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SUMMER 2020

P E R S O N - C E N T E R E D

C A R E & C O V I D - 1 9

R E S O U R C E S

c o n s i s t e n t s t a f f i n g

i m p l e m e n t a t i o n : A "h ow t o "

g u i d e

Prepared by: Kansas State University Center on AgingPEAK 2.0 Team

[email protected]://www.hhs.k-state.edu/aging/outreach/peak20/

Consistent staffing has many benefits.Caregivers are better able to supportresidents by getting to know a smallgroup of residents really well. It also hasbenefits for infection control by reducingthe number of residents each staffmember interacts with on a day-to-daybasis. Most of us can stand behind theidea and value of consistent staffing, buthave a harder time making it happen.After years of working with homes toimplement consistent staffing, we nowhave a “how to” guide to help your teamturn this important operational approachinto reality.

SUMMER 2020CONSISTENT STAFFING:"HOW TO"

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I M P L E M E N T A T I O N :

A "HOW TO" GUIDE

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# 1 : C R E A T I N G W O R K A R E A S

The first decision to make is how you are going to divide your largerresident population and environment into smaller living and workareas. For example, if you serve 75 residents, you will need to decidehow to divide those residents into groups of less than 30 residentsbased on their physical location. How do you go about making thisdecision? Here are some proven strategies.

I N V O L V E S T A K E H O L D E R SKeep in mind your staff are already working in this environment andserving residents. It is highly likely that your staff teams already haveideas that could make this work. Often times, direct caregivers andother team members have already developed informal work divisionbased on groups of residents. For example, the daytime staff may splitup, two aides primarily work with Hall 1 residents, and two aidesprimarily work with Hall 2 residents. These are the natural workpatterns you want to identify. Working with patterns that already existand gathering direct input from those staff members who will carry outthe change generates buy-in and leads to greater operational success.

Some ways to gather input from staff are to schedule learningcircles and discussions with direct care staff. It is helpful to havemultiple meetings at different times of day to gather input from a widevariety of shifts and people. Another strategy is to meet with staffmembers one-on-one asking open-ended questions getting their input.

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SUMMER 2020CONSISTENT STAFFING: "HOW TO"

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L E A R N I N G C I R C L E E X A M P L E :LEADER'S OPENING STATEMENTS

It is important for us to start staffing consistently. The goal is to make ourwork areas (what area we cover) smaller with less than 30 residents. As we haveour discussion today, I encourage you to take specific people out of thepicture. Do not think about specific staff members and who will work where orhow residents will be impacted. We will discuss these important things later. Isuspect there are already ways that you divide your work amongst each other. Iwant to start the discussion with a question about that. What are some of thoseinformal work divisions here? i.e. Do you have a tendency to determine whoworks Hall 1 or Hall 2? A second discussion question/topic could be- tell usabout your thoughts on what would be the best way to divide in groups ofresidents less than 30 here.

A leader will want to start the discussions; however, the leader shouldfollow the learning circle guidelines and not interrupt or insert newideas or topics until everyone has been heard. The facilitator of thecircle should prepare for the learning circles by having some openingstatements and questions. The goal for the circle is to listen to thevoices of those that work closest with the residents and use theirinput and suggestions to make decisions about work area formation.

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INVOLVE STAKEHOLDERS (CONT...)

As you are determining a good number for each work area,part of this will be determined by the physical environment;however, also consider what is financially feasible to staff.For instance, if you get too small it is very expensive to staffthe area. We have learned that somewhere between 15 and25 residents is a very feasible number of residents to serveand be cost effective.

E X A M P L E # 1 :

WORK AREA 1= 22 ELDERS

WORK AREA 2=22 ELDERS


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W H A T I S T H E B E S T N U M B E R O F

R E S I D E N T S P E R W O R K A R E A ?

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#1

#2

E X A M P L E # 2 :

WORK AREA 1= 14 ELDERS (DEMENTIA SPECIALTY) WORK AREA 2= 22 ELDERSWORK AREA 3= 22 ELDERSWORK AREA 4= 16 ELDERS


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W H A T I S T H E B E S T N U M B E R O F

R E S I D E N T S P E R W O R K A R E A ?

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#1

#2

#3

#4


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W O R K A R E A S : P H O T O S0 7

STAFF WORK AREA AND LIVING SPACE WHERE THEFORMER LARGE NURSE'S STATION WAS LOCATED

RESIDENT ROOM CONVERTED TO A RESIDENT LIVINGAREA


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CLOSET CONVERTED TO ASTAFF WORK SPACE.

