LTCF Solutions to Common Challenges

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Thursday, 31 October 2013 13:22

As 77 million baby boomers enter retirement and begin battling health issues associated with the elderly, demand for long term care (LTC) is on the rise. According to Census Bureau projections, the number of people ages 65 and older will increase an unprecedented 115 percent between 2010 and 2050.  As demand increases, this will burden an already troubled industry that is fighting a negative image. There are many challenges facing long-term care facilities (LTCF) today. Most of the issues which have contributed to LTCF’s reputation stem from two primary problems, however: lack of funding and staff shortages.

Long term care is expensive, and becoming more expensive.  Since 2003, LTC costs have outpaced inflation. Nationally, the median annual cost of a private room in a nursing home is $90,520. Because most Americans do not plan in advance to fund LTC, government programs account for 63 percent of LTC funding. The remaining 37 percent comes from out-of-pocket spending, LTC insurance, other private sources, and other public sources. Of course, this does not include the cost of unpaid care, typically provided by family members. 

Of government funding, Medicaid pays for 40 percent and Medicare pays for 23 percent in the form of post-acute care. Most Americans do not realize that general LTC is NOT covered by Medicare- only post-acute care (care required after a specific injury or illness).  As millions of baby boomers age and begin to contend with conditions such as Alzheimer’s, they are often shocked to learn that Medicare will not cover their stay in a LTCF. And while Medicaid is currently the largest source of LTC financing, those Medicaid dollars are now harder to get as demand increases and costs soar.

The other major crisis in LTCFs deals with staffing.  Turnover is high in LTCFs because wages are low, the work is often physically demanding (lifting and moving patients), and the injury rate is high. For these reasons, while demand for LTC increases, the pool of workers available to provide this care continues to shrink.   

Because of the staffing shortages, some LTCFs have been sued for alleged patient neglect.  This increases their medical liability insurance which, in turn, contributes to rising LTCF expenses and perpetuates their funding issues.

So how can LTCFs improve their image and their likelihood of success?  It seems to boil down to two things: education, and technology.

Obviously, the funding crisis must be addressed.  Recent government reforms aimed at restructuring healthcare are one means. More importantly, however, Americans must be educated about the actual costs of LTC (most Americans estimate average LTC care costs to be about $30,00- just a fraction of that they actually are).  By educating people about the real costs of LTC and the likelihood that they will need it (unlike other societies, Americans rely primarily on LTCFs to care for their disabled and frail elderly), we can encourage consumers to start saving now for LTC costs. Many employers are beginning to add LTC insurance to their list of available benefits.  While it is an emotionally-charged topic, as no one wants to think about the fact they may one day require LTC, the fact is we need to save for LTC just as we save for our children to attend college. 

And while simple education may help alleviate the funding crisis among LTCFs, it seems the biggest player in resolving the staffing shortage may be technology. Traditionally, LTCFs have not implemented health technology as quickly as hospitals and physician practices, due to cost and the training required. They simply have not been able to afford the “luxury” of electronic health records and other technological resources. But many LTCF operators are optimistic that becoming more reliant on available technology will improve the quality of care they are able to provide. 

For starters, maintaining EHRs helps ensure legible notes from nurses, physicians and others who have cared for a patient. This is especially helpful in caring for LTC residents, who may often move in and out of hospitals or other acute care settings. Technology can improve coordination and collaboration across these providers and settings as health information exchanges allow providers to share patient clinical data in order to provide more effective—and more efficient—care.    Not only can a resident’s information be exchanged quickly and easily, but the orders to transfer or discharge the resident can be completed quickly and easily, too.

Technology can also help engage patients and families and increase workforce capacity. Touch-screen technology now readily available on hand-held tablets, for example, enables nursing assistants to complete Activities of Daily Living (ADL) assessments more thoroughly then before- and in less time. This, of course, increases their productivity and reduces the strain on the already-taxed LTCF staff.  Similarly, alerts regarding specific resident events, such as weight change or out-of-range vital signs, allow nurses to respond more quickly to a change in the resident's condition. Telemonitors placed in patients’ homes can extend the reach of caregivers by allowing for remote monitoring.  This also aids in early detection of symptoms that require intervention, which may prevent a visit to an emergency department or an avoidable hospitalization.

Obviously, technology has the potential to integrate and help heal a fragmented system. LTCF operators are encouraged to use technology to create and maintain innovative and affordable long-term care.   Hopefully, as we continue to educate people about the costs of LTC- and the importance of saving for it- and also employ technology to provide better care, the last of the baby boomers and future generations will experience a dramatically-improved LTC industry.

~ Melissa McCain


Calmus, Diane. “The Long-Term Care Financing Crisis.” The Heritage Foundation. Web. 6     February 2013.

Ford, Eric. “Electronic Health Records Hold Great Promise for Long-Term Care Facilities.”     iHealthBeat. Web. 10 September 2010.

Raphael, Carol. “Long-Term Care: Preparing for the Next Generation.” The Commonwealth     Fund. Web. 21 July 2008.