The Management of Long-Term Care Facilities


The management of long-term care facilities can be challenging due to the specific services provided by these units. It is essential to consider the peculiarities of long-term care to ensure the provision of high-quality services and proper performance of the unit. Such areas as staffing and quality often require substantial analysis and precision, as well as the allocation of considerable resources. This paper includes a brief analysis of the operations of a nursing home and hospice care facility that can illustrate some distinctive features of long-term care.

Multidisciplinary Departments (Teams)

Abbey Delray

Abbey Delray is a nursing home with 100 certified beds that are rated high and provides long-term care to seniors with diverse needs (Official U. S. Government Site for Medicare, 2020). This facility is a part of the network created by the non-profit organization Lifespace Communities, Inc. This organization offers a living community for older adults where they can enjoy active lifestyles and receive the necessary care. The services offered by this nursing home are assisted living, independent living, skilled nursing, memory care, and rehabilitation (Abbey Delray, 2020). To manage its operations and provide high-quality care, the organization has such departments as administration, accounting, dietary and culinary department, housekeeping, nursing, as well as human resources, marketing, and lifestyle professionals (Lifespace Communities, 2020). The provision of care also involves the formation of multidisciplinary teams that tend to include nursing practitioners, administrative, culinary, and lifestyle professionals. These specialists collaborate effectively to identify each patient’s needs and develop plans to satisfy them. The nursing home also collaborates with the community and clients’ caregivers and relatives to ensure the highest quality of the provided services.

Heartland Hospice Care

Heartland Hospice Care is a part of the network developed by HCR Manor Care providing the following services to older patients: rehabilitation, skilled nursing, hospice care, memory care, independent and assisted living, home health care, and palliative care (Heartland Hospice Care, 2020). The hospice unit provides such services as pain and symptom management, medications, comforting care, patient and family education, spiritual and psychological support, therapies, and bereavement services. The organization includes accounting, administrative, dietary, management, human resources, nursing, therapy, and social service departments (HCR ManorCare, 2020). The provision of high-quality services at Heartland Hospice Care encompasses the work of multidisciplinary teams consisting of nursing practitioners, dietary specialists, social service workers, administrators, and therapists (for example, a massage or art therapist). The hospice facility under consideration pays specific attention to collaborating with the community, which is now characterized by a considerable focus on the pandemic issues and educating community members.

The Target Population

The target population of both facilities is the cohort of older adults aged 65 and above. However, the two units also provide care to other age groups depending on their needs associated with rehabilitation or terminal illnesses. Abbey Delray and Heartland Hospice Care have the necessary certification and participate in Medicaid and Medicare (Official U. S. Government Site for Medicare, 2020). As mentioned above, the two facilities provide educational services to the community, clients’ relatives, and caregivers, so it is possible to note that they serve a large audience meeting the needs of seniors mainly.

Major Staffing and Human Resource Issues

Abbey Delray and Heartland Hospice Care are quite highly rated by employees. However, the facilities still face rather serious problems related to staffing and human resources management. Some of the factors affecting people’s decision to leave are their salaries and workload (Indeed, 2019; Indeed, 2020). Former employees note that although the management is effective and the organizational culture is strong, employees have excessive workloads and quite low salaries. It is noteworthy that turnover remains one of the most burning issues in long-term care. It has been estimated that the turnover rate ranges between 40% and 100%, which is an alarming rate (Gilster et al., 2018). Organizations’ inability to ensure proper retention has an impact on their performance.

Both organizations are understaffed, and human resources specialists are involved in a continuous recruitment and hiring process of employees that are needed in the central departments. The major focus is on nursing practitioners, whose turnover is high, due to the peculiarities of the setting. Nurses are often unprepared to cope with fatigue, burnout, and other problems associated with the provision of long-term care. At the same time, both organizations are non-profit, so they can hardly ensure higher salaries for the personnel, which contributes to employee dissatisfaction. Scarce resources also make it difficult to intensify nurse training that can help in addressing their issues related to completing clinical tasks, time management, communication skills, and coping strategies (Pesut & Greig, 2018). However, this area should be one of the priorities as it is associated with quality improvement.

