Long-Term Care Providers Agree: We Need a Better Measure of Quality

Care seekers aren’t the only ones who want a better measure for quality long-term care. According to a new survey of long-term care providers conducted by CareScout, most providers agree we need a better standard for measuring quality. Nearly all believe that person-centered care should be part of that new standard.

That’s news, and good news at that. At CareScout, we talk with long-term care providers all the time, so we knew before we launched our survey that providers were interested in person-centered care, as are industry philanthropists (e.g., The SCAN Foundation) and the Centers for Medicare and Medicaid (CMS). However, even we were surprised at how widespread the beliefs are that long-term care needs to change and that person-centered care points the way.

We conducted our survey, titled, “Shaping the future of long-term care: What really matters?”  from September-October 2023. The survey was completed by 100 business leaders in the long-term care provider space. 

Our respondents were well distributed over a range of provider types. Approximately three-quarters were split between nursing facilities (37%) and home-based services (home health, 19%; home care, 17%).

The remainder serve in assisted living, adult day care, hospice or palliative care, continuing care retirement communities (CCRCs), and home facilities.

The sample was distributed across all regions of the country as well, drawing from 34 states. Approximately a third (34%) were single-location providers, with multiple-location providers ranging from 2-10 locations (35%), 11-50 (14%), and 51+ (17%).

We asked these 100 business leaders about the current state of quality measures, plans for the future, and the role person-centered care could play. Their responses show long-term care providers want change:

• 95% agree that the long-term care industry needs a better standard for measuring quality, with 57% strongly agreeing.

• 97% of providers agreed that standards for assessing quality in long-term care should include person-centered care measures, with the overwhelming majority, 71%, strongly agreeing.

In fact, according to these respondents, person-centered care may be here to stay. Nearly all — 96% — said person-centered care is important or very important within their organization, with most, 73%, seeing it as very important.

Some of the survey findings confirmed what we already knew: that staffing issues remain a number one concern in long-term care.

For example, when asked to name the most critical factors toward building success (respondents could name more than one), 54% of providers said employee hiring and retention, followed by person-centered care (36%). Managing costs (24%) came in third, followed by employee training (20%), and customer growth/building census (18%).

Training surfaced again when we asked providers: If they had the opportunity to join a long-term care quality network focused on quality, person-centered care, what would appeal most? More than two-thirds (69%) said they would value training or related support for person-centered care practices within their organization.

Providers also appreciated the visibility joining a quality network could bring. Other attractive aspects included quality care certification that can be shared publicly to showcase a provider’s quality (41%); access to long-term care insurance policyholders and other care seekers (26%); and premium online profiles that give direct access to customers (21%).

Cost is sometimes seen as a barrier to adopting person-centered care. Honoring someone’s goals, preferences, and values can take more staff time and focus, as can supporting not just their physical health but their mental, social, and spiritual health as well.

Yet when asked to name the top barrier to person-centered care within their business, 29% of providers said employee retention, while 20% pointed to regulatory standards that donʼt always match person-centered care (20%). Managing costs tied for third with the lack of standards on what person-centered care entails (17%), with 12% of providers citing employee training as their top barrier.

This indicates that providers are most concerned about retaining the staff to deliver quality care. Retention also came in first when providers were asked to name their biggest workforce challenges (29%), with rising costs and burnout rounding out the top three responses at 27% and 21%, respectively.

And, in an open-ended question where providers were asked to name the most important initiative they were working on or planned to over the next 12-24 months, staffing was the most frequent response.

All in all, providers regard staffing and staff development as both their biggest challenge and opportunity, with person-centered care seen as playing a significant role.

Another surprise came when we asked providers to tell us whether potential customers are more concerned about cost or quality when they ask about services. A general perception in long-term care is that for consumers, cost is king, and many care seekers choose providers based on pricing.

However, providers said 34% of their potential customers are more concerned about quality compared to 26% more concerned about cost, with most — 40% — equally concerned about both.

Our survey shows that overwhelmingly, long-term care providers see person-centered care as critical to the future of long-term care and the future of their companies. They recognize that while cost is important, quality matters just as much and maybe more. They know that hiring, supporting, and retaining caregivers whose goals are aligned with their clients’ will be key to their success.

In other words, these providers know what it will take to shape the future of long-term care. That matters — a lot.