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Abbey Delray and Heartland Hospice Care: Long-Term Care Changes


It has been acknowledged that due to demographic shifts in the American society, the healthcare system requires considerable changes. Long-term care needs specific attention and major improvements related to healthcare insurance coverage, quality of the provided services, and the focus on integration, to name a few (Tappen et al., 2017). These transformations can take place if healthcare practitioners and administrators, as well as policymakers and communities, collaborate effectively. This paper includes a brief review of some peculiarities of long-term care in the USA with the focus on two facilities, Abbey Delray (a nursing home) and Heartland Hospice Care (a hospice care facility).

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Administrations’ Roles and Responsibilities

Both facilities, similarly to the vast majority of such units, are a part of larger networks. Abbey Delray pertains to Lifespace Communities Foundation, and Heartland Hospice Care is governed by HCR ManorCare (Abbey Delray, 2020; Heartland Hospice Care, 2020). Therefore, the major strategic plans, including reimbursement patterns, funding, and others, are developed by the foundations. However, the administration of each department within the facility also has a set of clearly described roles and responsibilities. It is necessary to add that the units in question have similar departments as well since they provide similar services to seniors and their families. The major departments are clinical services and wellness, dining, financial, and administrator.

The heads of the clinical services and wellness departments are responsible for ensuring the provision of high-quality care to residents with the focus on their health and lifestyle aspects. These are front-end professionals who are in the closest contact with seniors, so these people have complete information about residents’ conditions and needs. The dining department head concentrates on the proper provision of the corresponding services and maintenance of the dining facilities. Financial department heads focus on such aspects as raising funds, fund allocation, reimbursement for customers and the staff. Finally, the administrator manages the proper functioning of the facility, concentrates on staffing, and provides reports to the foundation and the public.

Sources of Financing Available to Consumers

It is necessary to note that Medicare and Medicaid are federal healthcare insurance options for millions of people, as well as other state-wide care plans. Medicare does not cover any long-term care services that are not directly related to clinical procedures (Official U. S. Government Site for Medicare, 2020a). Medicaid tends to cover all types of long-term care services for eligible people within the network of the eligible facilities. As far as the facilities under consideration are concerned, customers have quite similar reimbursement opportunities. The patients can become the residents of Abbey Delray and Heartland Hospice Care based on their personal retirement plans or the funds provided by their families. Medicaid also covers the expenses for eligible seniors who want to become the residents of the mentioned units. It is noteworthy that Abbey Delray participates in both Medicaid and Medicare programs (Official U. S. Government Site for Medicare, 2020b). In addition, the facilities are funded by donors, so older people can become residents in terms of community donations.

At this point, it is necessary to state that managed care can serve as a facilitator of quality improvement in long-term care. The diverse options available to potential customers at the facilities under consideration show that people are free to choose among a considerable number of alternatives. The choice can be quite difficult to make due to quality concerns and resources availability. Managed care is instrumental in helping people to make the right choice and access affordable and quality care. Abbey Delray and Heartland Hospice Care, as well as the many other long-term-care providers, are rated in terms of the quality of the services they provide, and people can save funds when using their services and be sure that residents’ needs are met.

Reimbursement Systems and Changes

As mentioned above, long-term care is undergoing substantial changes that are also related to reimbursement. At present, quite a limited number of groups of seniors are eligible to access long-term care in terms of Medicaid and Medicare. Millions of seniors have their personal retirement plans involving healthcare insurance plans. Families also provide funds to ensure their older relatives’ proper stay in long-term-care facilities. In the 1970s, nursing homes and hospice centers were established by non-profit organizations to cater to the needs of older adults (Aldridge & Bradley, 2017). At present, such healthcare organizations can be private, public, and non-profit. These facilities may receive funding from residents and their families, federal and state budgets, and donations correspondingly. In many cases, health-related organizations providing long-term care tend to access a combination of funding options.

As far as governmental reimbursement, the change that took place in the 2000s was related to quality and cost-effectiveness concerns. For instance, states shifted from the flat rate to facility-specific and cost-based rate in their reimbursement methodology (Xing et al., 2016). Extensive research displayed the flaws in the system and various quality gaps in services provided by long-term-care facilities. Ratings were introduced to ensure the provision of high-quality services and appropriate use of funds. Another significant change that is still ongoing is linked to regulations and guidance (Tappen et al., 2017). The existing long-term care facilities have to comply with a range of federal, state, and city regulations and rules that are aimed at improving the quality of provided services. All in all, these policies are regarded as rather effective as they ensure the existence of proper standards that are important in the healthcare system. However, Tappen et al. (2017) added that some of this legislation and guidance is less effective than expected and may even lead to quality level drops or increased costs.