Significant Trends in Long-Term Care Affecting the Two Facilities


The demographic peculiarities of American society and the changes that are taking place influence long-term care in the country. It is possible to trace several major trends in the current provision of long-term care. Some of the most apparent trends are associated with epidemiological aspects. It has been found that the multimorbidity and intensity of the illnesses have enhanced substantially during the ten past years (Aldridge & Bradley, 2017). One of the factors contributing to this situation is related to seniors’ attitudes towards their health condition. Older patients prefer spending as much time as possible in their communities rather than residing in nursing homes or hospice care facilities (Aldridge & Bradley, 2017). This trend is likely to require the introduction of new services, including more clinical procedures. The use of advanced technology will also be necessary to be able to cater to the needs of the residents of units due to their deteriorating conditions. Finally, this trend will also lead to the need to hire more diverse and skilled personnel that will meet patients’ needs.

To address these shifts, both facilities under consideration will need to implement certain changes that can affect the programs they offer:

  1. Human Resources. One of the major steps to be undertaken is related to human resources management. Hiring high-skilled personnel, including physicians, and providing training will be pivotal for the units in question. Understaffing should also be minimized to provide intensive care for a large proportion of residents. It is possible to offer programs that involve an emphasis on mental health.
  2. Technology. Although Abbey Delray and Heartland Hospice Care are properly equipped, the units should continue utilizing technological advancements. The use of advanced patient monitoring systems, data management systems, and even robots should be considered.
  3. Collaboration. The facilities will need to collaborate with the community more effectively and encourage seniors to access healthcare services to maintain their health. This approach will help in reducing the rate of enrollees who have severe conditions or those who need emergency care in intensive care units. The introduction of programs developed in cooperation with the community is another point in the plan. These projects should aim at raising people’s awareness regarding different health issues, prevention options, and benefits of residing in nursing homes or hospice care units, as well as receiving home-based services.
  4. Marketing. Aldridge & Bradley (2017) note that hospice care facilities and nursing homes were characterized by volunteering and non-profit incentives of community-based groups several decades ago. At present, this sphere can be seen as a developing industry where non-profit and for-profit organizations provide a set of services to certain groups of people. Marketing has become an integral part of long-term care, so this aspect should not be ignored. As mentioned above, older adults and their families find long-term care an inappropriate option due to various reasons and misconceptions. Therefore, marketing professionals of the facilities under consideration should conduct thorough research concerning the needs of seniors ad their families, their attitudes towards their health conditions, and long-term care. Based on this research, new programs or improvements to the existing programs should be developed and implemented.

Changes in the Patterns of Provided Care

The changes in the patterns of provided care can be regarded as another prominent trend in long-term care. The primary health issue of the residents of hospice centers in the 1990s was cancer while only 1.1.% of residents had Alzheimer’s disorder (Aldridge & Bradley, 2017). In 2014, the primary diagnosis of almost 15% of users of hospice care was Alzheimer’s disease. The rate of seniors, including those receiving care in nursing homes and hospice care units, with mental disorders such as dementia is increasing (Aldridge & Bradley, 2017). In addition, people’s expectations are also changing with the focus on meeting spiritual and psychological needs (Xu et al., 2020). For instance, older adults tend to discuss religious aspects and spiritual issues during the last months of their life.

To address these changes, the facilities should also include the following areas in their development plans:

  1. Spiritual-based programs. Spiritual, cultural, and religious aspects should become more pronounced. Heartland Hospice Care has certain programs related to the areas mentioned above, but they should become more numerous and more patient-centered (Heartland Hospice Care, 2020). Abbey Delray does not offer any specific spirituality-oriented programs (Abbey Delray, 2020). It is possible to research to identify the exact needs of community residents regarding their background. The collaboration with the community with specific attention paid to religious facilities will be beneficial. Both facilities have to develop comprehensive programs involving seniors’ caregivers, families, and the community. It is important to inform people about the introduction of these initiatives, which is a task for the marketing department.
  2. Mental health. Both facilities in question offer memory care as a part of their services. However, they should develop sound programs for people with specific mental issues. It is critical to consider multimorbidity when creating such incentives as patients may need the provision of comprehensive care.
  3. Human resources and marketing. The implementation and development of the programs mentioned above will be associated with the corresponding changes in hiring and staff training and development. Raising people’s awareness about new programs, alongside other marketing instruments, may include the distribution of booklets, arranging meetings and activities in health-related facilities and communities.
  4. Technology. In addition to the technology mentioned above, the utilization of an advanced medical alert system will be necessary. It is also possible to use simulations and related software to train the personnel, especially when it comes to addressing mental health issues and associated emergencies.

