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2024-06-10 Spotlight: Is long-term care evolving or devolving?

Is long-term care evolving or devolving?

McKnight’s Long-Term Care News
By John O’Connor, editorial director for McKnight’s Long-Term Care News
June 9, 2024

With the midyear mark rapidly approaching, this might be a good time to consider the current state of long-term care. 

But rather than make an argument whether conditions for operators are getting better or worse, perhaps it would be more helpful to consider this question: Is long-term care evolving or devolving?

Compelling arguments can be made either way.

First, let’s look at some of the positive ways operators in this field are changing with the times. In my view, here’s the first among equals: person-centered care models have emerged as never before. There is no denying that many, if not most, skilled care operators have shifted to embrace care that focuses on respecting and responding to residents’ preferences, needs, and values. 

Here are some other ways the sector has made notable strides:

Enhanced infection control protocols
In the wake of COVID-19, long-term care facilities have significantly improved their infection control measures. This includes better staff training, use of personal protective equipment (PPE), and more rigorous cleaning and disinfection practices.

Reduced reliance on antipsychotics
There is clearly a growing trend toward reducing the use of antipsychotic medications in favor of non-pharmacological interventions. This approach prioritizes the mental and emotional well-being of residents, addressing the root causes of agitation and behavioral issues rather than merely sedating them.

Harnessing technology-driven tools
The adoption of advanced technologies, such as electronic health records, telehealth services, and remote monitoring systems, has improved the efficiency and quality of care. These tools facilitate better communication, timely interventions and personalized care plans.

Better staff training and education
Investing in the continuous education and professional development of staff has become a universal priority. These enhanced training programs aim to equip caregivers with the latest skills and knowledge, improving care delivery and resident outcomes.

Integration of palliative and end-of-life care
There is an increasing recognition of the importance of palliative and end-of-life care within long-term care settings. Integrating these services ensures that residents receive compassionate and appropriate care that aligns with their wishes and needs during their final stages of life.

If only that were the whole story.

Unfortunately, there are also some not-so-subtle reminders that the long-term care field might be regressing.

Let’s start with the obvious: There are simply not enough employees in this field doing the work that must be done. This was readily apparent when I began covering long-term care more than three decades ago. The only thing that has really changed is that the problem continues to worsen.

Frankly, the industry has done a much better job of explaining the factors behind this challenge than in actually fixing it. The reason why the problem persists is not too hard to understand: More workers cost more money – and someone has to pay those extra expenses. Regardless, when AARP and other major consumer groups are calling for minimum staffing requirements as never before, it’s hard to conclude that conditions are improving.

Here are some additional challenges where progress has moved at a snail’s pace, or worse:

A lingering reputation for substandard care
Long-term care facilities generally continue to suffer from a poor reputation. All too often, they are still viewed as places of last resort rather than environments where residents can thrive. 

Physical and infrastructure deterioration
Many skilled nursing facilities are now north of three decades in age. Moreover, new construction is pretty much zero. The result is an industry using old, ill-adaptive buildings to meet the changing needs of our aging population.

Financial instability and funding challenges
Many long-term care facilities face financial difficulties, exacerbated by rising operational costs, demanding investors and insufficient reimbursement. This economic strain continues to fuel cost-cutting measures that negatively impact care quality.

Continuing arrests of providers for fraud and abuse
Let’s face it, more than a few operators are playing fast and loose with the rules. Whether the motivation is need or greed, this continuing saga is doing little to improve public trust.  So, is long-term care evolving or devolving? The short answer is yes and yes. Which brings us to a more fundamental question: Can this dual reality withstand the test of what’s to come?