January 18, 2019
Federal regulations and consumer demand for higher quality long-term care (LTC) services have been the impetus for rethinking the way care is being delivered. Additionally, growing concerns about having sufficient numbers of appropriately prepared staff have forced administrators to consider interventions to improve recruitment and retention of certified nursing assistants (CNAs) beyond issues of pay.
Several researchers have been identifying how to bridge the gap between the demand for aging services and the availability of staff, understanding how the nursing home environment needs to be adapted to meet the needs of the employees, not just the residents. In order to ensure quality of care, there must be a stable, competent work force that feels supported by the facility, therefore patient-centered care must first begin with examining how frontline staff are recruited, in-serviced, supervised and disciplined.
In 2018, Michelle L. Oppert, Valerie J. O’Keeffe and David Duong investigated how the social and emotional skills of direct care staff impact the provision of services to older adults in Australia (Geriatr Nurs. doi:10.1016/j.gerinurse.2018.05.004), however many of the issues they identified are similar to those seen in LTC facilities in the United States. These issues are primarily related to the lack of understanding about what “person-centered care” actually means, how to practically deliver these services, how to ensure there is sufficient staff to promote resident choice, the degree of mastery the employees feel regarding the care of severely cognitively impaired residents, and staff ability to handle negative behaviors such as combativeness and aggression.
Administrators of LTC facilities will need to ask the follow questions: (1) What do staff members understand person-centered care to mean for direct care employees; (2) what are the barriers that currently exist in the facility that prevent staff from providing person-centered care; and (3) what education and support is required for supervisors and department heads to ensure the community has sufficient knowledge about implementing person-centered care.
A starting point in this process is to conduct individual or small group interviews of staff using open-ended questions, such as:
- What are some of the positive and negative aspects of your work?
- What do you understand person-centered care to mean in this environment?
- In what ways would you anticipate your work being altered by person-centered care?
- Do you feel you have sufficient knowledge and support to take care of a resident with severe cognitive impairment and behavioral issues such as aggression?
- Do you feel others around you, in other departments or at different levels in the nursing department, have an understanding about how you perform your work?
- What issues do you think may be barriers in your ability to deliver person-centered care?
- What interventions are important to make sure that staff are motivated to work here?
The ability of staff to feel mastery over the tasks they perform in the facility will likely be altered by the increasing demands for problem-solving skills, communication, and teamwork—skills that generally are not addressed during mandatory in-service education. Facilities will need to rethink how this education can be implemented into existing staff training as well the changing roles of supervisory personnel in demonstrating how and why person-centered care matters.
Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, has been practicing nursing for 33 years, specializing in the care of geriatric patients. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration.
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