Cooperation and Integration at Abbey Delray and Heartland Hospice Care


The facilities under consideration have rather limited cooperation and integration incentives and services. Abbey Delray has a distinct project encompassing cooperation in the sphere of spirituality and psychological support. The facility has chaplains who provide support to residents and their families (Lifespace Foundation, 2019). Chaplains also implement incentives entailing the cooperation with the community with the focus on spiritual support. This form of cooperation is relevant as it is instrumental in meeting patients’ needs related to spirituality as seniors tend to pay considerable attention to this area. These initiatives are funded by donors and community members. As far as the quality-related issues, it is possible to note that communication needs special attention. The program requires the use of proper communication channels that may involve the utilization of technology as poor communication in this area leads to patient dissatisfaction (Aldridge & Bradley, 2017). Heartland Hospice Care should also consider the integration of this kind of care because it can improve the quality of provided services.

Staff Training

Another type of cooperation that has an indirect effect on the improvement of delivered care is the provision of scholarships to the personnel. Abbey Delray has several programs for its staff that ensure employees gain an education, which enhances morale, increases employee motivation and satisfaction (Lifespace Foundation, 2019). The organization can also retain employees who obtain professional skills, so the facility may hire highly-skilled professionals. Again, the project is funded through the resources of the foundation and direct donations of the community and facility’s residents. Heartland Hospice Care can also consider introducing a similar initiative.

Health-Related Facilities and Community-Based Programs

The two facilities in question do not have comprehensive care plans characterized by cooperation and integration involving other healthcare facilities. The organizations provide home-based care and collaborate with the patient and occasionally with the corresponding primary-care practitioners. At that, Heartland Hospice Care has more elements of such collaboration compared to Abbey Delray, but these incentives (contacts or meeting the facility’s residents at a primary-care unit) are insufficient. The overall trend existing in long-term care entails the shift to intensifying integration and cooperation, but this process is very slow (Payne et al., 2017). The major barrier to the successful implementation of such projects is the lack of resources and some technological issues. The collaboration of long-term care units and primary-care facilities requires proper integration of information systems, which can be challenging, especially due to security issues and the lack of an integrated system used by many health-related organizations.


On balance, it is necessary to state that Abbey Delray and Heartland Hospice Care provide high-quality care and maintain a high level of patient satisfaction. At the same time, the units have to address the challenges related to understaffing and employee turnover. The programs offered by the facilities aim at the provision of comprehensive care to seniors, but these plans can be improved considerably. The units need to consider adding more programs associated with mental health. Staff training is another area to concentrate on as high-skilled professionals are needed. Finally, the facilities should also provide more integrated care as the provision of comprehensive services in close cooperation with primary-care units is the need to be addressed in modern health care.


Abbey Delray. (2020). A helping hand to support your independence. Web.

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Gilster, S. D., Boltz, M., & Dalessandro, J. L. (2018). Long-term care workforce issues: Practice principles for quality dementia care. The Gerontologist, 58(suppl_1), S103-S113. Web.

HCR ManorCare. (2020). Hospice career information. Web.

Heartland Hospice Care. (2020). Live each day to the fullest. Web.

Indeed. (2019). Heartland Hospice Services: Careers and employment. Web.

Indeed. (2020). Abbey Delray South: Careers and employment. Web.

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Xu, S., Liu, M., Shin, O., Parker, V., & Hernandez, R. (2020). Differences of quality in end-of-life care across settings: Results from the U.S. national health and aging trends study of Medicare beneficiaries. Journal of Palliative Medicine, 23(9), 1198-1203. Web.