LTC staffing: A global concern

Susan was recently invited to Australia to speak to the state offices of the Alzheimer’s Association, local providers, and other interested parties on organizational approaches to long-term care. In addition, a request was made to address Australia’s federal department directors of health and aging, education, workforce, dementia, training, mental health, and others. The invitations were offered as Australia is exploring better ways to deliver quality long-term care, and the government expressed a desire to examine our own organizational model, SERVICE.

Earlier in March of this year, directors from the Alzheimer’s Association of South Australia were in attendance at the 25th International Conference of Alzheimer’s Disease International in Greece, where we presented our organizational approach to care. After that meeting on SERVICE and culture change, they believed the answers to their staffing dilemmas were perhaps best found in an organizational strategy.

A whirlwind adventure ensued, traveling to all major cities in the country from the north of Darwin, central cities of Adelaide and Canberra, Brisbane and Sydney on the coast, and to Hobart in Tasmania. Interestingly, the staffing issues and concerns we Americans experience seemed to be much the same for Aussies: high agency utilization, high turnover, low staff satisfaction, and overall disengaged individuals doing a “job.”

When examining the organizational structure, regulatory environment, staff roles, and responsibilities as well as compensation, it was clear that what was missing is precisely what is often missing here in the US. And indeed their literature echoes much of ours in relationship to the desires of staff in long-term care.

All too often, as Australian leaders admitted, there was no plan, strategy, or mechanism for guiding overall community operations. In addition, little data collection or examination is found related to what staff wants, why they stay, or why they leave a particular organization. The rationale for turnover presented by most in leadership positions concerned low pay and a lack of promotional opportunities. However, what we already know in the states is that the staff cannot be bought, and what is most desired is respect and appreciation for hard work.

Employees around the world want to have input into decisions that are made, especially those decisions that affect their work. They desire meaningful employment and the opportunity to make a difference in the life of another.

While it varied from community to community, the experience in Australia was much the same. Staff lacked respect—as a profession and from those who supervised them. There was little orientation or preparation for their specific job, rarely any ongoing education outside of the mandatory in-services, and no input into decisions. While many Australian organizations had a community or corporate vision, it was not a working vision, and leaders admitted that the vision was not expressed in day-to-day operations.

As we experience in the United States, there was little consistent means of communication, and leadership teams were too busy to care and nurture their staff. Regulations were cumbersome, designed to protect residents from the lowest performers with little regard to the quality of life of the residents. “Expert panels,” assembled to determine industry needs and solutions to problems, were often highly credentialed individuals with little to no “hands-on experience” in long-term care. Surveyors, whom they call “auditors,” were punitive—not collaborative—despite pleas from the individual facilities.

Sound familiar?

So why does this have to be? We have enough research to determine what is needed in long-term care to make it a more pleasant place to work and live, and yet we don’t do it. Why? Is it leadership ego? Are leaders afraid to be vulnerable, to care for others including their staff? Is it power? Is it poor training? It is simply good enough the way it is today?

Many of us, including our new colleagues in Australia, do not think so and hence we will keep plugging away, facility by facility, country by country, hoping that if nothing else at least we can transform a few facilities, perhaps one at a time, to more happy and fun places to live and work.

Susan Gilster, PhD, FACHCA, NHA, Fellow, developed the Alois Alzheimer Center, Cincinnati, Ohio, which opened in 1987 as the first freestanding dementia facility in the United States.

Jennifer L. Dalessandro, BS, NHA, is the Assistant Administrator and Research Coordinator of the Alois Alzheimer Center and has helped it evolve into a person-centered facility.

For more information, phone (513) 673-1239 or visit or

Topics: Articles , Facility management , Staffing