4 Biggest Challenges of Long-Term Care

Last Updated on November 13, 2023

The Biggest Challenges of Long-Term Care in 2023

Even before Covid-19 brought unprecedented stress to the healthcare system, the long-term care industry in America has faced a series of challenges and crises on a number of fronts. With calls for federal assistance still mostly unanswered, what can leaders do to best address the many issues and challenges of long-term care facing them today?

Challenges & Issues in Long-Term Care

Long-term Care Workforce

In an industry that’s always had a high turnover rate, the current workforce shortage has been devastating. A 2022 survey by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) showed that an enormous 98% of nursing home providers are currently “experiencing difficulty hiring staff,” while 87% currently face “moderate to high staffing shortages.”

Staffing has continued to be one of the most persistent issues with long-term care organizations. Workforce issues in general also account for a number of other issues facing the industry, including “unmet resident needs, quality problems, worker training and competency, and lack of integration with medical care,” as defined by the Kaiser Family Foundation in 2017.

In September 2023, the Centers for Medicare & Medicaid Services (CMS) introduced a proposed minimum staffing requirement in response to a presidential mandate from 2022. The CMS proposal entails a minimum of 3.0 hours of direct care per patient day, with 0.55 hours provided by a registered nurse and 2.45 hours by a nurse aide. Furthermore, the proposal mandates the presence of a registered nurse on duty 24/7 upon the publication of the final rule.

> Don’t Miss: Preparing for New Long-Term Care Staffing Requirements

All the same, as other facilities like hospitals and health centers have slowly leveraged economies of scale and other methods to overcome shortages after Covid-19, many long-term care facilities remain in dire need of staff. In some areas, there simply aren’t enough workers to cover patient care needs. As a result, some LTC providers have also had to set limits on new admissions.

High-Acuity Patients

On top of funding issues in long-term care, many new residents referred to skilled nursing and other LTC providers are higher acuity than before. Subsequently, this is a result of an ongoing trend to move post-acute care out of the hospital and into less expensive settings. Concurrent with this trend is the drive to further reduce expenses by shifting residents from skilled nursing facilities into home-based settings.

The result is new and different responsibilities and obligations for facilities that may already be stretched to the max — essentially, treating “two distinct populations.” As a pre-pandemic analysis by Wolters Kluwer describes it: “patients there for a few weeks as they recover from specific illnesses or injuries, and residents who live there because they require skilled nursing care to live.”

While it is true that some larger organizations have embraced the chance to expand their SNF service lines and resident capacity with new options for home care, many others have struggled to produce the additional workforce with the skills needed to do so.

Government Funding & Public Awareness

Public Awareness Challenges

Representatives of the LTC industry have called upon Congress to help solve these problems for decades, especially in the few years since Covid-19 struck. With some regulatory changes and federal dollars — as opposed to the patchwork collection of state rules and assistance — LTC organizations could work to correct its labor shortage with higher wages, programs for overseas workers, and other initiatives.

Indeed, chronic underfunding has long been one of the key challenges of long-term care in the United States. Even back in the 1980s, experts warned that “the current system as structured is being stressed to its limits and that its functioning is inadequate, with serious problems in cost and financing, and in access to and quality of, long-term care services.”

Today, political science professor Robert P. Saldin points out that one of the reasons why the LTC industry remains largely ignored by the federal government is lack of political will. Lawmakers haven’t made a priority of funding such an essential industry because many Americans don’t understand the nature of the problem in the first place, he argues.

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Funding Challenges

“To the surprise of many, Medicare does not cover LTC expenses,” Saldin writes at National Affairs. “Financing LTC is especially difficult because the American public is generally ignorant about the issue and ill-prepared for the financial risk it poses … Those misperceptions severely limit reformers’ ability to rally political support for a new program to address the issue.”

Yet progress has still been made, though slowly. The version of the ‘Build Back Better’ bill that finally passed in 2022 included $150 billion in federal funding to help “provide the opportunity for higher wages and increased standard of living for the direct care workforce,” as the Partnership for Medicaid Home-Based Care (PMHC) said in a statement shared with Home Health Care News.

The funding was designed to “permanently increase by 6 percent the funding the federal government gives each state for in-home and community-based services, as long as the state creates a plan for strengthening and expanding services,” explained Rachel Roubein at the Washington Post.

More recently, the Whitehouse revealed it’s plan to slightly increase Medicare payments to skilled nursing providers up 3.7%, or $1.2 billion in FY 2024. According to a HealthLeaders Media analysis, this increase is part of the administration’s efforts to improve nursing home quality of care and patient safety.

How Can Leaders Meet the Challenges of Long-Term Care?

How can organizations get ahead of issues with long-term care? While long-term care can anticipate more industry shifts in the future, facilities can benefit from access to a wider range of employees now. For instance, a nationwide healthcare staffing and recruitment company can help fulfill that need, with thousands of workers available all across the United States.

Other workforce solutions can help organizations stretch their budgets by better managing and even automating administrative tasks. For instance, a healthcare managed services provider (MSP) or a vendor management service (VMS) can help streamline tasks related to hiring, billing and scheduling. This can help healthcare employers accomplish much more with added efficiency.

>Related: How to Improve Long-Term Care

Prepare for the Challenges of Long-Term Care with CareerStaff

As a leading provider of healthcare workforce solutions, CareerStaff Unlimited is here to guide you to the solutions that best meets your facilities’ unique needs. How can we help your organization meet the challenges of long-term care? Contact us to learn how we can help your facility meet the current long-term care challenges, or submit a staffing request today.

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