.It may lead to several troubles, including the denial of diagnostic tests.These tests may include x-rays and blood work.The cost of these tests becomes the primary responsibility of the hospice agency, even if the physician of the patient requests these tests.It is due to the expenses of these tests.It could be possible that these tests are not proven useful, hence they are not approved by the hospice agencies [9].Another drawback of hospice care is that it avoids hospitalization once the patient joins hospice care.However, Medicare hospice benefit may require a short-term stay in the hospital in order to manage symptoms.It is known as inpatient care [9].Yet, the coverage of treatment and admission criteria is handled poorly.Additionally, hospice care has a disadvantage that it does not allow participation in clinical trials or experimental treatments.It might be due to these being life-prolonging.

Benefits of Long-Term Acute Care
Benefits of Hospice Care A chronically ill patient can get rehabilitation services, wound care, and pulmonary services from professionals A critically ill patient can spend the last stages of his life with care and comfort through hospice care 24-by-7 monitoring is available in the LTAC system Constant monitoring is provided in hospice care The family does not have to care about the patient after admitting them to HTAC The family, patient, and physician can discuss and opt for hospice care

Less costly than regular hospitals
Durable medical equipment, medications, or medical supplies are not so expensive

Conclusion
The bottom line is that patients who need to get specialized treatment for chronic diseases or serious medical problems for at least 20 to Research shows that people are treated well in LTAC facilities and monitored thoroughly for their chronic issues.These patients are more likely to be recovered within 20 to 30 days while acquiring long-term acute care.Despite all the weaknesses of LTAC, chronically ill patients should not avoid getting assistance from LTAC.Patients with the hope of getting cured should be in LTAC.On the other hand, patients who are less likely to live more than 6 months should try to approach hospice care in order to get proper assistance.It may extend their life for a while.It also relaxes the family to go back to their routine lives with the support needed.
Patients with advanced cancer or other such terminal illnesses should choose hospice care right after they have stopped getting treatments.Even if the treatments do not ensure a cure, such patients should get hospice care.

Table 2 :
Comparison of drawbacks of LTAC and hospice care.