“Where will I go?”
This is a question asked by many seniors when faced with the options of long-term care. It’s not a fun topic of conversation to chat about at lunch. It’s not something we necessarily want to think about as we get older. In fact, it can be downright uncomfortable to plan out our golden years, getting into the details of how and where we will be cared for as we age. Nobody wants to think about relinquishing some control on their life, how they live it or where they live it.
The truth of the matter is, we all will get older and we all will need some help. Here’s the facts: In the U.S., 70 percent of individuals age 65 and older will need long-term care at some point and almost half will need nursing home care. Rural areas have it harder. On average, rural areas of the U.S. have a higher median age, with more adults age 65 and older than in heavily populated, urban areas. As this group continues to get older, the need for long-term care facilities to house them and care for them grows even more than in urban populations.
There are a few challenges to finding long-term care in rural areas, as well as staffing the few facilities that offer this type of care. So, with all the fuss about long-term healthcare:
Why work LTC in rural areas?
Dealing with constraints and challenges in long-term care.
A School of Public Health report shows that there are a few avenues of roadblocks to LTC in rural communities:
1.) Long-term care facility options may be scarce in rural areas.
Wait, why aren’t there LTC facilities in rural areas!? It seems like if there’s a need, it should be filled, right? Unfortunately, there are increasing gaps between the health and social needs of older people. Often a rural community might not have the budget for these essential services. The challenges to providing long-term care services in rural areas include: federal and state reimbursement policies, home and community-based long-term care services, the rural long-term care infrastructure, and long-term care research.
2.) LTC staffing is low.
Workforce shortages in long-term care facilities are common, often because the demand is disproportionate to the workforce. Simply put, there’s not enough hands on deck. Especially in rural areas, long-term care facilities have a difficult time meeting demand because there are more patients in the 65+ age that have health and budget constraints when compared to urban residents.
Being forced to make hard choices about LTC affects individuals and the communities they live in.
Because there is a shortage of long-term care facilities and workers in some rural communities, individuals and family members must make difficult and stressful choices to either opt for home health care, if it’s available, or move to a different community for their care. For obvious reasons, that isn’t always ideal for that person or their well-being. When an individual is moved to a new community, they can experience stress and fear due to a loss of social connections they were once familiar with, and a diminished family connection if family members aren’t able to visit as often in this new location. These decisions can be negative for the whole rural community also, as smaller communities can face economic loss when people opt for leaving.
Additionally, if families do choose to keep that individual in their current community with home care, that’s not always feasible or affordable for seniors or their families. While costs of a skilled nursing facility are four times as much as home health care, this level of care isn’t an option if the individual needs more in-depth care than a skilled nursing facility can provide. In fact, research shows that even with affordability in the mix, rural patients are still not accessing home health services. In a recent American Journal of Managed Care (AJMC) study, 1.56 million Medicare patients who were released from both rural and urban hospitals were analyzed. Within that sample, only 12.1 percent released from rural hospitals were sent to post-acute care with a majority of them being transferred to skilled nursing facilities. Post-acute care seems to be determined by patient diagnosis and the proximity and available skilled nursing facilities near that patient. In general, rural patients in hospitals are far more likely to be released to a skilled nursing facility, rather than home health services.
That brings it back to the first point: Long-term care facility options may be scarce in rural areas, so options are low. It’s a classic case of: What comes first, the chicken or the egg?
How do these challenges affect healthcare overall?
One of the solutions we need to help mitigate the LTC crisis is to keep seniors healthy and at home. Increasing the advancement and usage of technology, specifically telemedicine, can fill in the gaps to help monitor the booming senior population and their health, potentially reducing hospitalizations and necessary moves to long-term care facilities. In fact, the health tech market is expected to reach $20 billion this year.
That being said, there are some risks to all this tech. While tech can help, this cyber solution does come with a caveat. Cyber breaches that can lead to lawsuits are a huge issue. Health data breaches have increased by 70 percent in the last seven years, which can be costly for facilities that may not have the resources to protect themselves. Understanding the levels and reach that tech can help or harm the healthcare industry is crucial to finding a solution that will neutralize the long-term care crisis we’re currently facing.
Working LTC in rural areas and what that means for medical travelers.
Receiving this type of care in rural communities is clearly a challenge for seniors and their families, but there comes a time for everyone when children and family members can no longer care for the older people in their lives. Whether it’s a lack of time, a lack of skills or most likely both, a long-term care facility is ultimately the answer. So what is it like to work in long-term care? Surveying a group of LTC travelers, these are the top takeaways:
The hours and days are never the same.
Depending on the patient’s needs, an LTC nurse’s hours could be challenging and require flexibility. Some patients could struggle physically, cognitively, or both. Often, patients may have dementia, which changes their cognitive needs on a regular basis depending on their moods and requires mental stimulation at a higher level than other patients. Some seniors suffer from depression as well, so an LTC nurse needs to be up to the challenge of meeting their patients differing needs. Because long-term care facilities require staffing on a 24-7 basis, shift changes will occur in order to accommodate the patients and other LTC staff. Ultimately, an LTC traveler will usually get to decide a schedule that fits them, but the biggest things to consider when becoming an LTC nurse or an LTC traveler are flexibility with scheduling and patience for what each resident needs.
Working in LTC can be challenging, both emotionally and physically, but it’s also rewarding.
Even as an LTC traveler, relationships and bonds are made with residents, their families, and with other LTC nurses. Communication skills are key in helping patients live their best life. It can be challenging to communicate the nature of the resident’s health, the progression of Alzheimer’s or dementia, or the degenerative nature of the resident’s health overall to their family members. Convincing family members to hand over the reigns to the staff at a long-term care facility can be the most challenging.
The bond that an LTC nurse develops with their residents is “like family” and the work can be emotionally intense. It can be very tough to deal with a resident passing away, because one of the most rewarding moments is the friendship LTC staff can develop with residents. Hearing their stories, learning about their lives, being relied upon for all their basic needs, and generally developing a rapport with each resident and their families can be heartwarming, fulfilling and tough to let go of.
The long-term care workforce needs to be strengthened as more and more people head into those golden years. As a LTC traveler, you are offering your time and skills to families who really need the support.
So, where will you go? That’s the serious question we should all be asking, whether we’re working in LTC or not. We will all age, and long-term care is in the minds of everyone’s future, regardless. We all deserve the opportunity to live our golden years without worry, in a community we’re comfortable in.
The need for an LTC workforce in rural areas will not change and neither will the desire for a facility close to home where one can live out their remaining years with care and comfort. That’s a big demand, but it’s a necessary one we need to address.