Long-Term Care


Although there is a tendency to associate nursing with hospitals, according to the U.S. Bureau of Labor Statistics, over twenty percent of registered nurses (RNs) currently work in long-term care settings, such as nursing homes and home health care, and the percentage of licensed practical nurses (LPNs) working in long-term care is even greater. In the case of certified nursing assistants (CNAs), long-term care settings constitute over half of current employment

LTC Nursing

Furthermore, the demand for long-term care nurses is only increasing as the US population ages and more and more people live in nursing homes, assisted living facilities, memory care residences, and adult foster homes or otherwise require these services in their own homes or in adult day care centers.

The following guide provides comprehensive information about long-term care for nurses as well as other healthcare professionals interested in pursuing careers in this promising field.

Table of Contents

What Does LTC Stand For?

The abbreviation LTC stands for long-term care, a nursing specialty. A broad definition of long-term care would include all medical and non-medical services offered to people who cannot independently take care of daily living tasks, such as eating, bathing, or managing their medication.

What Does Long-Term Care Mean in Medical Terms?

african american CNA with an elderly patient

Although most LTC is non-medical and provided by friends and family members, individuals often need the services of trained healthcare professionals, such as nurses or physical, occupational, or speech therapists. Some medical long-term care services include helping people recover from accidents, surgeries, or illnesses. 

Some people require LTC unexpectedly, for example, after a car accident or a heart attack, but for most people, the need for LTC gradually increases as they age. 

What Does a Long-Term Care Nurse Do?

Long-term care nurses care for people who, for a variety of reasons, cannot carry out all daily life tasks independently, which is why they often assist patients with tasks such as the following:

  • Feeding
  • Bathing and grooming
  • Using the toilet
  • Dressing
  • Changing positions

What Is the Medical Role of a Long-Term Care Nurse?

Of course, LTC nurses have many medical duties as well. These are some of the medical/therapeutic responsibilities of a long-term care nurse:

  • Working with the medical team to carry out patients’ treatment plans
  • Administering medication
  • Monitoring and recording vital signs
  • Preparing equipment and helping physicians during patient examinations
  • Providing intravenous therapy (IV)
  • Providing wound care
  • Giving therapeutic massages or assisting patients with range-of-motion exercises. 
  • Supporting patients and their families emotionally
  • Educating patients about their conditions as well as their care plans

What Facilities Offer Long-Term Care?

There are many places where people receive LTC care, such as adult day care centers, adult foster homes, assisted living facilities, memory care or Alzheimer’s care residences, nursing homes, and even private homes.

Adult Daycare Centers

Adult daycare is often offered at community centers and is a service that can assist primary caregivers who have to work or who simply need a break. These centers supervise and help adults with LTC care needs by offering food, recreation, and therapy. Some centers also provide medical care, such as physical, occupational, and speech therapy.

Adult Foster Homes

LTC Nursing

Adult foster care or adult family care refers to homes for older adults who cannot live independently. These homes offer room and board, companionship, supervision, and help with daily living activities, including eating, bathing, and dressing. Adults requiring long-term care live in these homes with their caregivers and usually with other seniors as well.

Assisted Living Facilities

Although assisted living facilities offer LTC care, not everyone living in these facilities requires it. These facilities assist seniors who cannot live independently but who don’t necessarily need assistance around the clock. Aside from room and board, these facilities offer help with personal care, medication management, supervision, and social and recreational activities, among other services.

Nursing Homes

Nursing homes or skilled nursing facilities provide a higher level of care than assisted living facilities and are right below the level of care patients receive in hospitals. These facilities not only offer room and board, personal assistance, and supervision but also around-the-clock medical care, including skilled nursing care, medication management, and occupational, physical, and speech therapies.  

Memory Care Residences

Memory care or Alzheimer’s care residences can be stand-alone facilities or units within assisted living facilities or nursing homes. These facilities or units are specifically geared toward people with Alzheimer’s disease or another form of dementia, with staff trained to work with people with cognitive issues providing care and supervision twenty-four hours per day.

Private Homes

When offered the choice, most seniors decide to remain in their homes or in relatives’ homes, making private homes places where people can also receive long-term care. In the home setting, seniors can receive as much assistance as they need while remaining as independent as possible. Home care aides or personal care attendants can help seniors bathe, dress, groom, go to the bathroom, eat, change positions, and move around the house. Health care can also be offered in the home setting, such as checking vital signs, changing bandages, and assisting with insulin injections. Furthermore, emergency response systems are a type of LTC care service. In some cases, seniors can call for help, but other systems are automated, detecting a fall, for example, and others can monitor seniors’ locations, which can be especially helpful for people with Alzheimer’s or another form of dementia. 

What Is a Long-Term Care Unit in a Hospital?

Long-term care nurse with patient

Hospitals don’t actually have LTC units since patients are usually admitted for a short period. However, there are long-term care hospitals (LTCHs) serving patients that require much longer stays, such as a month’s duration or more. Often, patients in LTCHs transfer from intensive or critical care units and need services such as pain management, head trauma treatment, or respiratory therapy. 

Although these hospitals carry the name “long-term care,” the services they offer are not, in fact, what is usually meant by long-term care.

How to Become a Long-Term Care Nurse

Both LPNs and RNs can work in LTC settings without requiring any additional certifications, except perhaps a Basic Life Support (BLS) certification, which can be obtained through the American Red Cross or the American Heart Association. However, there are many certifications available for nurses, including the following:

  • NAPNES offers a long-term care certification for LPNs.
  • The American Nurses Credentialing Center offers the Gerontological Nursing Certification (GERO-BC™) for RNs who have practiced nursing for a minimum of two years with at least 2,000 hours of clinical practice in the area of gerontological nursing.
  • The Certification Board of Infection Control and Epidemiology, Inc. (CBIC) offers the Long-Term Care Certification in Infection Prevention (LTC-CIP) for anyone with post-secondary education in a health-related field. The CBIC recommends but does not require one year of full-time infection prevention experience.

