To demonstrate how an advanced skilled nursing facility can effectively deliver LTACH-level care — treating high-risk, ventilator-dependent patients in place while mitigating hospital readmission risk.

Case Summary & Outcomes

Patient Profile 58-year-old male with chronic systolic heart failure (ejection fraction 25%), ischemic cardiomyopathy, and depression/anxiety.
Clinical Status at Admission Left Ventricular Assist Device (LVAD) in place, status-post cardiac arrest, tracheostomy status, ventilator management, PEG tube care, severe malnutrition.
In-Place Intervention Stakeholder care coordination with CCF Mechanical Circulatory Support team, advanced nurse/RT competencies, Doppler vitals monitoring, EMS emergency dispatch protocols.
Outcomes Achieved Zero hospital readmissions within 30 days of transfer, lasting SNF clinical capability upgrade, successful transition to a comfortable home-like environment.

One of the most systemic bottlenecks in modern hospital systems is discharge planning for high-acuity, multi-system patients. A 58-year-old male patient with an active Left Ventricular Assist Device (LVAD) in place, a history of driveline infection, and an ejection fraction of 25% presented to a local emergency department with severe hypoxemia. During his emergency stay, he experienced a cardiac arrest, was intubated, and ultimately required a tracheostomy. Following stabilization, he was transferred to a Long-Term Acute Care Hospital (LTACH) for specialized care.

After his LTACH stay, the patient was medically stable enough to leave the high-acuity hospital setting, but he faced a significant barrier: he required active ventilator management, trach care, PEG tube feeding, and complex daily LVAD monitoring. Most skilled nursing facilities (SNFs) lack the specialized clinical credentials to accept active mechanical cardiac devices, leaving the patient stuck in an LTACH bed with no viable discharge destination.

Ohman Family Living at Briar chose to bridge this critical care gap.

Pre-Admission Infrastructure & Competency Training

Accepting an LVAD referral in a post-acute SNF setting requires deep coordination, clinical planning, and specialized staff education. Before the patient was transferred, the Briar team executed a multi-step readiness protocol:

  • Conducted a comprehensive hands-on bedside evaluation of the patient at the LTACH before accepting the referral.
  • Established regular stakeholder planning calls between the hospital team, the Cleveland Clinic Foundation (CCF) LVAD coordinator, Briar's attending physician, and the family.
  • Secured specialized clinical monitoring tools, including dedicated Doppler devices for accurate peripheral blood flow evaluation in the absence of a standard pulse.
  • Hosted on-site device reviews and hands-on staff competencies with CCF mechanical circulatory support representatives, validating training for both nursing and respiratory therapy departments.
  • Coordinated with the local Emergency Medical Services (EMS) team to establish shared emergency dispatch protocols for any necessary readmission pathways.

Delivering the Outcome in Place

Upon admission to Briar's Breathe Easy unit, the clinical team initiated a highly coordinated care plan. Attending physician Dennis Lagman, M.D., and the lead respiratory therapists monitored the patient's pulmonology and weaning parameters, while the clinical nursing staff managed the PEG tube nutrition, driveline dressing changes, and continuous LVAD power-module monitoring. Daily physician and telehealth consults kept the clinical trajectory tightly controlled.

The patient was treated in place at Briar with zero hospital readmissions within 30 days of discharge from the LTACH. By managing his complex clinical needs locally, the team avoided the revolving-door syndrome that frequently compromises post-acute transitions for high-acuity cardiac patients.

An Enduring Capability Upgrade

Beyond the immediate clinical success, this admission resulted in a permanent capability upgrade for Briar's clinical program. The advanced training provided by the CCF team expanded on-site competencies across our nursing, respiratory therapy, and rehabilitation departments, establishing a repeatable pathway for other LVAD and high-acuity cardiac-respiratory admissions in Geauga County.

Conclusion

While the vast majority of skilled nursing facilities decline complex cardiac device placements, Briar built the diagnostic monitoring and clinical education infrastructure necessary to deliver a successful outcome. This case study demonstrates that LTACH-acuity care is highly achievable in a specialized skilled nursing setting, giving complex patients the comfortable, dignified care environment they deserve while relieving pressure on acute-care hospital beds.