Staff Recruitment & Long Term Care

Answer

Staff Recruitment and Retention in Long-Term Care Facilities with Regard to Dementia Patients

Long-term care is critical in ensuring the health, comfort, and wellbeing of older adults. As the ageing population continues to grow rapidly, understanding the complexities and demands of long-term care has become vital. The prevalence of patients with dementia in hospitals and other settings has resulted in high demand for well-trained direct care workers (Galvin, 2017). One of the most vital determinants of quality dementia care across all care settings is the number and competencies of direct care staff.  Research has illustrated a direct correlation between the staffing levels of direct care workers and the quality of care delivered in nursing homes (Weiss et al., 2021). Despite the importance of such staff, the US is faced with a nationwide workforce shortage applying across different settings. From the retirement communities to the assisted living and skilled nursing facilities, the number of dementia patients is higher than the members of staff. An estimated 16 million older people are expected to be living with Alzheimer's disease and related dementias (ADRD) and other chronic illnesses by 2050 (Gilster, Boltz & Dalessandro, 2018). However, some states have not enacted laws and regulations, which state the certified minimum number of licensed direct care workers. This paper educates the board of directors for Intravalley Health concerning the evolving nature of staff recruitment and retention in long-term care facilities with regards to dementia patients and how it impacts the health system. Gilster, Boltz, and Dalessandro (2018) article titled Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care effectively demonstrates how staff recruitment and retention in long-term facilities for dementia patients has been a critical issue.

Background of the Issue

            Long-term care facilities have experienced a high staff to patient ratio in the recent past because of the growing number of dementia patients and the shrinking rates of staff recruitment and retention for direct care workers. The demand for health care providers within long-term facilities is projected to significantly increase by 2026 (Weiss et al., 2021). For instance, statistics indicate that the demand for nutritionists and dieticians is likely to increase by 15%, while that of social workers will probably hike by 16% and 24% for occupational therapists (Galvin, 2017). Additionally, the demand for physician assistants is likely to increase by 37% (Galvin, 2017). As such, the demand for direct care workers is projected to continue to exceed their supply. Globally, according to the World Health Organization (WHO), more than 47 million people are diagnosed with dementia, with close to 10 million new cases being witnessed each year (Harrington et al., 2016). In the US, 5.5 have ADRD and other chronic illnesses, and such numbers are likely to increase to 7.1 million by 2025 (Gilster, Boltz & Dalessandro, 2018). Surprisingly, over 80% of individuals with dementia are cared for by unpaid care providers (Gilster, Boltz & Dalessandro, 2018). Each day, the ratio of the number of family caregivers to the patients keeps on decreasing. Currently, the number of older adults with dementia outnumber the unpaid caregivers; thus, many dementia patients remain in need of care. However, states lack the minimum requirement for direct care workers such as nursing assistants.

In the current dementia care workforce in the long-term care facilities, one of the key well-documented weaknesses is that there is an inadequate supply of dementia specialists, especially geriatrics, who can offer the much-needed expert care for the treatment of patients and training the next generation of practitioners. Additionally, long-term care has limited availability of training for general healthcare professionals, especially the best practices of dementia care and the management of chronic diseases (Weiss et al., 2021). Moreover, research demonstrates that the current workforce is underappreciated, which has led to insufficient interest in long-term care services and the support industry (Alzheimer's Association, 2017). Moreover, a serious shortage of well-trained direct care workers has been reported, with some of the long-term care facilities closing down because of the lack of direct care workers. One of the reasons for such a shortage is the lack of adequate compensation to cater for the monetary needs of the nursing assistants and the direct care workers (Gilster, Boltz & Dalessandro, 2018). Also, a lack of a supportive work environment has resulted in many professionals avoiding the industry and focusing on other areas of healthcare. The ultimate effects have been felt by health service facilities, which have had to deal with a huge number of patients but a small number of staff. Dementia patients have suffered tremendously because the quality of care services they have received have been below par due to a lack of experienced and competent direct care workers (Gilster, Boltz & Dalessandro, 2018). Intravalley Health is no exception because it has been overwhelmed by the rising number of dementia patients, but the rates of retention for the staff members have been very low. As such, it is critical to adopt effective measures for staff recruitment and retention to ensure a better quality of health for dementia patients in long-term facilities.

Relevant Laws and Regulations

Although the federal mandatory staffing requirements demand that nursing homes should have a minimum member of registered nurses and licensed practice nurses, only several states have adopted rules and guidelines on staffing requirements for their long-term care facilities. However, despite the laws touching on how the staff members should be treated as well as the minimum numbers, it has been difficult to align with such regulations, and staff shortage has been felt across all units and facilities (Gilster, Boltz & Dalessandro, 2018). The following are the relevant laws and regulations focusing on the aspect of staff recruitment and retention in long-term facilities with regards to dementia patients.

The Registered Nurse Staffing Act

            The Registered Nurse Staffing Act is one of the relevant laws when it comes to staff recruitment and retention in long-term care facilities caring for dementia patients. According to this law, healthcare facilities are required to at all times maintain an adequate number of licensed registered nurses as well as licensed practical nurses and other personnel who can provide nursing care to the patients as required (CPI, 2017). In the quest to abide by such a provision, hospitals and other healthcare facilities have created staffing committees that establish plans for planning in each of the units. Such staffing plans establish the members of staff required based on the intensity of the patients' needs, the number of admissions, levels of experience for the nursing staff, and the availability of resources such as the ancillary staff and technology. As such, Gilster et al.'s (2017) argument about the inefficiency of laws establishing minimum staffing requirements in states is far-fetched.

