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A framework to inform staffing models for long-term care facilities in resource-constrained contexts
Emerentia C Nicholson1, Mariana M Van der Heever1, Cornelle Young1
1Stellenbosch University, Francie van Zyl Drive, Department of Nursing and Midwifery, Cape Town, South Africa.
Background:
Global human resource shortages exist, and long-term care facilities for older persons may struggle to implement a nurse and caregiver staffing model while balancing quality care and cost-effectiveness.
Aim:
To develop a framework to inform staffing models for long-term care facilities for older persons in resource-constrained contexts.
Design And Methods:
A multi-method approach was used, including a scoping review of the literature, interviews with nurses and caregivers, and a document review. For the scoping review, we searched four databases, yielding a final sample of 20 studies. We selected 19 nurses and caregivers through purposeful sampling and interviewed them at one private for-profit and one state-subsidized long-term care facility. Documents were also purposefully sampled from these two facilities, resulting in a final sample of 45 documents. The findings were triangulated to develop a framework, and six purposefully selected panel members (social workers and registered nurses) with extensive experience in LTCF management and elderly care validated it through an online panel discussion by assessing its trustworthiness and applicability to real-life situations.
Results:
Four processes were identified as essential for sound implementation of staffing models: Optimizing staffing levels, Enhancing skill mix, Applying sound staff allocation practices, and Valuing healthy workplace cultures.
Conclusion:
Efforts to meet staffing requirements and stay within budgets often result in fewer nurses and more caregivers being employed, resulting in skill mix imbalances and neglect of residents' acuity. This low-cost hiring approach may lead to adverse events and caregivers working beyond their job scope without corresponding training or remuneration.
Contribution:
This framework aims to support and inform facilities implementing staffing models in resource-constrained contexts, balancing cost-saving initiatives, quality care, and adherence to legal staffing standards.