A reader asks, “Is there a correlation between nursing staff length of service and resident longevity? Our 180-bed sister skilled nursing and rehabilitation centers have five residents who have lived with us for several years and who are all over the age of 100. Providing high quality care to those centenarians are 18 staff members, each of whom have been continuously employed for more than 20 years.”
First, allow us to say, Congratulations! Any facility that has such a large number of employees for that length of time must be taking wonderful care of their staff. While we cannot point to a specific piece of research that specifically correlates resident longevity to staff retention, what we do know is that consistent staff and low turnover does result in better care and enhanced resident, family, and employee satisfaction.
Turnover and the impact on residents in assisted living and long-term care have been studied. Nicholas Castle (2007) measured the effect of administrator turnover on the quality of care and determined that leadership turnover leads to many negative outcomes for residents.1 He found that when there is a loss of an administrator there are increasing pressure ulcers, resident catheters and use of psychoactive drugs, deficiencies and citations, and over twice the normal turnover of staff. Sadly, the turnover for administrators in assisted living and long-term care ranges from 43%-70% annually. When an administrator leaves, so does staff—RN turnover rises to 76%, LPN’s to 78%, and certified nursing assistants to 107%! In addition, turnover often results in increasing workloads for the remaining staff. And it is expensive. An average community housing 200 residents often spends as much as a million dollars per year on staff turnover.
It is clear that staff turnover influences the quality of care, is very expensive, and diverts monies that could have otherwise been spent on care.1 Turnover truly weakens the level of care provided and directly affects residents. Changes in staff distresses residents who develop relationships with caregivers, relying on them for recognition, support, and kindness—only to find that they are gone and a new person has taken their place. Can you imagine, when you are most dependent upon another human being for care, seeing that your needs are addressed and desires met and suddenly they are gone? Now you have to rely on a stranger who may or may not care to know you as a person, ensure that your needs are addressed, or be there when you call?
It is important for those of us working in assisted living and long-term care to remember that we are in the “people business,” and that our product or service, so to speak, is about meeting the needs of people, long term. Unlike acute care settings where time is often limited, long-term care offers the opportunity to meet and know the residents we serve and their families. Human relationships are special and it does not really matter where people come from, what they have experienced, where they live or play. People are all the same at the core. We all need respect, a sense of belonging, to be included, appreciated, valued and loved in order to survive. Consistent, knowledgeable, caring staff that has come to know the resident as a valued person and not a task will provide the kind of care that encourages a desire to live and nurture relationships with others. Regardless of the resident’s ability to participate, being with people each day is what makes life worth living.
Consistency creates a positive environment for staff as well, who enter this field with a desire to serve and genuinely care for others. Encouraging relationships means that leadership must allow for consistent staffing as well as value and reward employees for the good work they do. Leaders must allow employees the time to visit with residents and families, to know them personally, their life, their experiences, accomplishments, needs, and desires. Whether expressed from the resident or shared by the family, staff needs to hear the stories and experience the resident’s reactions and emotions directly. Staff should come to know the resident from many perspectives, and when they do it is a beautiful experience where everyone benefits.
It does not, however, happen by chance. Staff and resident longevity exist when leadership and staff value relationships and respect. This is found only in an organization that is committed to a vision and philosophy of service, where the vision lives in the daily life of all in the facility.
1. Castle, NG; Engberg, J; Anderson, RA: Job satisfaction of nursing home administrators and turnover. Medical Care Research and Review 2007; 64(2):191-211.