Originally published in the January edition of New England Administrator.
The marketing of long-term care (LTC) services is important to the overall US healthcare system, enabling LTC providers to reach those who need assistance, their families, and especially other healthcare professionals in the community. However, ethical concerns frequently arise. These concerns include the integrity of promotional materials and how marketing and sales influences decision-making, patient outcomes, and the overall quality of care. The stakes are high; the populations served are the vulnerable elderly, those with chronic conditions or disabilities, and those who depend on these services for their well-being and quality of life. And the penalties for failure to comply with regulations – or the promises you make – can be loss of business, loss of reputation, brand damage, litigation as well as financial penalties.
The Role of Marketing in Long-Term Care
For the sake of this discussion, long term care providers include nursing homes, assisted living residences, memory care centers, and home health agencies. These providers offer a range of services designed to help individuals who are dependent on certain activities of daily living (ADLs). Given that many people who require long-term care are elderly or facing significant health challenges, marketing efforts play an essential role in informing families and patients about their options. Providers must not only communicate the services they offer but also manage expectations among the organizations and individuals they serve. Remember, it’s nor what you say, it’s what they hear that matters.
“Marketing” is usually thought of as advertisements, brochures, websites, social media and direct outreach efforts like email marketing. Marketing is much more than that. The textbook definition is:
Marketing is the management of the company/customer interface and includes everything that may have an impact on customer understanding, perception and willingness to purchase the product [service] on offer.
Sales, on the other hand, refers to the interpersonal and behavioral activities associated with securing agreement and influencing current or future behavior. A primary goal of marketing is to create awareness of, and preference for what you offer, being transparent about the services and amenities, then sales facilitates informed decision-making. While there is nothing inherently unethical about marketing or selling these services, the approach and messaging must be thoughtful, transparent, and sensitive to the ethical concerns inherent with offering care to vulnerable individuals.
You can sell your services without selling your soul!
Ethical Issues in Long-Term Care Marketing
Several ethical issues in LTC marketing are particularly concerning. These include the accuracy of information, the manipulation of emotional appeals, the targeting of vulnerable populations, and the potential for exploitation. Each of these issues demands attention to ensure that marketing tactics align with the interests of providers, patients, families, and communities while maintaining respect for the dignity of individuals who need care.
Accuracy and Transparency
One of the most critical ethical concerns in LTC marketing is ensuring that the information provided is accurate and transparent. Long-term care providers must be honest about the services they offer, their availability, the quality of care and the costs involved. False claims or misleading statements can not only violate consumer protection laws but can also lead to significant harm to individuals who may make decisions based on inaccurate or incomplete information.
For example, a classic phony claim is when a nursing home offers a “home-like environment”
or when a home care agency claims to “treat every patient like family.” These claims stretch credulity and lead inevitably to disappointment of the expectations they created. This friction negatively impacts patient care, staff morale and well-being. Additionally, some providers might understate or completely omit important information about their services shortcomings, such as staffing levels or quality control practices, which are key indicators of the level of care the individuals will receive.
The true cost of care is another important dimension. Many families land in financial distress after enrolling a family member at a center or in a service that either charges more than they anticipated or imposes additional hidden fees. Transparent pricing and clear information about billing practices are necessary to build trust and help families make informed decisions.
Emotional Appeals
Families and individuals seeking long-term care are in highly emotional and stressful situations. The use of emotionally manipulative marketing messages, depending on their content, are an ethical concern at least and abusive at worst. Themes such as comfort, security, and peace of mind are usual, and these messages are understandable, but there is a fine line between providing reassurance and manipulating emotions.
Feelings of guilt or fear may drive decisions, but they’re manipulative and dangerous. For example, advertisements that feature heart-wrenching images of elderly individuals or emphasize the dire consequences of not choosing a particular provider can lead to hasty and potentially misguided decisions. Marketing messages that tap into anxiety over aging, disease, or death exploit vulnerable emotions rather than provide constructive guidance in a time of agitated need.