SNACK/DINING AREA IN A FORMER LARGE LIVING AREA


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RESIDENT ROOM CHANGED TO A SMALLER DININGAREA FOR RESIDENTS IN ONE WORK AREA

STAFF WORK AREA IN A RESIDENT LIVING/ACTIVITYSPACE FOR ONE OF THE WORK AREAS


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STAFF WORK AREA BUILTINTO A HALLWAY NOOK

SMALL STORAGE AREA IN AWORK AREA


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FORMER LARGE LIVING AREA CONVERTED INTO A DINING,LIVING, AND STAFF WORK AREA.

SMALLER LIVING AND HANG OUT AREA IN ONE OF THEWORK AREAS.


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# 2 : D E T E R M I N E S T A F F I N G N E E D S

F O R E A C H W O R K A R E A

Now that you have your work areas defined, you need to determinehow to staff them. At this point of the process, you need to partwith thinking about specific team members, scheduling conflicts andrequests, personalities, real life staff schedules, and residents. Thisis not the time to figure out how to accommodate Mary’s needs forTuesdays and Thursdays off for school, as an example. Our goal atthis stage is to identify what it will take to staff the work areas youhave defined.

F O R M A W O R K G R O U P

The next step is going to be to determine what type and how manystaff are needed each day and all hours of each day. For each work areayou just created, the goal now is to identify the number and type ofstaff needed to support each work area. Gather a work group andinclude a direct caregiver or two on this team. Once your work team istogether, set the stage. Tell them the goal (to identify what kind ofstaffing will be needed for each work area). Remind them that at thispoint of discussion, it is still important to not get locked into “how wedo things now” or existing scheduling patterns (that will come beforethings are finalized). Encourage your working groups to “get out of the box a bit. As youstaff these new work areas, people are likely going to need to workdifferently. Versatile workers may be a way to achieve consistentstaffing that you haven’t thought about. Versatile workers are teammembers who are expected to perform duties outside their traditionalrole on a regular basis. When moving into smaller work areas, changingexpectations so that each staff member is equipped to meet as manyresidents’ needs as possible enables the staffing to be more financiallyfeasible. Consider the versatile worker a tool in your toolbox to staffthe work areas within budget.

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When you are thinking of working differently, the more fluid andflexible your staff can be the more you can achieve for your residents.The goal is to train people with as many skills as you can up to theirlicense level. We have all been taught to believe that a nurse shouldnot run a vacuum because it is not fiscally responsible to have yourhigher paid staff doing this type of work. However, the idea is that weare paying people to do what the resident needs whatever it is.Throwing out this mindset and encouraging work outside of silos canhelp improve resident and staff satisfaction, which will help yourbusiness.

If you currently have 2 nurses, 4 aides, a bath aide, a restorative aid, ahousekeeper, activity director, social services, MDS nurse-- How could thosepositions be used differently? Are there qualified individuals who are currently in offices who could

be effective in the work areas?

Could the bath aide and restorative hours be converted to general aidhours and baths and restorative be a part of the general aid role in aspecific work area?

Could the MDS nurse hours be rolled into the nursing hours and thework area nurse be responsible for fewer MDS's and also do direct carenursing?

Are there efficient ways to share nursing hours between adjacent workareas while direct caregivers stay dedicated to a group of residents inone work area?


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A S C E N A R I O

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DETERMINE STAFFING NEEDS FOR EACH WORK AREA (CONT...)

What are the heavy care times?

When are times of day that take more help?

When are times that a majority of people like toget up? Eat? Take baths? Go to bed?

What is your current staffing pattern? FTEallotment (involve administration)

Do some areas have residents with higher carethan others (rehab, dementia care, etc.?)

Note: Involve not just nursing staff. Pull in housekeeping,social services, activities, office nurses, etc. These rolemay need to change to realize your overall goal ofconsistent staffing.

Remember to think of each work area as its own freestandingnursing home. What would it take to take care of the people init? Keep in mind, 75% of people/positions need to ONLY workin one work area. Only 25% of people/positions can workacross work areas (work in more than one work area).


