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Long-Term Care
Background
As a general rule, a long-term care pharmacist is engaged by a long-term care pharmacy to
provide pharmacy, infusion, education, consulting, and related services for a specific patient
population. There are two general career paths in long-term care pharmacy: one focuses on
dispensing/management operations and the other on consultant services. This profile
addresses both roles.
With the “aging of America,” the proportion of people needing long-term care can be
expected to increase. Long-term care pharmacists practice in a variety of settings, including
hospitals that own skilled nursing facilities, long-term care pharmacies, nursing homes, and
rehabilitation facilities, or they may practice as independent consultants. Pharmacists in this
field work with medication dosage requirements, drug interactions, drug therapy regimens,
and formulary decisions that differ from those used in other population segments. They
may be restricted to a limited number of medications to treat patients because of the
therapeutic effects of drugs in elderly patients. Although generally a geriatric population,
some long-term care facility populations include the placement of non-geriatric residents
such as those with HIV infection, multiple sclerosis, amyotrophic lateral sclerosis, or
developmentally challenged residents.
Characteristics
According to the survey results, 26% of work time is spent on medication management
services. This is followed by 24% spent on medication dispensing (including associated
patient counseling), 10% on data management, and 10% on patient management services.
Fifty long-term care pharmacists responded to the 2012 APhA Career Pathway Evaluation
Program survey. Fifty-seven percent had a bachelor of pharmacy degree and 52% held a
PharmD degree (this includes those with a Post BS PharmD degree. Eleven percent
indicated they earned an advanced degree (MA, MS, MBA, PhD, or other). Notably, 42%
had completed some certificate training, 21% had been through a residency program, and
12% completed some form of other training.
Respondents’ average age was 50 years old. Just over two thirds (65%) of respondents were
female. Thirty-two percent indicated some type of management role. Income data show
36% earn between less than $100,000, 60% earned more than $100,000 or more per year,
and 6% indicated that they earn more than $170,000. The average time worked per week
was 47 hours. Respondents represented 22 states.
Most respondents indicated that they were satisfied with their work with 38% indicating
“extremely satisfied” and 73% indicating “somewhat satisfied.” On a similar scale,
respondents said they felt the work was challenging, with 46% indicating “extremely
challenging” and 73% indicating “somewhat challenging.”
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Insider’s Perspective
What aspects of the job are most appealing?
Many of the long-term care pharmacists who responded to this survey cited the flexibility of
their schedule as one of the most appealing aspects of this work setting. Others liked things
such as the “opportunities to use clinical training,” “working with a unique and extremely
complex patient population,” “analysis of medication results in geriatric settings,” and
“working for a privately held company.”
One pharmacist said, “With the aging population, pharmacists are the ideal “patient
advocate” regarding safe medication use, appropriate drug therapy, unnecessary medications,
cost-saving factors, [and] more in long- term care settings. Collaborating with the health-care
team is beneficial for all of our seniors overall well-being as they age.”
What aspects of the job are least appealing?
Many respondents indicated that the “workload” and/or the “long hours” are the least
appealing aspects of the work. Several others said that “paperwork” was one of the least
appealing aspects.
Others discussed the burden of regulatory requirements, management challenges, and a lack
of resources as difficulties for some in this position.
What advice should students and practitioners consider when selecting the option of
long-term care pharmacy?
One respondent gave the following, comprehensive advice about long-term care pharmacy:
“Consulting at LTC facilities can require significant driving time and distances. You have to
have a sound clinical backing, be able to do "on the spot" research in areas you may not be
as familiar with, have a sense of humor, be able to communicate with other professionals
and the public, and accept that there are limits to what you will be able to accomplish.”
Another pharmacist simply said: “Develop a passion for serving, caring for, [and] advocating
for the geriatric community and the rest will fall in place.”
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Critical Factor Ratings
Interaction with Patients
Respondents rated this factor in the low mid-range at 3.9. Many respondents commented
that their interactions are greater with other health care professionals versus patients.
