Protecting Our Loved Ones: Improving Patient Safety for Long-Term Care
March 11, 2025
This week is Patient Safety Awareness Week, an annual recognition event intended to encourage everyone to learn more about health care safety and to recognize the work being done to reduce preventable harm. One particular area of health care vital to serving vulnerable individuals is long-term care facilities. Long-term care facilities, including nursing homes, assisted living centers and rehabilitation facilities, serve as both homes and healthcare providers for their residents—individuals with chronic illnesses or disabilities. They aim to improve residents' quality of life by assisting them with daily activities and managing their health conditions. However, the unique nature of long-term care settings presents specific challenges to patient safety. Residents often have complex health conditions, cognitive impairments and are at an increased risk for adverse events such as falls, infections and medication errors. The communal living aspect further complicates infection control and the management of chronic diseases. A study revealed that over half of the harm to residents in long-term care is preventable and more than 40% of hospital admissions from these facilities are avoidable. The COVID-19 pandemic had a devastating impact on long-term care facilities, with over 2 million resident cases and nearly 200,000 deaths as of February 2024. Staff members were also significantly affected, with 1.9 million cases. The pandemic exposed and worsened long-standing issues in nursing home care, including insufficient staffing, inadequate infection control and regulatory failures resulting in patient harm. These pre-existing problems contributed to disproportionately high rates of COVID-19 cases, hospitalizations and deaths among nursing home residents, who are particularly vulnerable due to serious underlying health conditions. For example, despite making up less than one-half of 1 percent of the U.S. population, as of October 2021, nursing home residents accounted for approximately 19 percent of all COVID-19 deaths. As of February 2022, more than 149,000 nursing home residents and more than 2,200 staff members had died of COVID-19. Despite federal interventions including free vaccinations, mandatory infection preventionists and comprehensive training materials, nursing homes continue to face challenges in infection control. The beginning of 2024 saw the largest surge of COVID-19 cases since the official end of the pandemic, highlighting the persistent difficulties in improving patient safety within these settings. The National Academies of Sciences, Engineering and Medicine has published a comprehensive guide to improve safety in long-term care facilities: Adequate staffing is fundamental to patient safety and quality care in long-term care facilities. Research shows that higher staffing levels, particularly among registered nurses and certified nursing assistants, are associated with better patient outcomes. To achieve better staffing, facilities should focus on: A strong safety culture within long-term-care facilities is crucial for improving patient care and empowering staff to address safety concerns proactively. Frontline workers should feel comfortable reporting errors, near misses and safety hazards without fear of punishment. Key components of a safety culture should include: Ongoing education and training are critical to maintaining high standards of care in long-term care settings. Training should emphasize: Long-term care settings often lag behind hospitals in implementing health technology, but adopting digital tools can greatly improve safety and efficiency. Key areas for improvement include: The COVID-19 pandemic highlighted the critical need for patient safety in long-term care, especially given our aging population. This has led to a focus on addressing systemic issues like staffing shortages and technology adoption to create a system that truly protects vulnerable individuals. Continued collaboration and innovation are essential to overcoming ongoing safety challenges and ensuring that residents receive the high-quality care they deserve. ReferencesThe COVID-19 Pandemic: A Turning Point
Recommendations for Improving Long-Term Care Safety
Adequate Staffing
Culture Transformation
Enhanced Training for All Staff
Technology Adoption