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Q U E S T I O N S F O R T H E W O R K G R O U P1 4

E XAM P L E F O R O N E W O R K AR EA


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I'm able to get to know the residentsin a whole new way. I used to domostly paperwork and now I dopaperwork, but I also get to be withresidents and live life with them. -Work Area Nurse

For each newly defined work area, start with a blankschedule. How many people need to be there eachday? How many nurses on each shift? Aides? 7 days aweek, how many people need to be there on eachshift? (Keep in mind that the PEAK criteria does notexpect the same approach to consistent staffingovernight from 10 pm-6 am)

At this stage, it is important to know your budget andFTE allowance. Administration will need to be involvedin this part to really get the nuts and bolts in what isbudgeted. What do you have to work with? Your officestaff, your dietary, your nursing, SS, LE. What is thetotal budget? What can be put into the work areabudget? What will be shared with the wholeorganization? Remember the 75% and 25% (above) ruleand who is included in that calculation? (SeeConsistent staffing measurement spreadsheet).

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DETERMINE STAFFING NEEDS FOR EACH WORK AREA (CONT...)


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E X A M P L E S C H E D U L E T E M P L A T E

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Will everyone come in at the same time oneach shift and leave at the same time?

Will there be some staggering of shifts? Will people work every other weekend?

Now you have your ideal scheduling needs identified, it is time to blend in theindividual personalities, skills, and schedules. In plain language, now you haveto make a real schedule that divides staff members into work area teams,considers people’s availability, sorts through personal conflicts, considersresident relationships and deals with current job expectations changing. Thisis the part where we figure out these real life logistics!

Take the staffing needs you identified in Step 2 and create positions that realpeople would want to work. Avoid creating positions that you know will bedifficult to hire for or ask someone to work. Some approaches to consider asyou think about creating positions and scheduling templates:


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# 3 T I M E T O "G E T R E A L"

Will they work two weekends on and one off? What will make these positions desirable?

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Remember to check F838: Make updates or changes to yourfacility assessment as needed through the implementationprocess.

As you work with the FTE's you are budgeted anddetermine ways of rethinking positions, are therestill gaps? Is there a need to negotiate moreFTE's? Be very realistic here and only requestwhat you absolutely need. Do not make decisionsbased on keeping people in their silos ( e.g.“Nancy won’t leave her position as an MDS nursefor the whole building, so we have to keep her inher position”). Work to bring people along andwork through these issues as you get further intothe process.

B U D G E T

TIME TO "GET REAL" (CONT...)


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A note of experience: Once work teams are formed inspecified work areas, teams tend to become moreaccountable and fill open holes. For instance, whensomeone calls in, the positions get covered, peoplemay call in less because they have strongerrelationships with their team and coworkers.

The actual expenses may go up initially if thebase budget was never realized (i.e. call-insnever filled, positions not able to be filledduring turnover, etc.). In the long-run, however,evidence demonstrates that “getting small” and“consistent staffing strategies” result in betterretention of staff, improve resident satisfactionand improved census. And, with the improvedwork environment, you will be able to recruitmore staff.


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T R A N S I T I O N I N G T O W O R K

A R E A S

Now, you move to considering your real worldsituation and staff members. There will be a naturallearning curve that will occur and there are likely tobe compromises and challenges that have to beworked through. When deciding who will work inwhat work area, here are some ways you couldapproach it:

1 9 TIME TO "GET REAL" (CONT...)

Staff surveys: Each staff take a survey. Ask if thereare any people that they don’t want to work with,staff members you really want to work with? Anyresidents they would really like to care for? If youhave identified leaders for each work area, is there aleader that the staff person would like to work for?Do they want to work with residents who havedementia or not?

Get the leaders together: If you have leaders for thework areas, they should be heavily involved. Discussthe information that you have. Do you have someclear matches to positions on the template? Arethere gaps? This is where you might do individualnegotiations. Where is there conflict with thepreferences from the survey and the positiontemplate? Are there situations where you need totalk and compromise? Will seniority be used to makethose tougher decisions? Bring people in one at atime and get their perspective. Ask them morequestions about their preferences. If you see anopening that you really think they would fit well in,talk with them about it. (There is power in a topsupervisor approaching a person and identifyingskills they see that would make them really fittingfor a position.)

Make a test run: Start plugging people into thetemplate and begin determining when to launch intothe new model. Some homes set a specific date andhave a little launch party. Be prepared to work out the kinks in those first coupleweeks. Check in with people intentionally. Keep asking;What is working? What isn’t? Be willing to makeadjustments.


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T R A N S I T I O N I N G T O W O R K

A R E A S

2 0 TIME TO "GET REAL" (CONT...)

3&4063$&4 $3& $07*% 1&340/ $&/5&3&% · 803,"3&"4 1)0504...

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