The 4 hidden risks in long-term care: What every nursing home and assisted living administrator should know
Caring for residents in long-term care settings comes with unique and evolving challenges. Whether you're supporting individuals with cognitive decline, managing pressure injury risk, or protecting your caregiving staff from injury, your facility is constantly balancing clinical outcomes, resident dignity, and operational efficiency. Awareness of these risks is the first step toward building a safer, more resilient care environment.
1. Cognitive decline is reshaping daily care
More than 45% of LTC residents in the U.S. are living with Alzheimer’s or other dementias, making cognitive impairment a central challenge in care planning, staffing, and safety protocols.1
2. Pressure injuries are preventable
Pressure injuries remain a critical concern in long-term care, yet they are largely preventable with the right interventions. Alarmingly, 1 in 10 nursing home residents will develop a pressure injury—a condition that can lead to serious infections, prolonged hospital stays, and even death if left untreated. This statistic, highlighted in Duke University's article Looking Beneath the Skin to Prevent Nursing Home Pressure Ulcers, reinforces the urgent need for proactive prevention strategies in care environments.2
3. Caregiver injuries are the silent crisis
Manual handling in long-term care (LTC) settings continues to be a significant contributor to caregiver injuries. According to research by McCloskey et al., 32% of work-related injuries in LTC facilities are linked to common handling tasks such as repositioning residents in bed, pulling them up, or catching them during a fall—activities that are part of daily care routines. Even more concerning, 88% of these incidents occurred during mobility activities where staff were non-compliant with the use of transferring equipment, increasing the risk of musculoskeletal injuries among caregivers. These findings highlight the urgent need for consistent use of safe patient handling solutions and training to protect frontline staff and improve care outcomes.3
4. Workforce shortages in nursing homes: A persistent post-pandemic crisis
The long-term care sector continues to face a critical workforce crisis. According to the 2024 State of the Sector Report by the American Health Care Association (AHCA), 72% of nursing homes report that their current staffing levels remain below pre-pandemic levels. Despite widespread efforts—including increased wages, sign-on bonuses, internal promotions, and paid training—94% of facilities still struggle to recruit new staff, with 67% citing a lack of interested or qualified candidates as a major barrier. These persistent shortages not only threaten the quality of care but also raise concerns about facility closures and resident displacement.4
Navigating the perfect storm
Long-term care facilities are navigating a perfect storm of clinical complexity, staffing strain, and regulatory scrutiny. By understanding the risks and recognizing the early warning signs, administrators can begin building a safer, more resilient care environment—one that protects both residents and caregivers.
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References:
- https://www.cdc.gov/nchs/npals/webtables/overview.htm (Table 4)
- https://nursing.duke.edu/news/preventing-nursing-home-pressure-ulcers#:~:text=Looking%20Beneath%20the%20Skin%20to%20Prevent%20Nursing%20Home%20Pressure%20Ulcers,February%2012%2C%202024 "Looking Beneath the Skin to Prevent Pressure Ulcers"
- "Linking Incidents in Long-Term Care Facilities to Worker Activities" - Rose McCloskey, Cindy Donovan, Alicia Donovan, 2017
- https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/State-Of-The-Sector-Nursing-Home-Staffing-Shortages-Persist-Despite-Unprecedented-Efforts-To-Attract-More-Staff-.aspx