= 3.9
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Conducting Physical Assessments
Long-term care pharmacy is often seen as an excellent opportunity to conduct basic
preliminary health assessments of patients. Evaluation of symptoms and other indicators
can be helpful in directing the patient’s therapy. However, respondents indicated that little
of their time is spent conducting physical assessments with a rating of only 2.0.
= 2.0
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Interpreting Laboratory Values
In comparison to the above factor, long-term care pharmacists have access to laboratory
tests and interpret these values in directing the patient’s therapy.
= 4.7
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Continuity of Relationships
Long-term care pharmacists have the opportunity to get to know their patients and
community health professionals. They develop a working knowledge of the idiosyncrasies of
their patients and their therapies; many pharmacists would agree that this is key to their
effectiveness. Those pharmacists with consulting roles in long-term care pharmacy have the
opportunity to develop continuous relationships with patients while those pharmacists with
a dispensing focus may not have as great an opportunity to develop these relationships.
= 5.6
1 2 3 4 5 6 7 8 9 10
No ongoing/ All relationships are
long-term relationships ongoing/long-term
Helping People
There are many pharmacists who cite helping people as the primary factor for choosing
pharmacy as a career. Helping people ranked relatively low with a 5.7 rating, showing that
the long-term care pharmacists who responded feel they have a more indirect effect on the
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well being of the individuals they treat.
= 5.7
1 2 3 4 5 6 7 8 9 10
All effect is indirect All effect is direct
Collaboration with Other Professionals
Collaboration with other professionals scored in the upper mid-range with a 6.8 rating.
While communication with doctors and nurses in a long-term care pharmacy is often limited
to authorizations or new prescription orders via the telephone and fax, this collaboration is
face-to-face when on-site. Often, both the pharmacy and the physician’s office are engaged
in longer discussions with each other, thereby allowing the physician, nurse, and pharmacist
to communicate accurately and concisely to ensure the patient gets optimal therapy.
= 6.8
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Educating Other Professionals
Typically, long-term care pharmacists engage in educating other professionals when they
provide in-service education. Some long-term care pharmacies choose to educate physicians
and nurses in their daily work.
= 5.1
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Variety of Daily Activities
Respondents were involved in a number of different roles. By definition, this involves
variety and includes prescription evaluation and therapy review. The challenges often arise
in resolving therapy and other prescription-related problems, especially for elderly patients.
Other tasks, such as dispensing activities and paperwork requirements may be more
repetitive in nature. Generally, the pharmacists felt their tasks were an even mix between
repetitive and variable
= 5.1
1 2 3 4 5 6 7 8 9 10
Highly repetitive Highly variable
Multiple Task Handling
A long-term care pharmacist is often required to handle multiple tasks at once to ensure the
timely and accurate dispensing of prescription medications in a pharmacy; this is especially
true in a large volume pharmacy. Tasks could include answering patient questions,
addressing nurses’ and physicians’ concerns, checking filled prescription orders, and
evaluating insurance problems. Respondents indicated that they tend toward working on
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multiple tasks at one time.
= 5.9
1 2 3 4 5 6 7 8 9 10
Always one activity at a time Always several tasks at a time
Problem Solving
The problems are often complex in many situations taking into account the physiological
changes in patients in this population. With a rating of 5.1, pharmacists indicated that they
equally use tried-and-true solutions as well as try untested strategies to solve problems.
Questions concerning insurance clarifications may rely on more established alternatives.
= 5.1
1 2 3 4 5 6 7 8 9 10
Always tried and true Always untested alternatives
Focus of Expertise
Respondents were again mid-range in their response indicating that they require both a
general and somewhat specialized knowledge base.
= 5.6
1 2 3 4 5 6 7 8 9 10
Generally defined area Sharply defined area
Innovative Thinking
In response to the question “To what extent does your practice involve generating new ideas
(innovative thinking) pertaining to pharmacy?” respondents rated the factor a 5.6, indicating
that their practice does provide the opportunity for innovative thinking. Opportunities for
idea generating in long-term care pharmacy may include novel therapy or the tailoring of
therapy for the patient.
= 5.6
1 2 3 4 5 6 7 8 9 10
Never involves Always involves
innovative thinking innovative thinking
Applying Scientific Knowledge
Applying scientific knowledge received an upper mid-range rating of 6.3. Scientific
knowledge is applied in determining dosage ranges and adjustments necessary taking into
account some of the pharmacokinetic considerations that need to be incorporated regarding
this population.