Additionally, the Washington State Nurses Association recommends all of the following specialization options for LTC care nurses:

  • Education
  • IV therapy
  • Wound, Ostomy, and Continence
  • Diabetes Management
  • Leadership
  • Case Management
  • Chronic pain management
  • Dementia care

How Long Does It Take to Become a Long-Term Care Nurse?

The time required to become a LTC nurse depends on a nurse’s qualifications. LPNs can receive their nursing licenses in as little as one year. For RNs, obtaining an associate’s degree in nursing takes two years, whereas a bachelor’s degree in nursing takes four years. After becoming licensed LPNs or RNs, nurses can choose to specialize in areas that would be relevant for careers in LTC, and these specializations can also vary widely in length. Whereas nurses can complete BLS training in a day, a Wound, Ostomy, and Continence (WOC) certification requires a total of 4,500 clinical hours (1,500 in each area), which could take years to accrue.  

Why Choose Long-Term Care Nursing

Nurses are and will continue to be in demand in the United States for the foreseeable future due to an ongoing nursing shortage. This shortage will only become accentuated as the US population ages since an older population will require more healthcare services. Therefore, the demand for long-term care nursing is expected to grow even more over the next decade. 

The US population aged sixty-five or older grew from 12.98% in 2010 to 16.63% in 2020. Furthermore, the U.S. Census Bureau estimates that in 2030 people over sixty-five will outnumber children for the first time in US history to the point that one in five Americans will be of retirement age. This demographic shift will result in an exponential increase in the need for LTC nurses. 

Is Long-Term Care Nursing Hard?

LTC nurse burnout

One of the main challenges of LTC nursing is managing the stress caused by understaffing, and this situation has only been accentuated by the COVID-19 pandemic. Research has shown that sufficient staffing is one of the most significant factors affecting nursing home quality. Specifically, there is a direct relationship between higher staffing ratios and better outcomes, such as lower mortality rates, fewer infections, fewer pressure ulcers, and less weight loss. Furthermore, since the beginning of the COVID-19 pandemic, more than 380,000 nursing home employees have quit their jobs, which has only worsened the understaffing situation for the remaining employees. 

Of course, it is stressful for nurses to know they could avoid patients’ ulcers, infections, and even deaths if only they weren’t stretched so thin, but patient outcomes are not the only source of stress. During the first year of the pandemic, LTC facility employees were disproportionately exposed to the virus, with 40% of all COVID-19-related-deaths nationwide occurring in these facilities—70% of deaths in some states. Of course, advanced age and chronic health conditions increased the residents’ risk of death. Still, LTC nurses and their families were also exposed. 

What Is Long-Term Care Nursing Like, and What Makes a Good LTC Nurse?

There are many misconceptions about long-term care nursing. Many think LTC is easy and even boring work. However, this conception couldn’t be farther from the truth. LTC nursing requires sharp critical thinking, both mental and physical fitness, and the ability to work in and even lead teams.

Critical Thinking Skills

People receiving LTC have complex healthcare needs and comorbidities. Therefore, LTC nurses must have strong critical thinking skills in order to analyze clinical situations and make the best decisions. For instance, nurses in this setting must be well versed in medication knowledge to be able to dose and manage medication correctly and also identify adverse effects of medication which can endanger patients’ lives.

Long-term care nurse helping resident

Mental and Physical Fitness

Long-term care nurses must be physically fit since they often help patients change positions, move about, bathe, etc., which can involve a lot of heavy lifting. Furthermore, LTC nurses also tend to have a heavy caseload, requiring them to multitask and keeping them on their toes both literally and figuratively. 

Team Work and Leadership

LTC nurses constantly collaborate and communicate with others, including clinical and non-clinical staff, patients, and family members. They must educate patients, family members, and CNAs on topics such as disease management and infection control; they must coordinate with the rest of the healthcare team to carry out patients’ care plans; they even coordinate with hospitals, pharmacies, and medical equipment companies, and in most of these situations, others will turn to them for leadership and decision making.

Tips for New Long-Term Care Nurses

Obtain Certifications

Although certifications are mostly optional in long-term care, having them offers nurses many benefits. Holding certifications increases nurses’ confidence, helps them offer patients better care, and facilitates teamwork.  

Work PRN 

Long-term care work can be highly stressful due to high caseloads, understaffing, and frequent resident deaths. Therefore, nurses should consider taking advantage of the flexibility that PRN work offers, allowing them to take time off whenever they need it or alternate facility types when they need a change of scenery.

Prioritize and Delegate

In long-term facilities, nurses could find themselves caring for over forty patients at any given time! Therefore, they must learn to delegate as much as possible to CNAs or other staff members in order to avoid burnout.

Communicate, Communicate, Communicate

Effective communication among members of health care teams is indispensable in LTC facilities to contribute to the quality of care and to reduce adverse events. In fact, research has shown that ineffective communication is a key factor contributing to adverse events, staffing turnover, and negative healthcare outcomes. Asking questions, writing clear reports, and offering and receiving help improve team members’ communication. 

Final Thoughts about Long-Term Care Nursing

Every nurse must consider what settings, populations, and responsibilities align with their own preferences and skills. That being said, a significant consideration for choosing a career path in nursing, as in any other field, should be the projected demand for that profession or specialization throughout the foreseeable future. When it comes to demand in the nursing industry, the need for nurses in the LTC setting is guaranteed to continue growing exponentially. 

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