One of Dr. Rajean Moone’s first childhood memories is interacting with nursing home residents in International Falls, Minnesota. Years later, as an undergraduate student, he volunteered at a nursing home in Duluth before completing a master’s degree in gerontology. Next: the Twin Cities, where he earned a PhD in social work and, simultaneously, a Minnesota nursing home administrator’s license.

portrait of Rajean Moone standing before wall with large maroon M

“I've always been interested in aging in general and that interest includes long term care,” says Moone, who now serves as Faculty Director of the Long Term Care (LTC) Administration program at the University of Minnesota, which is currently celebrating 50 years of educating people in the field. “Long term care has so many opportunities and challenges, which makes the field quite exciting.” 

Today, there are more than 25,000 older Minnesotans residing in nursing homes, and far more who require such care but have been impacted by a now three-year wave of facility closures and staffing challenges (long hours, low pay, COVID exposure), both of which have forced the majority of the state’s facilities to limit their admissions.

This most recent crisis facing LTC—its institutions, professionals, and those needing care—is not the first, nor will it be the last. The challenge is one of continuous innovation and improvement. Health care, culture, science, government policy (and certainly the way we age, think, interact with, care for, and live as older adults) have all changed radically over the course of five decades. 

“Long term care has so many opportunities and challenges, which makes the field quite exciting.” 

For Moone, that means “the opportunities to ensure high quality of care and life of the residents in senior care are boundless.” And if the program’s track record of purposeful problem-solving and creativity is any indication, these boundless opportunities have been front and center during the last 50 years of research, teaching, practice, and advocacy.

The constant? The North Star of the LTC Administration program has been, and continues to be, resident well-being. The way Moone sees it, “It’s our role to provide a platform for experts to teach emerging and best practice trends so that nursing home administrators can support an environment where these vulnerable adults live their highest quality of life.” [LeadingAge Minnesota, 2018]

From the Field

To mark the program’s 50th anniversary, we asked LTC students, alumni, instructors, advisors, practitioners, and pioneers to reflect on their work, goals, and visions for the next 50 years.

Portrait of Grace Benda standing in front of a brown brick wall

Grace Benda ’21, LNHA, Administrator, The Estates at Rush City
Grace Benda graduated in 2021 with a Bachelor of Applied Science (BASc.) in Health Services Management and minors in LTC Management and Public Health. While in school, she was a recipient of the Ingrid Lenz Harrison Scholarship. Benda and her team at The Estates at Rush City recently received a perfect score (zero deficiencies) for their CMS–2567 annual survey, which identifies violations of federal regulations in nursing and care facilities.

How does the LTC aspect of your education serve you in your current position?
My education has served its purpose to me ten-fold in my first year of being an administrator. The LTC minor gave me the foundation and confidence one needs to take on the role. Not a day goes by where I don’t utilize what I had learned through my education at the University, specifically the LTC aspect. 

Is there something during your first year of working full time in your profession that has taken you by surprise?
I think the amount of autonomy I have with many of the decisions I make. While in school, you are prompted to make decisions that may or may not have an impact. Whereas on the job, countless decisions are made daily that can have a very large impact on many different people. Being able to make the decision you feel is best is a crucial aspect of being in the role. 

What advice would you give to students who are currently studying LTC?
I would encourage students to get out and gain some hands-on experience in a facility. Being in a facility helps you absorb and put into action everything you have learned in the classroom plus so much more. My experience working in the kitchen, as a certified nursing assistant on the floor, and as a staffing coordinator, has helped me understand and appreciate the work that occurs in my facility. 

color portrait of Mara Borgeson wearing a flowered dress

Mara Borgeson, Current Student
Mara Borgeson is pursuing a BASc. in Health Services Management with a minor in LTC. She anticipates graduating in 2022.

What misconception do people have about the LTC profession?
I don’t think people realize the responsibilities that reside with the profession. There are so many rules and regulations you need to be aware of and follow strictly. The realm of classes we need to take, from law classes to medical terminology is really broad.