= 6.3
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
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Applying Medical Knowledge
Applying medical knowledge received a higher rating at 7.6. Medical knowledge is applied in
patient counseling, medication regimens, patient profile reviews, and collaboration with
other professionals.
= 7.6
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Creating New Knowledge by Conducting Research
Long-term care is a prime example of a setting designed mostly for the application of learned
knowledge. It is the arena where the results of pharmaceutical research and studies are used
to improve patient lives. There are some opportunities to conduct research in the long-term
care setting, mostly in the realm of disease state management. However, for the most part,
this setting is where knowledge is applied rather than created.
= 2.5
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Management/Supervision of Others
Respondents rated the factor mid-range with a 3.5, indicating that they tend to spend a lower
amount of time supervising others. However, staff pharmacists still maintain a supervisory
role because, when on duty, they are responsible for the conduct and practice in that
pharmacy.
= 3.5
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Management/Supervision of a Business
Respondents indicated they spend even less time managing the business side of the practice.
The disclaimer here is that those who are consultants may spend more time managing the
business because this is how they receive work.
= 2.8
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Pressure/Stress
Respondents indicated that they experience pressure or stress more often than not in their
practice. Stress comes from the multiple demands of the patient, nurse, and physician as
well as demands of the nursing facility itself. When this is added to the stress caused by the
dispensing pharmacy, it is easy to see why pharmacists feel pressure and stress in their work.
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= 5.9
1 2 3 4 5 6 7 8 9 10
Never experience Always experience
pressure/stress pressure/stress
Work Schedule
Respondents indicated that they were equally split across the continuum with a rating of 6.7.
The variability on this factor may be caused by the facility staff versus consultant roles.
Facility schedules would be more predictable while consultant positions may more
unpredictable.
= 6.7
1 2 3 4 5 6 7 8 9 10
Irregular/unpredictable Regular/predictable
Part-Time Opportunities
Respondents were again split that there are some opportunities for part-time work in the
field. Perhaps part of the discussion here is the need for pharmacists with a specialized
knowledge base being available for a position.
= 6.6
1 2 3 4 5 6 7 8 9 10
No opportunity for Always opportunities
part-time employment for part-time employment
Job-Sharing Opportunities
Long-term care pharmacists indicated a low range response to job-sharing at 3.5.
= 3.5
1 2 3 4 5 6 7 8 9 10
No opportunity for Always opportunities
job-sharing for job-sharing
Exit/Re-entry Opportunities
Opportunities do exist to exit/re-entry. The difficulty is being able to re-enter the same
position.
= 5.1
1 2 3 4 5 6 7 8 9 10
No opportunity for Always opportunities
exit/re-entry for exit/re-entry
Parental Leave Opportunities
Respondents answered mid-range on the subject of parental leave with a rating of 5.0.
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= 5.0
1 2 3 4 5 6 7 8 9 10
No opportunity for Always opportunities
parental leave for parental leave
Leisure/Family Time
Respondents rated this factor a 5.9, indicating that many feel they have time available for
leisure activities and family.
= 5.9
1 2 3 4 5 6 7 8 9 10
No free time Always opportunities
for free time
Job Security
Job security was rated in the mid-range area by these pharmacists. With the continued
shortage in some areas, long-term care pharmacists indicated a sense of job security.
= 6.9
1 2 3 4 5 6 7 8 9 10
No security/stability Total security/stability
Opportunities for Advancement
Respondents rated this factor mid-range with respect to opportunities for advancement.
Career advancement can often be limited by the size of the organization and the size of the
pharmacy. For pharmacists working in a company with only one nursing home under
contract, there may not be the opportunity to go beyond chief pharmacist. However, in a
larger company, they may have more versatility to choose the corporate ladder approach in
their career.
