Nurses in long-term care facilities in the United States

The aging of the U.S. population is one of the major forces shaping future demand for health services, especially long-term care. The cost containment pressures articulated in Chapter Five are compounding the trend toward delivery of more services in long-term care settings. However, as Harrington notes in this chapter, the rise in demand far long-term care does not necessarily signal increased employment opportunities for RNs. States are more carefully limiting the use of Medicaid dollars for nursing home support, and developing home- and community-based alternatives to nursing home admission. The industry is predominantly proprietary, a characteristic which has led to pressure to hold down wages, and use less-well-trained staff. Although there have been significant federal efforts to address historical concerns about the quality of long-term care, this part of the health care system continues to exhibit uneven quality. One measure proven to improve quality has been to increase RN staffing levels in these facilities. However, this strategy has yet to be implemented widely due to cost considerations.