Handbook of Healthcare Management
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Handbook of Healthcare Management

Edited by Myron D. Fottler, Donna Malvey and Donna J. Slovensky

The Handbook of Healthcare Management is a comprehensive examination of key management practices for global healthcare organizations, arguing that insight into and implementation of these practices is essential for success and sustainability.
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Chapter 19: Long-term care

Carol Molinari and Ting Zhang


The US population is aging. The growing proportion of elders (aged 65 years and older) in the US is projected to account for one in every five Americans by 2030 (Vincent and Velkoff, 2010). Even during the recent weak economic recovery and recession phase in the US, there has been stable growth in healthcare spending that reflects the non-cyclical and steady demand for healthcare. In 2011, older Americans spent 12.2 percent of their total expenditures on health, almost twice the proportion spent by all Americans (6.7 percent) (AoA, 2014). Long-term care reflects a broad array of home, community-based, and residential services to maximize a person’s ability to function and enjoy a quality of life. The continuum of long-term care covers various settings that range from home-based to institutional services. Long-term care personnel typically include direct care workers and aides, registered nurses, licensed practical and vocational nurses, licensed social workers, physical therapists, occupational therapists, physician medical directors, and administrators (Stone and Harahan, 2010). Today’s elders demand more medical and health support personnel, particularly for long-term care to help them in their later and final years, and are likely to spend more time with the long-term care system as compared to the acute medical delivery system (Yee-Melichar et al., 2014). Increased demand for long-term care across the continuum is enhancing the likelihood of shortages among long-term care workers, such as nursing assistants, home health and home care aides, and other workers.

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