TIP OF THE WEEK

Consistent assignment

 

“The true cause of burnout is the deadening effect of closing one’s emotions to people who are in obvious need of a human connection. Human life is sustained by affection.” – Dr. Bill Thomas, Eden Alternative

 

Building strong relationships between residents and staff in order to improve resident quality of care and quality of life is at the heart of consistent assignment.

 

WHAT IS CONSISTENT ASSIGNMENT?

Consistent assignment (also called primary or permanent assignment) refers to the same caregivers consistently caring for the same residents almost every time they are on duty. The opposite of consistent assignment is the practice of staff rotation, where staff members move from resident to resident throughout the nursing home each day. Nursing homes that adopt consistent assignment rarely rotate their staff.

 

HOW CAN CONSISTENT ASSIGNMENT HELP NURSING HOME RESIDENTS?

It is much easier for staff members to build relationships with residents and care team members when employees are assigned to take care of the same residents every day.

 

Since everyone is different, staff members that are asked to rotate to new residents regularly have to learn the wants, needs, and daily schedules of a new resident each day. These constant changes are difficult for both residents and staff. It makes it difficult for staff members to anticipate residents’ needs, understand nonverbal communication from residents who have trouble communicating, or create a comfort level for intimate, personal care. Residents find it difficult to have strangers caring for their intimate needs and get frustrated with explaining their needs time after time to new caregivers.

 

In a recent national Webinar, David Farrell, a national expert on culture change and workforce retention, estimated that 80 percent of U.S. skilled nursing facilities rotate staff from one group of residents after a period of time. Rotating staff report that they feel burned out some of the time, that they sometimes treat the residents impersonally, and that they have become hardened emotionally, Farrell stated.

 

THE GOALS OF CONSISTENT ASSIGNMENT ARE TO:

• Strengthen relationships among those who live and work at this nursing home
• Stabilize staffing through increased job satisfaction
• Improve quality of care by improving stability and familiarity in caregiving

CONSISTENT ASSIGNMENT AND QUALITY CARE

According to Farrell, healthcare organizations are “fragile ecosystems,” where the leaders’ actions influence such things as the culture of the organizations, the nature of relationships, staff retention, as well as quality of life and clinical outcomes for the residents. Studies have repeatedly confirmed that residents and their family members value the quality of the relationships they have with the frontline caregivers higher than the quality of the medical care and the quality of the food.

 

CONSISTENT ASSIGNMENT AND WORK-RELATED STRESS

Farrell cited one culture change implementation where staff members from different units (some with consistent assignment and some with rotating staff) were asked to identify job stressors. In general, staff from consistent assignment units cited stressors like preventing falls, stubborn residents, terminal residents, depressed residents, and death. Rotating staff cited similar issues, but included more additional stressors such as low wage, abusive residents, heavy workloads, disagreements with coworkers, and lack of staff.

 

PERSON-CENTERED CARE

Consistent assignment is a care practice that is endorsed in the nursing home culture change movement because it creates an environment where staff members and residents build meaningful relationships. Consistent assignment is supported by such groups as culture change organizations (Pioneer Network, Eden, LEAP, Action Pact), the Centers for Medicare & Medicaid Services (CMS), Paraprofessional Healthcare Institute (PHI), National Commission on Nursing Workforce for LTC, Quality Improvement Organizations (QIOs), and the Advancing Excellence in America’s Nursing Homes Campaign.

 

To learn more about implementing person-centered care practices in Ohio nursing homes: Go to www.centeredcare.org

 

Download a flyer with this information (PDF) >>

 

 

 

 

 

 

IN THE NEWS

 

HOLIDAYS AND AGING: SOME TIPS FROM GERIATRIC SPECIALISTS

November 28, 2007 - - University of California, San Diego Health Sciences - - The joys, charms, chaos and confusion of family life during the holidays can be very positive or highly stressful, with older family members who are frail or ill particularly susceptible to negative consequences if emotional, mental or physical health needs are not taken into account. Specialists in senior medicine at the University of California, San Diego (UCSD) School of Medicine offer some simple tips to help ensure that elderly family members with underlying health issues enjoy the season. Read more >>

 

MEDICARE CHIEF IS 'SECRET SHOPPER' OF INSURERS

November 27, 2007 - - MSNBS - - To get a better feel for the marketing practices of private insurers, Kerry Weems, Administrator for the Centers for Medicare & Medicaid Services (CMS), ordered senior CMS staff to surreptitiously attend agents' presentations to seniors and the disabled. They call it the "secret shopper program." Read more >>

 

MANAGING THE CHRONIC CARE OF PATIENTS IS NOT BEING CAPTURED IN TODAY’S REIMBURSEMENT SYSTEM

November 19, 2007 - - Mount Sinai Medical Center - - Full-time physicians spend an average of one full day a week providing services for patients that are not reimbursed by Medicare, according to a new study conducted by Jeffrey Farber, MD, Assistant Professor of Geriatrics at The Mount Sinai Medical Center, and published today in the journal Annals of Internal Medicine.

 

The study results could potentially prod insurance companies and Medicare to catch up to physicians’ current levels of productivity by reimbursing them for the care that is increasingly taking place outside of formal office visits. Read more >>

 

RADIO WAVES FIRE UP NANOTUBES EMBEDDED IN TUMORS, DESTROYING LIVER CANCER

November 3, 2007 - - Science Daily - - Cancer cells treated with carbon nanotubes can be destroyed by non-invasive radio waves that heat up the nanotubes while sparing untreated tissue, a research team led by scientists at The University of Texas M. D. Anderson Cancer Center and Rice University has shown in preclinical experiments. Read more >>

 

 

INDUSTRY EVENTS

 

December 13, 2007, 2:00 p.m. -- CMS SNF/LTC Open Door Forum
Dial: 1.800.837.1935 Reference Conference ID: 18787698

 

Cuyahoga Community College Fall 2007 Calendar:Continuing Education for Gerontology Professionals

 

Medicare Learning Network:Learning resources and products for the healthcare professional.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Ohio Department of Health, Technical Assistance Program – New Programs

 

Ohio Health Care Association Events

 

 

 

An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>