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At the same time, the operations of such non-profit organizations as Abbey Delray and Heartland Hospice Care are not confined to the control of government agencies exclusively. Since the facilities are funded by donors, these healthcare units provide reports to the public and the community. In these reports, facilities unveil the specifics of the services they offer, their funding details, their performance, and quality aspects (Lifespace Foundation, 2019; HCR ManorCare, 2018; HCR ManorCare, 2020). This transparency is necessary for the development of proper relationships with the community and attracting more donors that can include individuals, companies, and institutions.


It is also noteworthy that both facilities under consideration pay substantial attention to ethical aspects. The mentioned foundations’ reports include detailed descriptions of various programs and incentives that aim at ensuring equity. Both Abbey Delray and Heartland Hospice Care claim that diversity and equal access to high-quality care is their priorities. Abbey Delray offers plans that provide valuable opportunities for the most vulnerable groups with limited resources. Although the scarcity of resources is a common issue for the vast majority of health-related organizations these days, carefully apply the principles of rationing. The units in question provide comprehensive care and try to create the atmosphere appropriate for seniors and their well-being. Abbey Delray incorporates spirituality by offering the services provided by chaplains, which is positively received in the community. At that, some elements of rationing are still employed in order to achieve a higher level of cost-effectiveness.

Rationing is the concept that appeared in the last decade of the twentieth century and still has multiple definitions (Hunter, 2018). In simple terms, rationing is the exclusion of some groups from accessing some resources based on some factors. Rationing acquired new meanings during the COVID pandemic when healthcare professionals had to cope with a significant load on the system (Farrell et al., 2020). In many cases, age has been the primary factor affecting healthcare practitioners’ choices. However, this approach has proved to be ineffective left alone ethical concerns. Farrell et al. (2020) stress that a more comprehensive framework should be utilized, while age can be still employed as a tiebreaker. The factors that should be used to ensure appropriate and effective rationing include health conditions and life expectancy. This paradigm is already used in long-term care facilities, but the implementation of this approach is still slow due to numerous barriers such as scarce resources and the lack of training among healthcare personnel.

The current legislation regarding rationing is vague with its major tenet being ⸹1557 of the Affordable Care Act that prohibits age-based discrimination in healthcare facilities that receive federal funds (Farrell et al., 2020). However, no clear guidance and rules have been offered to practitioners to ensure the provision of care based on the principles of rationing and equity. The facilities in question exhibit a patient-centered approach as they focus on specific conditions of each resident trying to create the most effective care plans (Lifespace Foundation, 2019; HCR ManorCare, 2018). It is also noteworthy that Abbey Delray and Heartland Hospice Care have specific protocols concerning the provision of care during the COVID-19 pandemic. Thus, healthcare practitioners have direct guidelines and can make correct decisions in different types of situations while keeping costs reasonable. The units can manage their resources properly and ensure that the services they provide are cost-effective.

Quality Control and Improvement in Long-Term Care

The operations of the facilities in question shed light on the overall development of long-term care within the American healthcare system. Quality is the primary priority of all stakeholders involved in the transformations. Regarding the external factors affecting the quality of provided care and control over diverse processes and procedures, federal and state government have started paying more attention to long-term care (Farrell et al., 2020; Tappen et al., 2017). One of the major shifts in the area is the introduction of clear rules and formalized practices, which leads to quality improvement. Long-term care facilities also become members of different associations that can be seen as a type of external control. For instance, HCR ManorCare is a member of American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and its partners are recognized by the National Committee for Quality Assurance (NCQA) (HCR ManorCare, 2020). Such institutions and agencies develop evidence-based guidelines for medical organizations, which ensure proper quality control.