Name something you learned in your LTC courses that you believe will have an impact on how you go about your career in the field.
Learning to be an empathetic leader… I just recently started working in a LTC facility and you don’t know what it is actually like until you are working the job. It’s such a sensitive population to work with and being empathetic to the other workers and the patients is crucial. 

If you could ask a LTC pioneer or superstar one question, who and what would you ask?
One of the most influential factors that shaped our modern LTC system is the Nursing Home Reform Act of 1987, so I guess Bob Casey [US Senator, D-PA]. I would like to ask him how he imagined the LTC system to be 50 years from the 1987 act, and compare it to the progress we have made 35 years later.

color portrait of Patti Cullen wearing teal-colored suit coat

Patti Cullen, MA ’86, President/CEO, Care Providers of Minnesota
Patti Cullen is chair of the 2021–22 Health Services Management Advisory Board and a member of its LTC Committee. Care Providers of Minnesota is the state affiliate for the American Health Care Association and the National Center for Assisted Living.

How did you become involved with the University’s LTC program?
For ten years or more, I was the instructor for the regulatory class for the LTC program, providing four hours of ever-evolving content in this complex area. I eventually turned this task over to one of my colleagues, but remain connected to the program for a variety of reasons, including: 1) to ensure the information given to students is up-to-date; 2) to connect graduates to member organizations who can mentor and help them become leaders; 3) to ensure students get access to the resources provided by my organization (at no charge); and 4) to support my alma mater!

What do you see as your most important charge as Advisory Board Chair, particularly as it relates to LTC?
I want to be sure the students succeed, whether in completing their coursework or required internship or finding professional positions upon graduation. The health care profession, including LTC, needs to continue to build up our pipeline with quality leaders who can take on and conquer the myriad of challenges facing LTC today.

How does this charge reflect or address the more recent challenges within the profession?
The LTC program at the U of M is blessed with great diversity within its student ranks. We know that the workforce is the greatest challenge for the profession, with one of the solutions being recruitment of new immigrants. There is great capacity for the University’s LTC program to lead in the recruitment, training, and leadership development of immigrants to help fill workforce gaps.

color headshot of Akira Granberry

Akira Granberry, Current Student
Akira Granberry is pursuing a BASc. in Health Services Management with a minor in LTC Management. She is a recipient of the CCAPS Diversity Scholarship and anticipates graduating in 2023.

Name something you learned in your LTC courses that you believe will have an impact on how you go about your career in the field.
After taking a course that focuses on management in assisted living facilities, I was able to see that I want to start my career within assisted living so that I can get a few years of experience managing less complicated case loads. Skilled nursing and long term facilities are something that interest me, and I want to ensure I don't burn myself out by taking on too much responsibility before I'm ready.

What misconception do people have about the LTC profession?
People don't know what LTC entails. I feel like the industry of geriatric care is still very niche, but it's something that is going to need a lot of positions filled in the near future as the aging population keeps increasing. Not realizing there's an entire developing business industry dedicated to the elderly is the main misconception.

If you could ask a LTC pioneer or superstar one question, who and what would you ask?
I would like to ask the founder of assisted living, Dr. Keren Brown Wilson, how she thinks LTC facilities could be made to be more homelike (in the image of assisted living), while providing the constant care the residents need.

color portrait of Roger White wearing blue shirt, yellow tie, and tan vest

Roger White, SPHR, SHRM-SCP, LNHA, Associate Administrator, Head of People & Culture, Mount Olivet Home, Mount Olivet Careview, and Mount Olivet Day Services
Roger White is a former student in the LTC Administration Series who received his nursing home administrator license in 2020. A current CCAPS instructor, White teaches LTC Human Resources and Organizational Management. 

How has your participation in the LTC Administration series changed or enhanced your current position?
My participation allowed me to gain a holistic view of LTC administration. Complementing my career in human resources, the LTC Administration series brought the financial acumen, regulatory knowledge, clinical considerations, and organizational management components to allow me to add an Associate Administrator piece to my position.  