= 4.3
1 2 3 4 5 6 7 8 9 10
No opportunities Always opportunities
for advancement for advancement
Opportunities for Leadership Development
While pharmacists see only limited chance for advancement, they see a greater opportunity
for leadership development. With a rating of 5.1, long-term care pharmacists see a great deal
of leadership opportunity. = 5.1
1 2 3 4 5 6 7 8 9 10
No opportunities for Always opportunities for
leadership development leadership development
Community Prestige
Long-term care pharmacists gave this factor a 4.8 rating. Pharmacists can become well
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known in their community for helping individuals. Long-term care pharmacists are simply
looked to as confidants because they are a familiar face and a trusted health care professional
in the long-term care community.
= 4.8
1 2 3 4 5 6 7 8 9 10
Much less prestige than Much more prestige than
anyone else in the community others in the community
Professional Involvement
Professional involvement of individual pharmacists is critical to the development of the
profession as a whole, and pharmacists need to communicate with each other so that the
profession can continue to advance in providing optimal health care for the public. Long-
term care pharmacists rated this factor in the upper mid-range at 6.5.
= 6.5
1 2 3 4 5 6 7 8 9 10
No opportunity for Always an opportunity for
professional involvement professional involvement
Income
Respondents indicated that they tend toward feeling properly compensated for the work
they perform.
= 7.1
1 2 3 4 5 6 7 8 9 10
Not properly compensated Properly compensated
Benefits (vacation, health, retirement)
Often directly linked to income or salary, benefits scored slightly above income at a rating of
6.5.
= 6.5
1 2 3 4 5 6 7 8 9 10
No benefit package Excellent benefit package
Geographic Location
Long-term care pharmacists have great opportunity to relocate almost anywhere in the
United States.
= 6.4
1 2 3 4 5 6 7 8 9 10
Limited to one location Can practice anywhere
Working Remotely
Much of the work done by long-term care pharmacists cannot be done remotely. There are
opportunities, especially for consultant pharmacists, to complete documentation activities
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remotely.
= 3.7
1 2 3 4 5 6 7 8 9 10
Never can work remotely Always can work remotely
Autonomy
Autonomy in a long-term care pharmacy, in general, can depend on whether the pharmacist
works alone or always works with another pharmacist or supervisor. One of the liberties of
being a pharmacist in practice is that the pharmacist on duty has final say in most decisions
that occur under his or her supervision. In most cases, long-term care pharmacists are
highly autonomous.
= 7.0
1 2 3 4 5 6 7 8 9 10
No autonomy Total autonomy
Self-Worth
Respondents rated self-worth as the second-highest factor in this profile. Although the
focus of the long-term care pharmacist is to help improve the lives of their residents through
the use of prescription medications, many feel that they are helping not only the patients but
their patients’ families as well. Intrinsically, this act creates a great deal of self-worth and the
feeling of accomplishment in the pharmacist’s daily work.
= 7.1
1 2 3 4 5 6 7 8 9 10
Never allowed Always allowed
Future Focus
The majority of what a long-term care pharmacist may be addressing is the immediate needs
of patients. However, reviewing drug regimens and suggesting changes also can be forward
looking. Pharmacists indicated that they have a tendency to focus on the future with a score
of 6.1.
= 6.1
1 2 3 4 5 6 7 8 9 10
Focus on immediate task Focus on future
Professional Prestige
Respondents to this question responded mid-range. Long-term care pharmacists can develop
a reputation in the long-term care community for providing thoughtful and thorough
service.
= 4.8
1 2 3 4 5 6 7 8 9 10
Never provided Always provided
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Unique Practice Environnent
The opportunity for a unique practice environment is very dependent on the management
philosophy of the particular pharmacy organization and the nursing homes where they
operate. Long-term care pharmacists rated this factor at 6.4.
= 6.4
1 2 3 4 5 6 7 8 9 10
Not at all unique Extremely unique
Advanced Degree
Respondents rated this factor in the lower range indicating that, for the most part, advanced
degrees are not typically required. The vast majority of pharmacists are able to complete
their work with the initial degree they received and additional specialized training.
= 2.5
1 2 3 4 5 6 7 8 9 10
Advanced degree not required Advanced degree required
Entrepreneurial Opportunity
There is limited entrepreneurial opportunity available in long-term care pharmacy. Perhaps
the greatest opportunity is for consultants in this field because they have the opportunity to
work with a variety of groups and create a niche for their practice.
