Future Planning and Change Management in Long-Term Care

Introduction

Long-term care is one of the most significant issues for people to consider as they age. On the other side of the coin are the people who work in and manage long-term care facilities. They are finding that they need to focus on making those facilities the highest quality and most efficient for both patients and staff. Future planning must be considered for these long-term care operations, and that means change management must be addressed. The primary reason for future planning and change management in long-term care facilities is not that the business model itself must change, but rather that there will soon be a large influx of people needing this kind of care.

Baby boomers are aging, and the U.S. population as a whole is growing older. That means the future will bring more people who are elderly and in need of care from those who are younger and able to provide it. While not every aging person will need care in a long-term facility, many of them will. That is both the beauty and the challenge of people living so much longer today than they did in the past — they get more time, but they also face more years of struggling with failing minds and bodies. Because of this growth in the aging population, managers of long-term care facilities should begin making plans for the future now. If they wait until a large influx of new residents has already arrived, they will not be in a position to care for those people and will be forced to turn away aging individuals who have nowhere else to go. That outcome would be highly unfortunate, and it can be avoided with proactive future planning and a genuine commitment to change management.

Nursing facilities — also called nursing homes or skilled nursing facilities — are among the most common final destinations for elderly people who can no longer care for themselves (Anderson & Anderson, 2001; Johnson, 2003; Judd, 2009; Snodgrass, 2004). Often, relatives attempt to care for these individuals. That can work well in some cases, but in many cases the demands of caring for an ailing elderly person simply become too great. Not every caregiver accepts the idea of placing a loved one in a nursing home, but sometimes it is the only safe option available. A nursing facility is designed to provide round-the-clock care to patients who are no longer able to care for themselves and who would not be safe living at home even with outside assistance (Anderson & Anderson, 2001). That may be because of mental health issues such as dementia, or because of physical needs that realistically cannot be met in a home setting.

Types of Long-Term Care Facilities

Regardless of the circumstances, nursing homes are among the long-term care facilities that must begin preparing for a larger number of residents in the near future. There are various ways this can be accomplished. Reorganization of existing space may be possible, but nursing facilities may also need to consider expanding or constructing newer, larger buildings. Many nursing homes throughout the country are already at capacity and must turn people away or maintain waiting lists. Those waiting lists are going to grow exponentially within the next few years, and only nursing homes that are well-prepared will be able to move forward, sustain their finances, and continue helping those in need. Dynamic leadership will be required for these organizations because of their size and the speed at which they will need to expand (D'Antonio, 2010; Dossey, Keegan, & Guzzetta, 2000). Planning ahead is far more important and effective than struggling to catch up at a later date.

Assisted living facilities represent another long-term care option that will be rapidly expanding. They offer a step down from nursing homes in terms of the level of care provided. Residents have considerably more privacy, but still receive help with medications and other daily living tasks. There are usually different complexes or apartment units offering varying levels of care, which allows a resident to remain in the same facility even as his or her health declines and needs change over time. These facilities are likely to be the ones hit hardest by demographic change, because many aging baby boomers will spend time in them before reaching the stage where nursing home care is required (Kotter, 2011; Marshak, 2005).

Future planning is not a luxury for these facilities — it is an absolute necessity. While it is not possible to plan for every eventuality, it is possible to study the issue, identify developing trends, and incorporate change management principles that allow for flexibility in future plans (Chin, 2008; Phillips, 1983; Saltman, Dubois, & Chawla, 2006). Managing any facility that cares for people who are losing or have lost the ability to care for themselves is a stressful and critically important endeavor. It is made more complicated by the demographic shifts occurring in society, by aging infrastructure, and by a struggling economy. However, economic or other pressures cannot be allowed to compromise the care provided to residents. Change management and future planning must keep individual needs at the center and ensure that those needs continue to be met, even as demand grows well beyond current capacity.

Before aging seniors enter an assisted living facility or nursing home, many of them transition to senior housing. At that stage they are still capable of living independently, but they often have very limited income, do not drive, and must rely on public transportation to reach medical appointments and grocery stores. Not all seniors will live in this type of low-income housing, but demand for it already exceeds the available supply. As the elderly population grows, the need for senior housing will increase substantially (Dossey, Keegan, & Guzzetta, 2000; Snodgrass, 2004). More of these complexes are needed now. However, funding remains a significant obstacle, because senior housing generates little revenue. Units are generally rent-subsidized, meaning residents pay very little monthly, which produces minimal return on investment for the facility and creates ongoing financial concerns.

Future planning for senior housing must include strategies for building more complexes as cost-effectively as possible. That solution has not yet been fully identified, but it must be addressed urgently. Construction and preparation take time, and if managers wait until demand surges further, it will be too late to respond adequately. The grants and loans required to fund these developments should be pursued in the present. The country has never experienced an age-related demographic shift of this scale, which makes it difficult for those operating elder care facilities of any kind to be certain of the right course of action — but the need to act is clear.

Long-term care has already experienced many aspects of change management, having evolved from a landscape dominated exclusively by nursing homes to one that includes assisted living facilities offering a wide range of care levels. The mission of caring for the elderly has changed and continues to change, but it is likely that both mission and vision will need to evolve further to accommodate the influx of aging baby boomers (Anderson & Anderson, 2001). That evolution may produce better care, but it may also mean a greater struggle for a larger number of people. Because of that possibility, managers of these organizations must carefully and honestly address the issues they face today. Predicting the future is not easy, but analyzing past and current trends is the most reliable approach. At minimum, it ensures that decision-makers have considered all available information before choosing a direction.

The Evolution of Long-Term Care

One of the central challenges right now is the speed of change. If the demographic shift were occurring more gradually, there would be more opportunity to adapt. Because it is happening rapidly, more must be done to develop the capacity to change quickly — something that has not previously been required of these managers. While that is not necessarily a negative development, it does mean that mistakes are more likely because there are fewer established models to follow and less historical data on which to base decisions. That environment, however, also encourages more dynamic thinking, and those who can provide it will be well-positioned to succeed (Chin, 2008; Draper, LaDou, & Tennenhouse, 2011).