The pandemic has caused many of us to reflect on our lives, work and priorities. It’s also led to catastrophic losses and to greater public awareness of problems in our field. In the mental health world, we encourage people to try to learn and grow from tragedy. I hope we in the long-term care world can do the same.

My hope for our evolution is grounded in my belief that most people working in this field have a genuine desire to assist elders. In my opinion, the first step in revamping long-term care is to limit the industry to those companies with this primary goal. With mission-driven organizations remaining, we can provide services with the greatest benefit to seniors and their families. 

Based on thousands of conversations with residents over the years, I suggest we put more emphasis on the following:

  • End-of-life discussions: The pandemic has heightened the public’s awareness of mortality. Long-term care facilities can build on this enhanced recognition by addressing end-of-life concerns earlier in the care process so that palliative and hospice services are accepted sooner, when they can be of most benefit to the families and residents. 
  • Family healing: Restrictions on family visitors during the pandemic have crystalized the importance of family involvement in the care of residents. As I pointed out in this piece, we don’t admit residents, we admit families. Establishing resources such as support groups for relatives as they cope with the illness of loved ones pays off in improved care quality, increased resident and family satisfaction, great likelihood of good facility reviews and referrals and other positive consequences.
  • Toileting: Lack of timely assistance with toileting is residents’ most common frustration and it can result in anger, depression, falls, urinary tract infections, skin breakdown and a host of additional problems. The unorthodox idea of revising the fee structure to reimburse for toileting would allow for more aides paid at a better rate, address resident priorities and prevent costly ailments, as I discuss here. The proposition is at least worth an outcomes study.
  • Staff support: With 42% of the COVID-19 deaths in the country occurring in nursing homes, many direct care workers have experienced a shocking amount of loss, in addition to job exposure to the coronavirus, a lack of community support and the general stress of life in a pandemic. Attend to staff trauma with additional employee resources, such as stress reduction workshops, information about post-traumatic stress disorder and guidance on emotional and financial assistance.   
  • Image management: Nursing homes are in the spotlight right now, creating an opportunity for care providers to increase public understanding of how facilities help residents, families and workers, and to expand the ways in which we do so. For instance, McKnight’s Long-Term Care News showcased cookouts for staff and a parade celebrating residents’ recovery from the virus; these events can be covered in the local press as well. Other options include the (virtual) hosting of diabetes management information sessions, family support groups and other educational efforts based on the needs of the community. 
  • Collaboration with surveyors: When the LTC field is limited to those with a genuine eldercare mission, surveyors can police less and collaborate more. Making the assumption that facilities are trying to do the right thing, surveyors would educate where needed, investigate factors contributing to deficiencies and work with organizations and payor sources to create positive change.

Out of the devastation of the pandemic, we can rebuild a better world. I envision nursing homes as ethical and sustainable businesses that offer services to local community members throughout the lifespan, with health education, volunteer opportunities and emotional support for families and residents as they navigate illness and end of life. 

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at