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MPRO, Michigan’s Quality Improvement Organization, has produced a video on the benefits of the consistent assignment staffing model that more nursing homes are using to schedule their staff.

The video features interviews with staff and residents from three facilities in Michigan that are using consistent assignment, which helps to strengthen relationships between direct-care workers and consumers and leads to better care and less turnover.

“Without the opportunity to form close relationships and a system that protects the continuity of the relationships, person-centered care and sustainable culture transformation cannot occur,” said PHI Organizational Change Consultant Cean Eppelheimer.

“Being well-known within the community through the practice of consistent assignment is fundamental to quality person-centered eldercare and underlies the development of a more meaningful workplace,” Eppelheimer continued.

According to Advancing Excellence in America’s Nursing Homes, a national campaign aimed at improving the quality of nursing home care, consistent assignment (pdf) means that residents see the same caregivers (registered nurse, licensed practical nurse, or certified nursing assistant) almost every time they are on duty.

“Nursing homes that begin using consistent assignments might have to change the way they manage staffers,” said Mary Jane Koren, MD, chair of the Advancing Excellence in America’s Nursing Homes Campaign and vice president at the Commonwealth Fund.

“After the initial startup, they often find the new way is a better way: They often catch medical problems in the early, treatable stages,” Koren said. “In the end, nursing homes that adopt consistent assignment reduce staff turnover and work to improve other quality measures gain something priceless: They’ll have a facility that fosters strong relationships between caregivers and residents, and offers the highest standard of care.”

– by Deane Beebe

The newest additions to PHI’s National Clearinghouse on the Direct Care Workforce:

Attracting and Retaining Talent: Frontline Workers in Long-Term Care — This March 2011 report explains the Jobs to Careers program, a model of in-service trainings designed to advance the skills of direct-care workers. The program has been implemented in Hartford, Connecticut, and Portland, Oregon. The report presents a list of next steps and recommended goals to improve state and federal policies relating to direct-care worker training. Jobs to Careers is managed by the national nonprofit Jobs for the Future.

The Ties that Bind: Consistent Assignment Gives Residents a Sense of Security, Family — This article, published in the June 2011 issue of Provider, examines the use of consistent assignment in long-term care facilities. It explains why consistent assignment benefits residents, caregivers, and supervisors. The article further suggests ways to most effectively implement consistent assignment in a nursing home or other facility.

House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing — This fact sheet examines the likely consequences of a Republican-led proposal to convert Medicaid into a block grant and repeal the Patient Protection and Affordable Care Act. The authors predict that the Republicans’ plan would lower federal Medicaid spending by 34 percent — a reduction of $1.4 trillion — between 2012 and 2021. Nursing homes would be enormously affected by the cuts, the authors note, since Medicaid accounts for more than 40 percent of the country’s nursing home spending. The fact sheet was published by the Kaiser Commission on Medicaid and the Uninsured.

Implementing Transformational Leadership in Long-Term Care — This article explains the concept of “transformational leadership” (TL), an approach to management that emphasizes the importance of treating workers as individuals: considering their needs, stimulating them intellectually, motivating them by using positive feedback, and acting as an aspirational role model to promote desired behavior. The authors posit that TL would help to reduce turnover, improve quality of care, and increase job satisfaction when applied to long-term care settings. The article appeared in the May/June 2011 issue of Geriatric Nursing.

PHI’s National Clearinghouse on the Direct Care Workforce is a national online library for people in search of solutions to the direct-care staffing crisis in long-term care. It houses over 1,000 articles, reports, issue briefs, and fact sheets on the direct-care workforce.

– by Matthew Ozga

Mary Jane Koren

Modern Healthcare‘s August 16 issue features a commentary on the many ways that consistent assignment benefits nursing homes and residents, written by Mary Jane Koren, M.D., M.P.H., chair of the Advancing Excellence in America’s Nursing Homes campaign.

Koren, a geriatrician and vice president at The Commonwealth Fund, explains in “Predictable Scheduling: Nursing Homes Can Boost Quality, Bottom Line with ‘Consistent Assignment’” that when a nurse aide routinely cares for a nursing home resident, it improves the quality of care and is cost-effective.

Relationship between Consistent Assignment and Quality

Consistent assignment is one of the targets identified by Advancing Excellence in America’s Nursing Homes, a national campaign to improve the quality of nursing home care. Participating nursing homes set quality targets, and the campaign provides tools to measure progress and achieve goals.

The campaign data shows that nursing homes that have made inroads in improving quality outcomes are often facilities “with low staff turnover and…rely on consistent assignment,” Koren writes.

For example, she explains that when an aide develops a relationship with a resident through consistent assignment, the use of physical restraints can decrease and the development of pressure ulcers can be reduced. Ongoing relationships allow aides to observe and report potential medical problems, thus reducing costs.

Since residents rate relationships with caregivers as important, Koren says that nursing homes that employ consistent assignment have a “competitive edge in a tough market.”

“The PHI team has coached many nursing homes to implement consistent assignment,” said PHI Director of Training and Organizational Development Services Susan Misiorski.

“I can’t emphasize enough how critical this practice is to ensuring high job satisfaction, high resident satisfaction, and quality care outcomes,” Misiorski said.

Case Study on Consistent Assignment

Consistent assignment is one of the practices featured in a recently published PHI case study that highlights the outcomes achieved by the Edgewood Centre in Portsmouth, NH.

– by Deane Beebe