In the wake of the COVID-19 pandemic, few corners of the American healthcare system have faced as much scrutiny—or as urgent a need for reform—as long-term care. In Pennsylvania, one of the nation’s oldest and most populous states, that reform now has an institutional anchor: the Long Term Care Transformation Office (LTCTO).
Housed within the Pennsylvania Department of Health, the LTCTO serves as the state’s central mechanism for improving the quality, safety, and sustainability of long-term care facilities. Created in 2022 as a direct response to the vulnerabilities exposed by the pandemic, the office coordinates policy, funding, data collection, and provider support across nursing homes, assisted living residences, and personal care homes.
While its name suggests bureaucratic understatement, the LTCTO marks a substantive shift in how the state approaches elder care regulation. It is not simply a compliance watchdog, but a facilitator of structural change—working to raise standards while recognizing the operational constraints of a strained industry.
A System Under Pressure
Long-term care in Pennsylvania has long been defined by dual pressures: a rapidly aging population and a labor-intensive service model built on thin margins. The state is home to more than 700 nursing homes and over 1,200 assisted living and personal care facilities. Roughly 70,000 Pennsylvanians reside in skilled nursing facilities at any given time, while thousands more receive lower-acuity services in residential settings.
The pandemic exposed the weaknesses of this system. Staffing shortages, infection control failures, and outdated infrastructure contributed to disproportionately high mortality rates. Federal and state oversight was often reactive rather than proactive, and resources for continuous quality improvement were limited.
In response, Governor Tom Wolf’s administration proposed a dedicated office to guide systemic transformation. The result was the LTCTO—designed not just to regulate providers, but to help them meet higher expectations through support, data, and coordination.
Mandate and Mission
The LTCTO has a broad mandate. Its primary goals include strengthening infection prevention and control, supporting workforce development, improving clinical outcomes, and fostering person-centered care. These goals reflect both immediate operational needs and longer-term structural priorities.
To achieve these objectives, the office acts as a central hub—linking state agencies, long-term care providers, industry associations, and academic partners. It manages federal relief funds directed toward nursing home improvement, oversees pilot programs, and serves as a conduit for best practices and technical assistance.
A key part of the LTCTO’s mission is ensuring that policy reform is rooted in on-the-ground realities. The office has prioritized stakeholder engagement, holding listening sessions, conducting facility site visits, and establishing workgroups that include nurses, administrators, resident advocates, and infection preventionists.
Infection Control as a Starting Point
One of the LTCTO’s early priorities was strengthening infection control capabilities across long-term care settings. During the first year of operation, the office helped deploy infection prevention specialists to nursing homes throughout the state. These professionals provided training, conducted assessments, and supported facilities in implementing evidence-based protocols.
The LTCTO also manages the Long-Term Care Infection Prevention and Control (IPC) Readiness Review, a tool that evaluates facilities’ preparedness to respond to outbreaks. The review covers staffing, ventilation, PPE stockpiles, and surveillance systems. Facilities that score below threshold levels are offered follow-up support, rather than immediate penalty.
By coupling oversight with support, the LTCTO aims to build capacity rather than simply enforce compliance. The goal is to shift from a reactive model—focused on punishing failure—to a proactive model that fosters continuous improvement.
Funding and Strategic Investment
The LTCTO administers tens of millions of dollars in federal and state funding aimed at system transformation. These funds support a range of initiatives, from direct facility grants to workforce recruitment programs and technology upgrades.
One notable example is the Long-Term Care Quality Investment Pilot, which awarded grants to nursing homes to improve resident engagement, staff training, or clinical quality. Facilities used the funding for initiatives such as implementing electronic health record (EHR) systems, expanding dementia care training, and piloting restorative care programs.
The office also works to align funding incentives with measurable outcomes. Facilities that demonstrate improvements in specific metrics—such as reduced hospital readmissions or improved resident satisfaction—may be eligible for enhanced funding or technical support.