= 3.8
1 2 3 4 5 6 7 8 9 10
Not at all Extremely
Additional Training
Certificate training programs are available in geriatric pharmacy along with other programs
geared toward this patient population. Some states require certification to serve as a
“consultant pharmacist.”
= 5.8
1 2 3 4 5 6 7 8 9 10
Not required Always required
Interacting With Colleagues
As one would suspect, respondents indicated that they interact with coworkers on a daily
basis.
= 6.9
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Travel
Long-term care pharmacists are split with their needs to travel for their day-to-day activities
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as seen with the mid-range rating of 4.0. Again, this may be due to a number of respondents
who consult in the field versus those who have a permanent practice location. In addition,
some pharmacists work for an organization with multiple sites and may need to travel to
different locations.
= 4.0
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Writing
Respondents were in the mid-range regarding writing, rating the factor at 3.5.
= 3.5
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
Working With Teams
Respondents indicated they tended toward the middle with regard to working in teams,
giving this factor a rating of 5.3. This rating may take into account that the staff of some
organizations work together and can communicate regularly when needed, whereas those
who work solely in the pharmacy may not work in teams.
= 5.3
1 2 3 4 5 6 7 8 9 10
None of my time All of my time
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Mean Scores for Critical Factors
1.Interactionwithpeople 3.9
2.Performingphysicalassessments 2.0
3.Interpretinglaboratoryvalues 4.7
4.Continuityofrelationships 5.6
5.Extenttowhicheffectisdirect 5.7
6.Collaborationwithotherprofessionals 6.8
7.Educatingotherprofessionals 5.1
8.Varietyofdailyactivities 5.1
9.Multipletaskhandling 5.9
10.Problemsolving 5.1
11.Focusofexpertise 5.6
12.Innovativethinking 5.6
13.Applyingscientificknowledge 6.3
14.Applyingmedicalknowledge 7.6
15.Creatingnewknowledgebyconductingresearch 2.5
16.Managingothers 3.5
17.Managingbusinessoperations 2.8
18.Pressure/Stress 5.9
19.Workschedule 6.7
20.Parttimeopportunities 6.6
21.Jobsharing 3.5
22.Exitandre‐entry 5.1
23.Parentalleave 5.0
24.Freetimeforleisure/familyactivities 5.9
25.Jobsecurity 6.9
26.Opportunitiesforadvancement 4.3
27.Opportunitiesforleadershipdevelopment 5.1
28.Communityprestige 4.8
29.Professionalinvolvement 6.5
30.Income 7.1
31.Benefits(vacation,health,retirement) 6.5
32.Geographiclocation 6.4
33.WorkingRemotely 3.7
34.Autonomy 7.0
35.Self‐Worth 7.1
36.Futurefocus 6.1
37.Professionalprestige 4.8
38.Uniquepracticeenvironment 6.4
39.Advanceddegree 2.5
40.Entrepreneurialopportunity 3.8
41.Additionaltraining 5.8
42.Interactingwithco‐workers 6.9
43.Travel 4.0
44.Writing 3.5
45.Workingwithteams 5.3
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Reference
Schommer JC. APhA Career Pathway Evaluation Program for Pharmacy Professionals 2012
Pharmacist Profile Survey. February 2013.
Professional Organizations
American Pharmacists Association (APhA)
2215 Constitution Ave, NW, Washington, DC 20037
Tel: 800-237-APhA Fax: 202-783-2351
www.pharmacist.com
American Society of Consultant Pharmacists (ASCP)
1321 Duke Street, Alexandria, VA 22314
Tel: 703-739-1300 Fax: 703- 739-1321
www.ascp.com
American Society of Health-System Pharmacists (ASHP)
7272 Wisconsin Avenue, Bethesda, MD 20814
Tel: 301-657-3000
www.ashp.org
National Community Pharmacists Association (NCPA)
205 Daingerfield Road, Alexandria, VA 22314
Tel: 703-683-8200 Toll-Free: 800-544-7447 Fax: 703-683-3619
www.ncpanet.org
