When staff shortages in long-term care reach a level where it affects my quality of life I can no longer remain silent.

Much of the industry has yet to embrace the concept of PERSON-CENTERED CARE PLANNING (PCCP). It is interesting that the Federal Government has accepted the principle along with the obvious benefits to resident care that accompany it.

Central to this concept is the belief that the resident or responsible party is fundamental to voicing his/her preferences as to the care received. The government has made it an integral part of the annual inspection and nursing home certification process. The MDS (Minimum Data Set) 3.0 mandates certain policies, procedures, and questions to be asked of the resident if the long-term care facility is to participate in Medicare/Medicaid. Specific questions about the resident’s preferences as to his/her environment and quality of life.

Section F of the MDS 3.0 assessment includes, “Preferences for Customary Routine and Activities.” Questions like:

  • How important is it to you to listen to music you like?
  • How important is it to you to be around animals such as pets?
  • How important is it to you to keep up with the news?
  • How important is it to you to do your favorite activities?

I cannot emphasize enough that the resident or the responsible party read each line of the MDS assessment form and understand its significance in obtaining the necessary and desirable care.

An important aspect of the PCCP is the recognition of the resident’s need for stability in their daily routines. Staff shortage causes a disruption in the individual’s expectations and places the resident outside his comfort zone. Inconsistencies and repeated assignment changes have an adverse effect—often upsetting the resident for days at a time.

‘‘Minimum Nurse Staffing Ratios for Nursing  Homes.’’

CMS’s own study reported that facilities with staffing levels below 4.1 hours per resident day  (HRPD) for long stay residents may provide care that results in harm and jeopardy to residents (Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report, 2001, Abt Associates).                           16/pdf/2015-17207.pdf  pg 42200

A report by the National Association of State Units on Aging, published in 2005, entitled, ‘‘Nursing Home Abuse Risk Prevention Profile and Checklist’’ concluded that understaffing and inadequate training of NAs [nursing assistants] are major causes of abuse, especially for individuals with dementia.  pg 42224

Residents in a long-term care suffer through enough indignities each day. The changing of staff only worsens the condition. To have a constant parade of strangers come thru my room to attend to my daily needs, to help me dress, to help me shower, is unsettling, to say the least. I have my routine, a certain sequence of events, a certain way I prefer things to be done. I have to repeat my desires with each and every stranger from each and every department.

The regular staff knows:

  • What time I like to be awakened
  • What my morning medical requirements are
  • How I like my bed made
  • That I don’t like the overhead light left on
  • I like my door left open in the morning after I’m dressed
  • I like the bathroom door closed
  • That I drink a small milk and small prune juice for breakfast
  • That I want my personal coffee cup filled with only hot water in the morning
  • For lunch and dinner, I drink regular coffee
  • I provide my ice and cold drinks for my room and dislike being interrupted
  • Laundry personnel put my clothes away in the proper drawers
  • They know what time I prefer to go to bed

All the above contribute to my comfort and a feeling of contentment and control. My expectations are met.

Staff members working extra shifts to fill in for shortages can only result in a decline in the level of care residents receive. Three and four days of sixteen hours each increases the risk of injury to the resident, the staff, an increase in med errors, and a premature onset of employee burnout. It results in an unhealthy work environment. Nerves get frayed, tempers are short, and instances of resident abuse rise as does friction between employees causing more turnover.

A report by the National Association of State Units on Aging, published in 2005, entitled, ‘Nursing  Home Abuse Risk Prevention Profile and Checklist’’ concluded that understaffing and inadequate training of NAs are major causes of abuse, especially for individuals with dementia.

The research showed that nursing assistants in 10 Philadelphia-area nursing homes selfreported  [sic] abusive behaviors over a one month period. During this period,

51 percent reported yelling at a resident in anger;

23 percent insulted or swore at a resident;

8 percent threatened to hit or throw something at a resident;

17 percent excessively restrained a resident;

2 percent had slapped a resident; and

1 percent had kicked or hit a resident with a fist.    pg 42224

Administrations cover up understaffing by transferring staff from one unit to another. One such employee had her assignment changed three times in forty minutes. This just spreads the resident  and employee disruption and dissatisfaction throughout the entire population.

The following is a benefit analysis for proper staffing:

How Does Consistent Assignment Benefit Residents?

Residents do not have to explain to new caregivers how to care for them day after day.

Staff can respond to resident needs more quickly, confidently and naturally when they know the residents.

Residents are more comfortable with the intimate aspects of care when they know their caregivers.

Residents with dementia are much more comfortable with familiar caregivers.

Residents can have stronger relationships with staff.

Staff are more likely to detect residents’ clinical problems early when there is consistent assignment.

Residents have more choice and control.

Residents participate more in activities.

How Does Consistent Assignment Benefit Nursing Home Staff?

Staff members know individual resident’s preferences, needs and routines.

Staff give better care and can be more organized when residents and team members are known.

Having meaningful relationships with residents increases staff job satisfaction.

Staff absenteeism decreases.

Staff have more positive attitudes.

How Does Consistent Assignment Benefit Nursing Homes?

Nursing homes have better staff and resident satisfaction.

Nursing homes have better quality measures and fewer survey deficiencies.

Nursing homes have fewer family complaints.

Nursing homes have decreased staff injuries.

Nursing homes have lower staff turnover and absenteeism, which help reduce costs.

It’s difficult to understand why, with the positive gains to be made by proper staffing, that understaffing continues to be a chronic problem in long-term care. Prolonged staff shortages and high turnover are a direct result of the administration’s mismanagement and their lack of concern for the care and well-being of their residents and their employees.



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  1. Another good blog, Bob.
    I think under staffing is a widespread problem in nursing facilities. Not sure if it is due to inability to find qualified help, or poor compensation and benefits. The place my Mom is at seems to be good. There are several staff members who have been there twenty or thirty years. In talking with one of the NA’s I learned that they are unionized and have good benefits and a pension. If nursing homes want to attract good, qualified employees then they would do well to offer these types of benefits to their employees. Unfortunately, the place where my Mom is at is in bankruptcy. Hoping they won’t close the doors.

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