Workforce Stabilization and Retention
Staffing remains one of the most persistent challenges in long-term care, both in Pennsylvania and nationwide. High turnover, burnout, and wage competition from other healthcare sectors have strained the system’s ability to maintain consistent, high-quality care.
The LTCTO is developing a multi-pronged strategy to support workforce stabilization. This includes investing in CNA training programs, offering retention bonuses through grant programs, and supporting career ladder initiatives that allow aides to advance into nursing or administrative roles.
In partnership with the Pennsylvania Department of Labor & Industry, the LTCTO is also working to better align workforce development programs with long-term care demand. This includes collaborating with community colleges, technical schools, and workforce boards to create sustainable pipelines into elder care careers.
Data as a Strategic Asset
One of the LTCTO’s most transformative functions is its focus on data integration and performance tracking. Historically, data from long-term care facilities has been siloed—collected by different agencies for compliance purposes, but rarely used for strategic planning.
The LTCTO is working to unify these datasets, linking health outcomes, staffing levels, infection rates, and quality metrics. This approach allows for better identification of trends, early warning systems, and targeted interventions. Facilities that consistently underperform across multiple metrics can be flagged for additional support or inspection.
Public-facing dashboards are also in development. These tools aim to improve transparency for families, policymakers, and providers, while preserving necessary privacy protections. By making quality data more accessible, the office hopes to drive competition and accountability without imposing blanket mandates.
Regulatory Alignment and Federal Integration
The LTCTO does not operate in isolation. It coordinates closely with the Centers for Medicare & Medicaid Services (CMS), the Pennsylvania Department of Human Services, and the Office of the Long-Term Care Ombudsman to ensure regulatory alignment and program integration.
This coordination is especially important given the overlapping jurisdictions in long-term care. While the Department of Health licenses and inspects nursing homes, many facilities also receive Medicaid funding and are subject to federal survey requirements.
By creating a centralized transformation office, Pennsylvania is better positioned to streamline these oversight functions and reduce redundancy. The LTCTO acts as a liaison among federal and state actors, helping to ensure that initiatives such as the CMS Nursing Home Quality Strategy are adapted to local realities.
Challenges and Institutional Hesitation
While the LTCTO’s mission is ambitious, the road to transformation remains difficult. Many long-term care providers operate on razor-thin margins and struggle to meet even existing compliance requirements. Introducing new standards, metrics, or expectations—even with funding attached—can trigger resistance or fatigue.
There is also skepticism from some industry stakeholders who fear the office will eventually drift toward enforcement over support. Transparency about the LTCTO’s evolving role and consistent engagement with frontline staff are crucial to building long-term trust.
Workforce limitations further constrain progress. Even the best reform strategy requires trained staff to implement it, and Pennsylvania continues to face a shortage of nurses, aides, and clinical supervisors willing to work in long-term care settings.
Long-Term Bet on Systemic Reform
Despite these obstacles, the LTCTO represents a rare commitment to long-term system improvement in a sector more often associated with crisis management. It reflects a recognition that piecemeal reforms and reactive inspections are no longer sufficient.
By combining regulatory authority with programmatic support, data intelligence, and funding flexibility, the LTCTO aims to raise the floor of care across the state—while allowing room for innovation and local adaptation.
The office’s work is still in its early stages, and its long-term impact will hinge on continued investment, political support, and clear performance benchmarks. But if successful, the model could offer a blueprint for other states seeking to modernize elder care without dismantling the existing provider base.
Looking Ahead
The coming years will test the LTCTO’s ability to scale its initiatives and sustain momentum. Expanding its technical assistance network, improving access to performance data, and building a more resilient workforce will be central to its mission.
For Pennsylvania’s aging population and those who care for them, the stakes are high. If the LTCTO succeeds, it could help redefine what long-term care looks like in the post-pandemic era—not as a liability or afterthought, but as a pillar of public health infrastructure.