Long-Term Care Survey Alert

The key is to be up-front about the approach.

Not all residents act out equally or at all with every staff person. Thus, by simply mixing and matching staffing assignments, you may be able to head off staff complaints about being harassed by residents.

For example, consider providing same-gender or same-race staff to care for a resident who harasses staff of the opposite gender or of a different race, suggested attorney Joanne Lax, in a presentation on the issue at the recent American Health Lawyers' Long-Term Care and the Law conference in New Orleans.

Important: If you take this step, be sure to discuss selective assignment with staff and/or the union in advance to avoid allegations of discriminatory assignment on the basis of race or gender, Lax cautioned.

A primary CNA model in which CNAs select their own assignments and focus on developing rapport with a particular resident is another option. Steven Littlehale, MS, APRN, BC, implemented that model in a long-term care facility and found it worked well for caregivers and residents alike. When CNAs were empowered to select their own residents, "we discovered that one person's 'difficult resident' was another CNA's favorite," says Littlehale. (For details about the model, see the previous issue of LTC Survey Alert, which is available through the free Online Subscription System. If you haven't signed up, call 1-800-874-9180.)

Tap the power in numbers: Multiple staff assignment may, in some cases, help control a physically combative resident or defuse an adversarial environment created by a resident who fabricates abuse or error against certain caregivers, Lax noted.

Also provide staff sensitivity training to help them empathize with a resident struggling with disabilities and a loss of home and autonomy.

Case in point: Katy O'Connor, MSPT, reports being in one Florida facility where CNAs spent one night in the nursing home during their first week on the job. The CNAs could only get up to use the bathroom if they used the call bell. They also wore marbles in their shoes, mittens on their hands -- and donned goggles with petroleum jelly. Meals consisted of pureed food and thickened liquids. As a result of their overnight stay, "the CNAs were much more 'in tune' with the residents, which always increases the quality of care," says O'Connor, a consultant with Zimmet Healthcare Services Group in Morganville, NJ.