Chronic critical illness is a significant component of every ICU clinician’s day. Although accounting for only 10% of all ICU admissions, chronically critically ill patients account for a large number of ICU-bed days and consume up to 40% of ICU resources.1– Much of these resources are consumed beyond the seventh day of mechanical ventilation. Since 1983, the considerable burden of chronic critical illness on acute hospital ICUs has been relieved somewhat by the rapid growth of long-term care hospitals (LTCHs). These institutions manage a range of long-term care conditions such as complex wound care, but many of them admit patients requiring prolonged mechanical ventilation (PMV) after acute illness. LTCHs focus on successful weaning of patients requiring PMV by taking advantage of personnel who are trained and experienced in managing this unique patient population.2 Ideally, patients undergo a rehabilitation-based approach to care that encompasses multidisciplinary input from expert nurses, respiratory therapists, nutrition specialists, physical, speech and occupational therapists, and experienced discharge planners.2–3 Some centers also include psychiatrists, clinical psychologists, and palliative care specialists on the care team to help patients and families with their often complex emotional needs.