Why is LTC so hated

Specialties Geriatric


I hope I am not offending anyone with this question. I have been on allnurses for a while now, trying to find out as much as I can about the nursing career before getting started. One thing I have noticed is that LTC seems to be thought of as the last resort for nurses who can't get jobs elsewhere. I've seen many posts with people saying, "getting a hospital job seems hopeless, I guess I'll go to LTC." I don't get it, why is LTC worse than working at a hospital? I was thinking of volunteering at an LTC or hospice and getting a CNA position there later so I can hopefully be hired as an RN upon graduation. I am also interested in Hospice but that seems to be hard to get into for new grads. From some of the posts I've read though, it sounds like working LTC is the tenth circle of hell :confused:. Can someone enlighten me? Can LTC nursing be enjoyable?

In my opinion, any patient care experience (including LTC) would be valuable for a nursing student.

LTC is sometimes (although I don't agree with this) viewed as a last resort because there may not be as many "skills" at a LTC facility (IV starts, drips, post-op care, etc.) The reason I disagree with this is that there are MANY LTC facilities that have some sort of skilled care unit that is actually very similar to hospital care. I have a friend that is working in an LTC on skilled nursing, and she does trach care, wound care, IVs, and all kinds of stuff.

The nurse/patient ratio also may deter some; LTCs tend to have more patients per nurse than hospitals, although I don't know if that changes when you get into skilled care. Lastly, some people just seem to think that the hospital is "IT" for whatever reason; I don't get this either. Nurses work all kinds of places, and it just depends on what you're into.

LTC is not universally hated, so don't let folks deter you. If you are interested, working as a CNA/UAP at a LTC facility (preferably with a skilled care unit) may give you an idea of what to expect.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

The attitudes about LTC being the nursing specialty of last resort are reflective of society's overall negative opinions regarding the frail elderly.

Plenty of value is placed on the lives of infants, children, and younger adults. However, older people tend to be devalued in American society. For example, many people become excited at the thought of a nurse who works in postpartum, pediatrics, trauma, the emergency department, reproductive medicine, the NICU, labor & delivery, or other areas where younger patients end up. However, the thoughts become less enthusiastic when the nurse is employed in an area where many elderly patients are seen, such as rehab, long term care, geri-psych, hospice, assisted living, or oncology.

LTC can be very rewarding and enjoyable if you have a passion for working with the geriatric population. Many elderly patients crave attention and will bond with caring nursing staff.

Specializes in Emergency, Telemetry, Transplant.

I personally don't hate LTC. It takes a very special person to be a RN in LTC, and I freely admit that I am not that kind of person. I do not consider LTC nursing as a "lower form" of nursing. I know many nurses who worked their entire careers in LTC and loved as. As I said, (and I don't mean this cynically) it takes a special person.

Specializes in M/S, Travel Nursing, Pulmonary.

I am one of those people who used to say "I would retire before I worked in a nursing home." I still feel that way, despite my interviewing with a LTC facility when I wanted off night shift.

My reason: Nothing to do with LTC nurses not having the same skills to practice, compensation or thinking acute care is any more valuable. Simply put, I resent that Medical Care in the U.S. has become more like working in a warehouse and less like.........well, medical care. IMO, LTC exemplifies this flaw more than any other field. Pt. ratios are worse in LTC than anywhere else, holistic/personable care is sacrificed in the name of making a bonus or two for admin. and "just keeping people alive for the shift" is acceptable more so in LTC than anywhere else.

Mind you, hospitals are closing the gap on a daily basis and are guilty of the same, just not to the same extreme. That is why I have no desire to work LTC, it is the field that has, more than any other practice, lost its way and completely forsaken the patient.

I was one of those nurses who HATED ltc and swore I would never work there.....that is until I actually tried it out and found out that I love it :)

You've raised a lot of issues that I haven't thought about. LTC patients are probably the least likely to make it out of a facility alive (that's the point of "long term care," right?), least likely to be able to speak up for themselves, and least likely to have visitors over frequently. Is hospice also a "warehouse-like" environment, or does it have a different sort of culture? Maybe I should as that over on the hospice board.

I was wondering, is there anything specifically I should look for when looking for facilities to start volunteering/ working at? There are several in my area that are connected to large, reputable hospitals, would they be better to work for in terms of nurse/patient ratios and treatment of staff? Or should I look for small independant places, or maybe non-profit nursing homes?

Specializes in Trauma/Tele/Surgery/SICU.

I don't think I hate LTC I have never worked it. I do know that we did clinicals in two LTC's and I found it incredibly depressing and distressing. The nurses looked like they were jogging all day long. They were so happy to see us take over care for one of their patients and the patients were so happy just to have someone pay attention to them. A couple of the CNA's and nurses in both places had horrible attitudes and were very rude to the patients.

I saw elderly people lying in soiled briefs, dressings that had not been changed for days, and pt.s strapped in wheelchairs, tied to their beds etc. The poor nurses and cna's looked so overwhelmed it was obvious even to me (1st semester nrsg student at the time) that both places were ridiculously understaffed.

I basically made up my mind then I would not want to work in a LTC. I have to say that after reading many of the threads on here where nurses say they get 20 or 30 or more patients per shift I still do not want to work LTC. I thank god there are those that do because I know I couldn't do it!

Specializes in ICU, PICU.

I think the reason a lot of new nurses dread LTC is because many hospitals (many new nurses' passion) hardly even consider LTC as experience. They still have to invest lots of money on training. I'm used to a fast-paced ICU, and want to keep up that same pace and level of critical thinking... so it's really hard for me to bite the bullet and apply for LTC jobs when I know I have potential to be a great ICU nurse... I really love a challenge. Does that make sense?

On the other hand, some RNs LOVE the pace of LTC facilities. It's nursing care but a different degree of it...

To each his/her own on this one... You really have to decide the best fit for you!

I love LTC. They have them in huge state/fed prisons. It's usually called a special needs unit. I don't know why people hate LTC. But to be honest its probably due to Ageism and America not respecting the elderly as much as they do like other countries. Hospital isn't the "IT" job in my honest opinion. Try getting a job in a federal facility and being able to retire in 20 years I think is the "IT" job:)

Specializes in Med/Surgical; Critical Care; Geriatric.

I worked LTC and really liked it. I did staff nursing, DON, ADON, Skilled Unit Manager, and MDS. I enjoyed being a staff nurse the most and primarily worked on the Medicare Skilled/Subacute Wing. Many of my residents were short-term admissions and were discharged - believe it or not. One of the main problems was having enough talented and dependable CNA's....the pay for CNA's is horrible. I left LTC primarily because of all the duplicate and triplicate documentation. But I've learned recently, some facilities have gone to electronic documentation like hospitals.

When I hear someone dogging nurses that work in LTC, I just tell them that unless they've ever worked there, they don't know how hard those nurses work. After all, they have to be the eyes and the ears of the physician when they have to call a doctor about an ill resident. The nurses and the cna's know those residents like a family member that lives in their home. It is the "subtle" changes in a resident's behavior that gives the nurse a "clue" that they're getting sick.

I have a lot of respect for those that work in LTC. It's a specialty in and of itself! :heartbeat

Rhonda :)

Specializes in Med-Surg, Cardiac.

I've never worked in LTC but I go to various nursing and personal care homes a lot in my part time paramedic job.

I admire the nurses there so much. They have so many patients and so much responsibility. I don't know how they can do it. I know I couldn't.

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