Affordable Care Act (ACA)

            Although the ACA does not provide for the minimum number of staff-patient ratios in nursing homes and other long-term facilities, it has expanded health coverage and codified protection for people with pre-existing conditions. For instance, those with dementia and other chronic conditions do not need to engage in cost-sharing primarily because of their pre-existing conditions (CPI, 2017). Additionally, the number of Americans with health insurance has been on the rise since the ACA was implemented. Patients expect that they will receive quality services. However, increased access to healthcare emanating from ACA has resulted in an increased number of patients compared to the number of nursing professionals and other healthcare professionals. The ACA is relevant in the current tropic because it reinforces the importance of appropriate staff recruitment and retention to ensure the health and wellbeing of dementia patients in long-term care facilities.

The National Alzheimer's Project Act

The National Alzheimer's Project Act was unanimously passed by Congress in 2010 and signed into law by President Obama with the aim of creating a national strategic plan that could coordinate Alzheimer's and dementia disease efforts across the US. One of the goals of the law is it ensure care quality and efficiency. For the quality to improve, dementia patients have to be provided with competent and experienced direct care workers who can provide the much-needed services. Additionally, the law should expand support for people with Alzheimer's disease and related dementias as well as their families (CPI, 2017). Such support can be expanded when there are enough professionals to take care of dementia patients and provide the required family support systems. However, in the current state, where the number of dementia patients in long-term care facilities is way higher than the number of healthcare professionals, such a goal is unattainable.

State Rules and Guidelines

 Eight of the states in the US have created regulations that require hospitals and other facilities to have staffing committees responsible for planning aspects of nurse-patient ratios and staffing policies. Connecticut, Illinois, Nevada, Ohio, Oregon, Texas and Washington have all established the committees, which help in devising staffing plans that help in the achievement of safe and appropriate staffing plans (CPI, 2017). In California, regulations have been passed, which require a minimum nurse to patient ratio, which must be maintained at all times by each nursing unit. Additionally, in Massachusetts, a regulation was recently passed, which require ICUs to have a 1:1 or 1:2 nurse-patient ratio based on a patient's stability (CPI, 2017). Such rules and regulations are relevant in the present case because they illustrate the importance of having appropriate staff recruitment and retention for better care among dementia patients in long-term care facilities.

Strategic and Operational Impacts on Health Services Organizations

Shortage of staff among the dementia workforce in long-term care facilities has the strategic impacts of failed achievement of the mission and vision statements of such organizations. Shortages and high staff-patient ratio in long-term care facilities lead to low quality of healthcare services, staff and patient dissatisfaction, and low profitability (Gilster, Boltz, & Dalessandro, 2018). When the staff-patient ratio is higher than the minimum numbers, the implication is that the quality of services delivered will be very low due to errors, which will translate to higher morbidity and mortality rates. Galvin (2017) assert that nurses experience burnout and dissatisfaction because they have to work for long hours. As such, the primary goal of ensuring the delivery of quality care services to dementia patients and the health and wellbeing of the patients is compromised. Ultimately, many dementia patients will not want to be committed to such long-term facilities. For hospitals and nursing homes that are for-profit, a reduced number of patients will translate to reduced profitability (Weiss et al., 2021). As such, healthcare organizations will find it hard to attract clients, and their strategic goals and objectives will be unachievable. The increasing demand for healthcare services due to a rise in the ageing population and serious medical problems will mean that the health service organizations will struggle to match the needs of dementia patients. Strategically, health service organizations will struggle to meet their mission and vision because the quality of care will be compromised by the staffing challenges.

The operational impact of high staff to patient ratio and other staffing challenges for health service organizations are poor quality of services delivered due to the direct care providers working for long hours and under very stressful conditions. According to Galvin (2017), When the staff in nursing homes and other long-term care facilities are not in the required numbers, the available staff will often work long hours, which contributes to fatigue, injury, and job dissatisfaction (Saville et al., 2019). Nurses who operate in such environments are most likely going to be prone to mistakes and medical errors. The care delivery process is affected because some of the duties will be assigned to staff members who lack the competencies and experience to deliver them (Gilster, Boltz & Dalessandro, 2018). Galvin (2017) adds that there will be delayed nurse responses to patient calls. For example, with a huge number of dementia patients to attend to and a reduced number of direct care workers, health services organizations will be overwhelmed (Saville et al., 2019). Low staff morale will also be witnessed and low rates of staff satisfaction. Overall, the quality of care delivered will be very low, and patients will complain about such an aspect. Operationally, health services organizations will operate at sub-optimal levels, and the effects of such issues will be seen in the quality of patient outcomes.

In conclusion, the issue of staff recruitment and retention in long term care facilities with regard to dementia patients is evolving. There is an increasing number of the ageing population and dementia patients but without a corresponding number of direct care workers. Although a federal law exists to provide for the minimum staff to patient ratio, long-term facilities do not have a defined minimum number. Projections for the future indicate that the demand for healthcare professionals for long term facilities is likely to increase because of the projected hike in the number of dementia patients. Staff shortages are attributed to unconducive working environments, lack of fair compensation, and decreased attractiveness of the direct care jobs for healthcare professionals. Some of the relevant laws to the issue are the Registered Nurse Staffing Act, Affordable Care Act (ACA), the National Alzheimer's Project Act, and state laws and guidelines, which underscore the importance of having a minimum number of staff for different nursing units. However, only a small number of states have adopted guidelines towards ensuring a low staff to patient ratio. The strategic impact of such an issue is that health service providers have failed to achieve their mission and goals. Operationally, the impact has been an overwhelmed staff members who suffer from fatigue and low rates of satisfaction. Ultimately, the quality of care has been compromised, and patient outcomes have been negative. As such, it is critical to examine new ways of staffing and recruitment of direct care workers for dementia patients in long-term care facilities.