This paper examines key dimensions of long-term care administration across three interconnected areas. It first analyzes staff engagement models — particularly the Transforming Care at the Bedside (TCAB) program and the Care Transitions Coordinator (CTC) program — and their roles in improving care quality and reducing re-hospitalization rates. It then addresses the financial and structural challenges that an aging population will pose over the next two decades, including rising chronic illness burdens and evolving care delivery settings. Finally, the paper explores ethical issues unique to long-term care, such as patient autonomy, denial of terminal illness, access disparities, and surrogate decision-making in nursing home environments.
Long-term care refers to the wide range of medical activities designed to assist people living with chronic health issues. Debates concerning hospital quality and nursing care often occur independently of one another. The activities that ensure adequate performance of hospital nursing play a role in quality improvement and the realization of effective cost control. Nursing home practitioners are critical to the provision of quality and efficient care. Facilities that adopt front-line staff-driven performance improvement approaches — such as Transforming Care at the Bedside — demonstrate how practitioners, driven by effective leadership, can improve both the quality and efficiency of hospital care (Needleman, 2009).
Healthcare organizations may adopt strategies and approaches to improve the provision of quality care, with particular emphasis on the engagement of front-line staff. The Transforming Care at the Bedside (TCAB) model is one that nursing homes should embrace. Its primary objective was to engage front-line staff and nursing leadership to improve the quality and safety of care by creating a high-quality work environment that attracts and retains nurses — who in turn improve the experience of care for patients and their families. Numerous organizations that utilized the TCAB program successfully engaged front-line staff and subsequently initiated changes that improved unit processes, thereby improving the quality of care (Needleman, 2009).
The Care Transitions Coordinator (CTC) program, on the other hand, facilitated physician engagement for homecare and hospice healthcare facilities. Physician engagement provides for patient follow-up with their physician within one week of discharge on a regular basis. This practice also helps reduce re-hospitalizations, representing a significant step toward improving care quality. The CTC program is relationship-based, with the coordinator serving as a central point for sharing information among all individuals engaged with the patient. However, the program requires cooperation among physicians and other healthcare practitioners to achieve its objectives. Research indicates that the primary outcome of this program was a decrease in re-hospitalization rates, and it also enhanced the physician-patient relationship, contributing to improved quality of care (Fleming, 2013).
There is a notable similarity between the CTC and TCAB programs: both play a role in staff management. Although they are not the only models with the capacity to increase staff engagement, they have proved to offer substantial help in improving the quality of care in nursing homes and homecare facilities. Scholars have examined how policies influence the quality of care in nursing and homecare, and the government has a clear role to play in financing long-term care — particularly for retiring elderly individuals and economically disadvantaged members of society (Fleming, 2013). States must also continue to integrate acute and long-term care services for the elderly in order to contain spending.
The financing of long-term care remains a critical policy area. In the United States, for example, Medicaid offers lower payment rates compared to private insurance, making it a more accessible but constrained option for many patients. Hospitals also have a role to play in implementing policies that work in tandem with programs such as TCAB and CTC. When hospitals integrate their operations to improve the quality of care, this increases efficiency in care provision. Therefore, organizations, nurses, and other key stakeholders must embrace such policies. Organizations will also need to value the contributions of their staff and shift their institutional vision from viewing nursing as a cost center to recognizing it as a critical service line (Fleming, 2013).
"Rising demand, financial burden, chronic illness"
"Future care environments and service changes"
Denial is another ethical issue significant to long-term care. Patients often show reluctance to accept a terminal diagnosis, and this becomes an ethical concern because it affects how practitioners address impending death and the decision to accept long-term care (Pratt, 1999). There is also considerable variation in access to long-term care services from state to state, between urban and rural settings, and even within regions. To the degree that access to proper care is considered a right, unequal access qualifies as an ethical issue. When long-term care staff suspects that a patient is not safe at home due to neglect or abuse, this also presents an ethical dilemma.
In such cases, staff must protect the welfare of the patient without making unfounded accusations. If their concerns are substantiated, they have an ethical obligation to report the matter to the appropriate authorities (Pratt, 1999). Nursing homes are increasingly focused on reinforcing ethical decision-making and are working to redefine ethical guidelines to fit the long-term care context (Goldsmith, 1993). As a result, they are developing strategies, rules, procedures, and educational programs to assist families and staff in making sound ethical determinations in cases of dilemmas.
With advances in technology and improvements in staff proficiency, nursing homes are now capable of providing higher levels of care. As part of broader efforts to address ethical issues, long-term care staff must carefully manage patient autonomy through established frameworks (Goldsmith, 1993). If a resident is capable of making a sound decision, they retain the right to make their own medical choices. However, if a patient lacks sufficient decision-making capacity, a surrogate assumes responsibility — applying either a substituted judgment standard, based on what the patient would have wanted, or a best-interest standard, based on the most appropriate course of action given the circumstances.
These frameworks reflect a broader commitment within long-term care administration to balancing institutional responsibilities with respect for individual rights. As the field continues to evolve, the integration of ethical education, clear institutional guidelines, and collaborative decision-making processes will remain essential to ensuring that both patients and their families are supported through complex and often emotionally challenging circumstances.
Fleming, O. M. (2013). Improving patient outcomes with better care transitions: The role for home health. Cleveland Clinic Journal of Medicine, 80(1). doi: 10.3949/ccjm.80.e-s1.02
Goldsmith, S. B. (1993). Long-term care administration handbook. Gaithersburg, MD: Aspen Publishers.
"Surrogate decisions and ethical guidelines development"
You’re 55% through this paper. Sign up to read the remaining 3 sections.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.