Staffing: A Basic Yet Often Overlooked Component of Quality Care

Around the country, eldercare advocates are calling for improvement in nursing home quality and a deep and meaningful demonstration of person-centered supports and services. But this is not an easy task given today’s complex nursing home resident and the ever-increasing focus on the short-term rehab client. Providers respond with the best of intentions by developing new systems, implementing culture change models, and renovating buildings, only to find that consistent quality continues to elude them. All too often, the most basic element and answer is overlooked: Staffing.

Sufficient staffing to meet a resident’s person-centered needs is the linchpin of quality in any long-term care organization. There is an undeniable correlation between sufficient staffing, workplace culture, and quality measures. This correlation is a central focus of the recently updated Nursing Home Compare Five Star Quality Rating system.

Staffing has been elevated in importance in the Nursing Home Compare system; payroll-based staffing reporting will be used in its calculations by the end of 2016. Through the payroll reporting system, staffing numbers contributing to the rating will be able to be pulled at any time, providing a more accurate picture of staffing numbers and effectively disabling the possibility of the staffing star rating being based upon “staffing up” during survey.

In addition to directly affecting the Five Star Rating system, sufficient staffing also impacts the other quality measures that contribute to the number of stars awarded. Whether you are looking at pain, pressure ulcers, or antipsychotic medications, staff who are knowledgeable and able to consistently follow the plan of care will determine the outcomes of those quality measures. Simply put, a sufficient number of staff with strong caregiving and communication skills is the best asset an organization can have. Sufficient staffing impacts the workplace culture and the relationships, which in turn can affect staff turnover, the consistency of the care provided, and the stability of the workforce.

With the increased attention on staffing and the profound impact it has on quality person-centered care, systems must be developed to assess individual nursing homes’ population for correct staffing. The unique care needs of each elder must be considered and will ultimately determine sufficient staffing numbers.

Providers should also consistently consider staffing as a possible cause of adverse outcomes. By incorporating the topic of staffing in the QAPI process and regularly inquiring into how staffing correlates to quality, providers can gain a more complete picture that will help support a successful quality-improvement process.

— by Cean Eppelheimer, PHI Organizational Change Consultant