An ethical marketing tactic focuses on providing useful, factual information while respecting the emotional weight of the decisions families are making. For-profit hospice providers are particularly at-risk in this regard and, in my experience, too often guilty. When discussing issues related to aging, memory loss, and terminal illness, empathy must be balanced with respect. (2)
Targeting Vulnerable People & Situations
A critical ethical issue in direct-to-consumer LTC marketing is the targeting of vulnerable populations, particularly the elderly, individuals with disabilities, and their families. These individuals are often in a state of psychological upset, emotional, financial, and physical vulnerability, which makes them more susceptible to manipulative marketing tactics.
Some LTC providers exploit this vulnerability by targeting seniors with limited cognitive ability or by using misleading messaging to persuade them to choose their services. For example, ads that promise “luxury” services or promote amenities that don’t really exist are an unethical attempt to take advantage of those who may not be able to fully comprehend the implications of these promises. This results in individuals and families finding themselves in environments that disappoint and create more upset, in addition to not meeting their needs.
Some LTC providers may target those who do not require care. Families may be in crisis or under stress and may not have the time or expertise to thoroughly research their options. In such cases, the provider might attempt to push a decision that is not in the best interest of either the patient or the provider. Families may be presented with “too good to be true” promises, leading them to make decisions that prioritize cost savings or appearance over quality care.
Ethics & The Profit Motive
Most of the nursing centers and homecare agencies in the US are for-profit organizations. Profit motive in long-term care marketing can lead to conflicts and ethical issues when providers prioritize financial goals over the well-being of residents, clients or patients. In some cases, providers overstate the quality of their services or underplay the importance of staffing levels, safety protocols, and patient outcomes in their marketing materials. Other providers, focused too heavily on profit, may cut corners in care or become more interested in attracting new customers than ensuring the health and safety of current customers, clients or patients. Recent high-profile media stories about Steward Health show how these profit-related motives can hurt patients, employees and entire communities, in addition to badly damaging the organization’s brand.
In long-term care, assisted living in particular, this profit focus can lead to a conflict of interest where marketing materials focus more on amenities (e.g., luxurious rooms, attractive décor, recreational activities) than on the true indicators of quality care (e.g., staff levels, active lifestyle, training, infection control, resident satisfaction). When providers overemphasize amenities or aesthetics in their marketing, it could mislead families into thinking these factors are more important than the core elements of care that ensure health and safety of guests and staff.
The Damage of Deceit
In the classic, Nicomachean Ethics, Aristotle emphasized that virtue (ethical behavior) is above all practical and not altruistic. Being ethical produces a host of benefits for both the person and the community. Unethical practices and marketing are extremely damaging to providers’ brands. Since the reputation or brand of any long-term care provider is typically generated and perpetuated by word-of-mouth, once unethical, deceitful or poorly managed expectations become public, the negative news – and therefore the damage – travels far faster than any positive news. In the face of negative experiences working with a long-term care provider, professional referral sources, families and friends tell twice as many people as those who have positive experiences with the same provider. The bottom line is that bad news travels fast, and unethical behavior almost always damages the provider’s reputation and therefore their brand.
Balancing Ethical Considerations
LTC providers must strike a balance between promoting their services and adhering to ethical marketing practices. Providers should ensure their marketing tactics focus on transparency, honesty, and respect for vulnerable populations. Marketers and sales staff must be mindful of their responsibilities to not exploit emotional vulnerability, manipulate decision-making, or mislead potential clients. At the same time, providers must focus on delivering high-quality care and fostering trust with patients and families.
In conclusion, while marketing and sales tactics are essential for long-term care providers to reach those in need of services, they come with significant ethical obligations. Providers must navigate the ethical complexities of marketing and selling with integrity, transparency, and respect for their clients’ needs and emotions. In this way, long-term care operators ensure they are truly serving the best interests of their residents, clients, patients and staff, while promoting a reputation built on trust and ethical business practices.
To secure intelligent answers to your questions about ethical marketing & sales, contact Stackpole & Associates: istackpole@stackpoleassociates.com or call +1-617-719-9530
- OpenAI. (2024). ChatGPT 4.0 Pro (November 25, 2024) [Large language model] was used in drafting this article.
- For an excellent review of how to use effective marketing & sales without “smuggling” inappropriate emotions, see, Cialdini, R. Influence: The psychology of persuasion.
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