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Long-Term Care Survey Alert

MANAGEMENT:

Don't Leave Your Facility on Shaky Ground: Take Steps to Stabilize Staffing

Published on Mon Apr 20, 2009

Find out why and how to vanquish this serious problem.

Whether you're on a journey to culture change or seeking to make other quality improvements, achieving stable staffing may be just the ticket. A Centers for Medicare & Medicaid Services' pilot involving 254 nursing homes led to that conclusion.Some of the facilities in the pilot wanted to move forward with culture change while others were looking for ways to improve their workforce retention, reported consultant Barbara Frank in an Advancing Excellence in America's Nursing Homes webinar on staffing. But the facilities all found that if they stabilized their staffing, they saw a significant reduction in pressure ulcers and restraint use. So "whether you're looking to move forward in culture change or quality improvement or get better survey results or a better bottom line -- staff stability is key to it all," emphasized Frank.

In another CMS-funded study, researcher Susan Eaton looked at why nursing homes in the same neighborhood drawing from the same labor force had very different staff retention levels, Frank reported.

The study found that high turnover created a "vicious cycle" of instability that "feeds off itself," Frank said. That's because the facility has people working with inadequate staffing, and brings in people who are tired, as well as agency staff who don't know their way around. And that leads to stress, resentment, poor judgment, injuries, and people quitting, Frank cautioned.

The bottom line: Staffing instability "sucks your resources and energy out of you," Frank cautioned.

Consider Practices That Promote Staffing Success

In the study, Eaton found that in nursing homes with low turnover, good attendance, and high performance, the human resource policies "reflected ways to support people," Frank reported in the webinar. Attendance policies proved to be a key example. Nursing homes with high turnover had rigid attendance policies and perceived favoritism, creating lack of trust among staff, Frank noted. Yet, those with low turnover held people accountable for good attendance, but also helped them find a way to be there.

Managers in the facilities with solid staffing also "walked the walk" where they didn't just provide inservicing on team work -- they actually went on the floors to answer call bells and help out, Frank reported.

Toolkit Helps You Drill Down

Facilities that want to finally turn around their high turnover -- or simply "tweak" a system that's working well -- can use the Quality Partners of Rhode Island's staffing stability toolkit, available on the QIO's website (www.riqualitypartners.org),Frank suggested. (For more information on accessing the toolkit, see "resource" at the bottom of the staffing assessment tool on page 38 of this issue.) The toolkit helps a facility figure out its staffing problems, their causes, and come up with targeted interventions. It includes nine worksheets, including ones that help facilities examine their current staffing composition, current staff by length of service, turnover rates, absenteeism, etc.

Ask and let the numbers speak: Two strategies included in the toolkit can identify why staff may be leaving. One is to simply ask people, including past employees. Try to get a feel for the stress points in the job,advised Frank. And you can look at the fiscal data combined with staffing information, such as staff composition, length of service, and when people leave --is it the first week or six months? Do you have too few people working full-time and too many in part-time positions managing their own hours? You may find you have too many part-timers filling in as supervisors, leading to lack of continuity and poor CNA stability, Frank noted.

Also look at the facility's absenteeism rates and the cost of turnover.Drill down to figure out how fiscal incentives might be contributing to the dismal staffing picture. For example, the administration may see that the facility should pay a retention bonus rather than a sign-on bonus if people are taking the latter and leaving the job.

More questions: Are you investingin resources that reward and encourage longevity and reliability?

Some administrators ask why they should reward attendance when people are supposed to come to work, Frank noted. But if you have to pay extra for last-minute assignments,you are rewarding people for deciding when they come to work, she pointed out.

Also: If you send someone home for the day because the census is low, you may save $80 that the employee counts on to make ends meet, Frank cautioned. But when that person finds a more reliable job, the facility has lost $2,500 in turnover costs.

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