Revolutionizing Long-Term & Nursing Home Care

It’s time to revolutionize long-term care. This segment of the healthcare system has endured enormous challenges over the last few years. Over 200,000 long-term care facility residents and staff died from Covid-19 during the pandemic (KFF 2022). The Baby Boomer generation has entered old age, a demographic shift that reinforces how important long-term care and nursing home care are. Administrators and other staff in long-term care have had to repeatedly make do with too few resources and too much regulation.

Enormous challenges have presented enormous opportunities. As the pandemic recedes, a motivated coalition of healthcare leaders is taking the opportunity to revolutionize long-term and nursing home care. It starts with putting residents first. With buy-in from government, academia, and professional organizations, experts are hopeful that the future of long-term care could be brighter.

Read on to learn more about the state of long-term and nursing home care and how it’s being revolutionized.

Robert Lane is president and CEO of the American College of Health Care Administrators (ACHCA). He earned his BS in allied health administration from the University of Kansas, and holds a graduate certificate in gerontology and an MA in health and human services administration from the University of Oklahoma. Lane is a Fellow of the American College of Health Care Administrators and a certified nursing home administrator.

A seasoned healthcare executive with 39 years of experience, Lane has worked in the skilled nursing, assisted living, and long-term acute care space. He has also served as faculty for the health administration program at St. Joseph’s College in Maine. Lane is the past board chair of ACHCA and has been a board member since 2013.

“I’d like to see long-term care on the same playing field as other healthcare settings when it comes to payment and regulation,” Lane says. “The profession has not been fully recognized for the important role it plays in the full continuum of care.”

Today, there are approximately 65,000 regulated long-term care facilities and 15,000 certified nursing homes in the US. Up to 30 million people may need long-term care by 2050. However, in its current state, long-term and nursing home care could have been more efficient and sustainable, with many underlying problems related to how the US finances and regulates long-term and nursing home care (Public Policy & Aging Report 2023).

The Covid-19 pandemic exacerbated inequities and inefficiencies latent within the system. America’s average age is ticking higher with the Baby Boomers, and income inequality remains persistent (Census Bureau 2021). Accessible and high-quality long-term care shouldn’t be a luxury. Lane notes that long-term care is such a needs-based business that it could actually be affecting demographic shifts instead of purely being impacted by them.

“Most families tend to try to provide care in the home as long as possible, but eventually the demands are too great, and placement becomes necessary,” Lane says.

In 2022, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a report entitled “The National Imperative to Improve Nursing Home Quality.” The 605-page report detailed its findings and recommendations after a two-year period spent examining how the US delivers, finances, regulates, and measures the quality of nursing home care.

“The NASEM report was the most important piece of research in the last 20 years,” Lane says.

The report spanned several areas, seeking ways to improve care delivery, workforce, transparency and accountability, financing, quality assurance, quality measurement, and technology. And it provided actionable recommendations, such as identifying and fulfilling care preferences for all residents, improving working conditions across the workforce, increasing access to quality care through a federal long-term care benefit, developing a health equity measure, and prioritizing models that reduce disparities, including diversity, equity, and inclusion training. The importance of prioritizing equity featured prominently throughout.

The Moving Forward Coalition was established to address the recommendations of the NASEM report, and is working to create a practical and sustainable change in long-term and nursing home care. It brings together a broad support network to fundamentally strengthen how the US provides, pays for, and oversees nursing home quality.

“ACHCA is a supporter of the Moving Forward Coalition, and we are optimistic for its success,” Lane says. “I believe that the seven areas of focus for the coalition, borne from the NASEM report, are our best chance to truly transform our profession.”

America needs to do a better job of honoring its elders, and ageism permeates its increasingly isolated and tech-filled society. It’s difficult not to draw a parallel between those attitudes and the under-resourced nature of long-term and nursing home care. Lane believes that more education is needed and that increasing opportunities for K-12 students to visit, volunteer, and/or learn from long-term care settings could help positively transform attitudes toward the elderly.

“Children who are comfortable around the elderly are that way because they’ve had the chance to spend time with them,” Lane says. “So many kids don’t have contact with grandparents, and thus grow up without that advantage, hence the ageist approach we see.”

Another advocacy issue for long-term and nursing home care revolves around extending certain waivers that were issued during Covid-19’s public health emergency. These waivers temporarily loosened strict regulations and made it easier to provide services like telehealth, or to get reimbursed for certain types of care.

As the pandemic recedes, administrators are fighting to keep the best parts of the Covid response, now that they’ve proven effective. MHA and other college students can make their voices heard as well.

“Administrators can and should be involved in advocating for less onerous regulation and better Medicaid payment rates,” Lane says. “Students can get involved by learning about the process and by participating in discussions with their instructors, mentors, and colleagues.”

The future of long-term and nursing home care is being decided today. But it’s not being decided unilaterally. Leaders of the future will need to be more collaborative, Lane notes, as younger generations enter the workforce and demand more flexibility in how they carry out their responsibilities. Community-minded cultures that can adapt to new paradigms will be the ones that succeed. A less ageist society and a more sustainable long-term and nursing home care system are possible.

“I believe the future of long-term care will involve fewer providers, more regionalized organizations instead of larger multi-facility companies, increasing emphasis on payment based on data-driven metrics, and hopefully, less regulation,” Lane says. “Somehow, we’ve got to make long-term care more attractive as a place of work, and I think education is the key to getting there.”