Internal control systems are also common for current long-term care. Long-term care facilities are often facilities established by large national foundations and associations that have considerable resources. These foundations invest significant funds to implement research and improve the quality of the provided services (HCR ManorCare, 2018). As mentioned above, such institutions are completely or partially funded by donors so they provide regular reports concerning their practices and operations. Human resources management is another area contributing to ensuring a high quality of care (Tappen et al., 2017). Long-term care facilities have to face numerous staffing issues, but they tend to pay extensive attention to staff training and development. Employees gain formal and on-the-job education and training, which equips them with the necessary knowledge and skills to cater to patients’ needs.

Providers’ Effort to Meet Seniors’ Needs

One of the most recent trends in long-term care is associated with the integration of care since nursing homes and hospice centers aim at becoming a part of the integrated care system. However, this effort meets various challenges linked to resources scarcity, lack of training, technological and legal issues (Tappen et al., 2017). Due to the demographic changes, long-term care has lost its marginal status and requires rapid and systemic changes. It is still regarded as a supplementary industry while it is a part of the healthcare system addressing the health-related needs of an increasing cohort. Long-term care providers try to meet the target population’s needs by advocating for and implementing an integration-based approach. Effective collaboration and integration are regarded as the most effective model for the provision of comprehensive care to seniors (Aldridge & Bradley, 2017). Long-term care facilities try to collaborate with primary care units to address acute conditions and enhance older patients’ experience during their transfer to long-term care (Tappen et al., 2017). The use of advanced technology is another effort made to address older patients’ health issues.

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Care providers are also concerned with seniors’ involvement in the life of the community and the creation of the atmosphere of non-discrimination, dignity, and respect (Tappen et al., 2017). Strict quality control regulations imposed by the government, associations, as well as long-term care facilities’ administration, are instrumental in providing high-quality care (Farrell et al., 2020). The focus on cultural, psychological, and spiritual needs is another trend that is apparent in the industry. It has been acknowledged that older patients are more concerned with spiritual aspects, so care providers want to meet these needs as well. The implementation if different projects, including religious leaders and communities, are rather common for long-term care facilities.


On balance, it is necessary to note that long-term care has undergone substantial transformations during the past decades. This kind of care commenced as an effort of communities to meet the needs of their elderly members and grew into a rapidly developing industry. Policymakers, healthcare practitioners and administrators, as well as other stakeholders, are willing to collaborate effectively to improve the industry and ensure the provision of comprehensive and integrated health care. Quality is one of the highest priorities of all these actors, although various issues still persist. The existing issues tend to be caused by the lack of resources and insufficient knowledge. Further cooperation of the mentioned groups, as well as the focus on the medical staff training and development, are the necessary premises for sustainable development of long-term care in the USA.


Abbey Delray. (2020). A helping hand to support your independence. Web.

Aldridge, M. D., & Bradley, E. H. (2017). Epidemiology and patterns of care at the end of life: Rising complexity, shifts in care patterns and sites of death. Health Affairs, 36(7), 1175-1183. Web.

Farrell, T. W., Francis, L., Brown, T., Ferrante, L., Widera, E., Rhodes, R., Rosen, T., Hwang, U., Witt, L. J., Thothala, N., Liu, S. W., & Vitale, C. A. (2020). Rationing limited healthcare resources in the COVID‐19 era and beyond: Ethical considerations regarding older adults. Journal of the American Geriatrics Society, 68(6), 1143-1149. Web.

HCR ManorCare. (2018). 2018 HCR ManorCare quality report. Web.

HCR ManorCare. (2020). Who we are 2020. Web.

Heartland Hospice Care. (2020). Live each day to the fullest. Web.

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Hunter, D. J. (2018). Desperately seeking solutions: Rationing health care. Routledge.

Lifespace Foundation. (2019). Aligned to serve: 2018 foundation report. Web.

Official U. S. Government Site for Medicare. (2020a). Is my test, item, or service covered? Web.

Official U. S. Government Site for Medicare. (2020b). Nursing home profile: Abbey Delray. Web.

Tappen, R. M., Wolf, D. G., Rahemi, Z., Engstrom, G., Rojido, C., Shutes, J., & Ouslander, J. G. (2017). Barriers and facilitators to implementing a change initiative in long-term care using the INTERACT® quality improvement program. The Health Care Manager, 36(3), 219-230. Web.

Xing, J., Mukamel, D. B., Glance, L. G., Zhang, N., & Temkin-Greener, H. (2016). Medicaid reimbursement and the quality of nursing home care: A case study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California. World Medical & Health Policy, 8(3), 329-343. Web.

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