Revolutionizing Long-Term Care: Navigating the Next Five Years of Transformation

Contributed by: Chad Worz, PharmD, BCGP, FASCP, Chief Executive, The American Society of Consultant Pharmacists (ASCP)

The long-term care industry will be completely transformed over the upcoming 5-year span. This transformation is influenced by seismic shifts in almost every business sector. Technology, workforce, and services that “follow the patient” are all shifting at an exponential rate. 

Technology is always changing but now that it influences every aspect of care, innovations in pharmacy packaging, storage, and logistics will continue and new strategies and products will evolve to meet the needs of the individual and in the setting of care they choose to reside. Additionally, innovations in data sharing and artificial intelligence will begin to influence medication selection and care planning designed to maximize desired outcomes. 

The convergence of information and analytical systems will yield efficiencies that will help other areas of significant change like the workforce. Since the pandemic, the long-term care environment has struggled with staffing shortages. Some estimate long-term care lost over 210,000 jobs, reverting to 1994 levels. Even with efficiencies from technology, staffing shortages and retention issues are still significant challenges. Facilities and pharmacies are exploring innovative recruitment and retention strategies, investing in staff training and development, and advocating payers for better reimbursement to support better wages and staffing ratios.

At the center of all this change is the patient. The elephant in the room is growth in the older adult population in terms of both the over 65 years individuals and those over 85. In 2022, the U.S. Census Bureau reported almost 58 million people in the United States over the age of 65 and 6.1 million over the age of 85. These numbers are anticipated to swell to 73.1 million and 9.1 million respectively. This decade will see the largest percentage increase in these populations of any decade this century. Roughly 2% of the over 65 population use nursing home services each year, if that percentage holds, in 2030, over 300,000 more people will require nursing home services per year.

There is a growing emphasis on person-centered care, which prioritizes the individual preferences, needs, and goals of residents. Facilities and pharmacies are moving away from a one-size-fits-all approach and focusing on creating personalized care plans that respect what matters to residents and supports their autonomy and their dignity. For years, the John A. Hartford Foundation has been investing in aging experts and practice innovations that transform how the care of older adults in delivered. Nearly $700 million dollars has been provided in grants to create age-friendly systems, to support the role of caregivers, and to preserve dignity and honor during serious illness and end of life. 

Taking together, these significant sectors within long-term care are driving change. Determining how your pharmacy supports these rapidly moving issues is paramount to success into this medically complex, growing age group. The following are some specific examples of what is coming next for long-term care pharmacy:

1. Reimbursement

No one ever complains that their reimbursement is sufficient, but the historical downward pressure on pharmacy reimbursement, its link to the dispensing of a product and the increased pressure on the price/cost ratio of those products is making pharmacies unsustainable. The drug pricing aspects of the Inflation Reduction Act of 2022 may be well intended but their impact on pharmacy threatens pharmacy survival. Volume and through put of prescriptions continues to be the only way for pharmacies to survive. This threatens smaller service and quality-oriented pharmacies, and larger pharmacies have a one-size-fits-all philosophy necessary for survival but at the expense of patient choice and satisfaction. Payers must be forced to pay reasonable rates for individual services like dispensing, vaccination, reconciliation, regimen reviews, therapy management, and patient specific accommodations like compliance packaging, deliveries, and medication administrations. 

2. Utilization Management

Pharmacists and pharmacies will be asked to help make drug selections and tailor medications to people not just based on their diagnosis but also their living situation and what matters to them. The best treatment regimens will change based on whether the person lives in a nursing center, or they live independently at home. Pharmacists and pharmacies that can navigate the payer systems and balance the needs of the patient with the sustainability of the services they provide will succeed.

3. Compliance and Adherence

In the U.S., poor adherence is estimated to cause 125,000 deaths per year, 10% of all hospitalizations and underlie $100-$300 billion of avoidable health-care costs.  

Skilled nursing homes and some assisted living centers administer medications via nurses and nurse aids. This provides assurances that medications are given. In community settings where medications are self-administered, compliance and adherence must be reliably assessed and measured. This is a challenge that innovative pharmacists and pharmacies must tackle. per year, 10% of all hospitalizations and underlie $100-$300 billion of avoidable health-care costs.  

Skilled nursing homes and some assisted living centers administer medications via nurses and nurse aids. This provides assurances that medications are given. In community settings where medications are 

self-administered, compliance and adherence must be reliably assessed and measured. This is a challenge that innovative pharmacists and pharmacies must tackle.

The baby boomer generation has transformed American life since they were born into it, they now will take aim at health care for themselves as older adults. Pharmacies and pharmacists that embrace the transformation, demand fair reimbursement, and carve out services within and outside of traditional payer systems will continue to find ways to survive.