Depends on the area. I'd agree with owlegrad that it's not as fierce as general institutional, but there's two or three possible flavors (Nursing Home and Hospice can be together or separate depending on how the state classifies them):
Long-Term Acute Care (Kindred is the archetype): Where Physicians' Mutual patients spend the rest of their lives due to critical mistakes as well as hospitalizations that take more than 90 days due to patient complications or long-term recovery. You deal less with crash cart sorts of problems and more with parenteral nutrition, nosocomial infection, pain control. I have a high respect for their pharmacists as they run the gamut from inpatient to rehab and are shorter-staffed than a standard STAC for the patient load.
LTC with Nursing Home-Rehab/Hospice (inpatient and outpatient): I think you know the general patient population by now. Lots of note writing and progress notes for JC. Hospice could be contiguous with Nursing Home or separate, I find that the hospice work to be some of the most humanizing in the profession. Must be willing to go beyond evidence-based medicine as very few of the hospice remedies are evidence-based. Depending on the setup, this can range anywhere from the LTAC sort of inpatient setup to the closed-shop outpatient. There's also consultant work for the JC note writing that's freelance work if you can set it up. State statutes and regulations for each make the practice quite variable between states, so while your skills in one state will matter, there's more to pick up when you move states. WA and OR allow for euthanasia, which makes hospice trickier as there are specific protocols to follow with major consequences for deviation, AZ, MN, and IL don't which makes hospice practice easier on that regard, but have much more complicated interpretations on rescue therapy.
Personally, if you have worries about hours, I'd consider working LTC full time and locum for retail PRN. It's a good career with a practice site that is not as volume conscious as retail.
