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Ethics and Long-Term Care: Or Lack Thereof The SeniorScape™

Updated: Nov 6, 2022

I’ve pondered this question for many years and was the motivation for me writing my first book, “Nursing Homes to Rehabilitation Centers: What Every Person Needs to Know”.

At that juncture, I had worked in approximately 40 nursing homes.

Many of the nursing homes in which I worked were owned and operated by people who were devout in their religious beliefs and steadfast in their personal commitment to following laws and rituals. Most troubling was that the fervent adherence to these beliefs and rituals seemed directly at odds with the way in which the people who were entrusted to their care were being treated. This always seemed like a total oxymoron especially since the ethics that were the basis of these people’s religious tenets is respect and caring for elders.

As the years went by, I worked in more facilities owned and operated by people of different religious persuasions who were equally committed and steadfast in their observances. The similarities in the way in which people were being treated and “cared” for were inescapable.

The commitment to profit seemed to outweigh any commitment to providing care, and certainly not quality care.

The ill effects of long-term care which have existed for decades were highlighted through COVID. I, along with many others, hoped this would be the impetus for swift and radical change that would benefit the over a million residents of the over 15,000 U.S. long-term care homes and moving forward, for the increasing numbers of older adults who will need care, especially as the older demographic continues to grow by leaps and bounds.

That has not taken place. There have been investigative reports, newspaper articles, proposed policy initiatives and legislation, sound bites, twitter rants, and speeches that espouse the need for some form of change.

My insights are based on research and experiences in over 50 nursing homes, as well as interviews I’ve conducted with and work alongside healthcare workers and colleagues. Staff shortages are often given as the reason for poor care.

I say this with confidence and conviction. Caring from the top down is in short supply and I believe, is at the root cause and the basis of what appears to be an immoral system. In actuality, when I wrote my first book, the first title I had in mind was: The IM-Morality of Long-Term Care.

Most recently, of the friends and colleagues with whom I’ve spoken who work in the system, 99% of them say no one cares about them. They are nothing more than a body hired to do a job. A system that doesn’t care for its workers, and especially workers who are also caregivers, is a care-less system. An oxymoron since the system is about caring for people. This is like a house of cards bound to fail.

I have felt this myself. There is little care or concern for anyone. I have often questioned why one goes into the caring for people business if the intention is not directed at taking care of people.

Recently, a person in the know answered that question for me: “it’s the best return they can receive on the dollar.”

In an industry that is struggling with staff shortages and the fact that fewer and fewer people want to go to nursing homes, it seems like the desire to find and ensure profit is intensified. The result is finding a way to squeezing every dollar and every ounce of energy from people already stressed, overwhelmed, overworked, underpaid, undervalued, frustrated, and disgusted. Many healthcare workers who went into the profession with a caring heart have become disheartened. They lost their way, and thus, have lost their why.

The end result is poor care.

In a conversation with a colleague this AM, and many conversations prior, I have stated that there is too much finger pointing. There is an adage that when one points a finger, there are 3 pointing back at you. The owners and operators need to look more closely at what they are doing that is creating environments where people feel disheartened and disconnected. What can they do to better the situation for those that are in their employ? What can they do to show they care for the people who are entrusted to their care?

This takes self-examination. Self-examination can take many paths including religious and spiritual.

Commitment to your business includes commitment to and care for your people, even more so if you are in the taking care of people business. These are foundational business ethics, but they are also human ethics; tenets that should be observed. It seems these should supersede any commitment to religious beliefs and rituals.

What can we do while we are waiting for a system to change or the people who own the businesses in the system to change? Will the system ever change? If so, when? Based on my research, personal experience, and association with many of the players involved, I can say with a high degree of certainty it is unlikely to happen.

Our responsibility is to keep ourselves as healthy as possible in an effort to stave off the conditions which will cause us to become the customers of that system. The statistics* indicate that someone turning 65 has almost a 70% chance of needing some type of long-term care services and support as they continue to advance in years. Baby Boomers are considered the second largest generation and as they reach the years of retirement age, more of them will need extended care.

A few statistics worth noting:

  • More than 80% of residents need help with at least three activities of daily living (ADLs) such as dressing or bathing. Around 90% who can walk require assistance or supervision. (

  • 14% of caregivers for older adults are at least age 65 years of age.(

  • Over 550 nursing homes have closed since June 2015. Despite these closures, occupancy has decreased by almost two percentage points.(LeadingAge)

It is important that we take control of our own health and well-being, rather than surrendering and accepting whatever happens to us. This involves taking control and developing an action plan.

The Place to Begin is Within: the Time to Begin is Now.

To find out more about Mindful Longevity Plans and Developing your own Personalized Plan

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