A problem with broad classifications of anything, including CRE property, is that characteristics, conditions, and considerations can vary greatly across different levels of subcategorization. That points comes out strongly in two areas of healthcare real estate: long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs).
Becker's Hospital Review, a respected trade publication, had run a 2023 piece highlighting the importance differences. They are worth reviewing.
Clinical and hospital facility design and planning can be based around the most common patient ailments and conditions the clinicians are likely to confront. Here are the top five for LTACHs:
- Pulmonary edema and respiratory failure
- Respiratory system diagnosis with ventilator for 96+ hours
- Septicema without ventilator support 96+ hours with major complication or comorbidity
- Respiratory system diagnosis with ventilator support ≤96 hours
- Respiratory infections and inflammations with major complication or comorbidity
And the top five for SNFs.
- COVID-19 (this may have changed since then)
- Urinary tract infection, site not specified
- Metabolic encephalopathy
- Sepsis, unspecified organism
- Encounter for other orthopedic aftercare
There are further medical complications. At LTACHs, often the most frequent conditions "include a major complication or comorbidity." And while small percentages of patients discharged to an SNF have high "extreme" conditions, "these patients make up over half the population transitioning to an LTACH." So, movement back and forth is something to anticipate.
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Given the conditions, each type of facility has different needs in equipment, capabilities, and staffing. Here are five differentiators for each type. Start with LTACHs again.
- On-site physician visits at least once per day, sub-specialists available on location
- Approximately 1-6 patients per nurse, ratios lower in critical care units; High-acuity care provided by BLS- and ACLS-certified nurses with advanced critical care training
- 24/7 respiratory therapy in house in every location
- Onsite services such as telemetry, radiology, pharmacy, lab, and dialysis
- CMS-compliant infection control standards with hospital-level air ventilation systems and negative pressure isolation rooms
And for SNFs,
- On-site physician visits at least once every 30 days for the first 90 days, sub-specialists seen offsite
- Approximately 10-40 patients per nurse
- Limited respiratory therapy in select locations
- Radiology, pharmacy, lab, and dialysis services accessible, but not onsite
- Residential-level air ventilation systems
All these differences translate to potential considerations, including overall space deployment, electrical power capabilities, water and plumbing, office space allocation, structural requirements, loading docks and ambulance bays, and more. The tenants likely differ in how they're paid, maybe credit risks, and operational needs as well.
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