You completed the LTC series during the first year of COVID-19. Since then, what has most surprised you about changes in both the profession and those who are in need of care?
I have been surprised by some of the hesitations in the profession to adapt quickly, consider unintended consequences in communication, and maximize networking opportunities. COVID-19 caught the world by storm, and helped our profession understand that we need to be rapid change agents, deliver transparent and frequent communication, and share what is and is not working with our industry practices. 

What advice would you give to students who are currently studying LTC?
The best advice I would give is that they must have a deep passion for people—not only for residents, but for trying to meet the needs of the families and friends, while also ensuring the holistic needs of the employees and caregivers are met. The industry is significantly diverse, and administrators must be able to gain trust, maintain relationships, encourage growth, and bring passion to the employees to be successful.

The Next 50 Years

In a 2010 interview, alumna, associate professor, and LTC pioneer Ruth Stryker-Gordon (1925–2021) was asked: “Do you think the culture of long term care has changed?”

Portrait of Ruth Stryker-Gordon

“Oh, definitely, definitely,” she responded. “I think they’ve still got a ways to go, but it’s so different than when we started. People talk like they know what they are doing sometimes. [laughs]…They never did before. Yes, I think you can find good places these days.”

Interviewer Dr. Dominique Tobbell went on to say, “I’m sure the programs like the one you and your husband [Dr. George Kenneth Gordon] were involved with were pretty key to having that changed culture.”

RG: "Oh, I think in the State of Minnesota. I really believe that, yes.”

Of course, Stryker-Gordon had the advantage of hindsight and was reflecting on her many decades in the LTC profession. 

But what’s ahead? To find out, we asked our interviewees the following question: Using your crystal ball, and with a hopeful heart, what advances and positive changes would you like to see for long-term services and supports in the next 50 years?

I would like to continue seeing innovation within the realm of resident care and emotional support. I don’t believe there is one correct answer as to how we get there, but I believe it will take an open mind for many providers in order to create positive change in this sector. One awesome example of this involves the company I work for, Monarch Healthcare Management. They are diving into an area of care innovation that involves robots!  —Grace Benda 

The biggest change I would like to see is growth in the workforce. Right now, so many LTC facilities are so understaffed that it makes the jobs of the workers much harder and the quality of life for the seniors lower.  —Mara Borgeson

We need to start over with payment and regulatory flexibility for all local communities to implement creative solutions to meet the needs of their senior populations. …We have to allow for hub-and-spoke approaches to the delivery of long term services and supports that reflect the cultural needs of the seniors in that community, but also, the availability of workers to meet those needs.  —Patti Cullen

Using your crystal ball, and with a hopeful heart, what advances and positive changes would you like to see for long term services and supports in the next 50 years?

I'd like to see more support and understanding of how the LTC environment functions. As more people begin to age in the upcoming decades, more families will need to … help their parents transition into different lifestyles. Leaving home for assisted living or LTC is a scary and often uncomfortable change for individuals, and not having the knowledge about the aging process can make it more difficult. Ideally, education about LTC will be delivered to people earlier on, and the stigma around aging will dissipate.  —Akira Granberry

I see that long term services and supports will be seamless and allow for older adults to age in place. Long term care will become even more individualized and person-centered with nursing homes providing care not only collectively in buildings, but also throughout communities. Those working in senior care will be leaders in age-friendly health care and respected partners in a broader health care system.  —Dr. Rajean Moone

I would like to see long term services and supports... create communities of continuous and comprehensive education. Being a student helped me understand the challenges that are ever-present in our unique industry. Staffing, retention, employee relations, and organizational management challenges have been magnified beyond our imagination over the past few years. Helping our students understand the inherent differences in our employee populations, gaining insight into holistic employment practices, learning intercultural dimensions, and managing through individualistic and collectivistic approaches have given me great hope for our future, our future leaders, and the future of long term care.  —Roger White


LTC at UMN: A Historical Timeline (1972–2022)


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