A delicate balancing act of staff rosters

When you’re trying to balance care of residents with the cost to the Provider there is often tension over staffing levels, clinicians want more resources while management wants less cost. In this update, James Saunders provides some insights on how to assess whether you have the right number and mix of staff.

The right staffing level concerns both skills and staff levels. While there is the push for mandatory staffing levels in Aged Care facilities several countries, including the US, have tried and abandoned this approach. A US Senate Inquiry in 2001 concluded that care outcomes were not solely related to staffing and the cost of introducing mandatory staffing levels would be prohibitive. The inquiry fostered some great research, based on time and motion studies and qualitative factors to determine both minimum staffing levels and best practice levels required to provide appropriate care.

Accreditation Standard 1.6 – Human resource management requires a facility to “have sufficient appropriately skilled and qualified staff to ensure that services are delivered in accordance with the standards and the Residential Care service’s philosophy and objectives”.

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ACFI funding is intended to provide acuity based funding to ensure adequate staffing, irrespective of, if a resident’s financial means is available to deliver the care and services required.

While the Department stops short of saying ACFI is for wages, it is generally accepted that approximately 70% of facility expenditure is on wages (inclusive of indirect costs). Against this, the Government provides circa 70% of revenue for Aged Care. Excluding capital contributions (Accommodation supplements, CAP etc.)

We’ve found that the relationship between wages and ACFI often provides a useful initial indicator of whether your roster is appropriate.

The ultimate indicators of whether staffing levels allow for appropriate care are quality indicators i.e. number of pressure ulcers, falls, behaviour management, dehydration, malnutrition, infections, continence management, complaints and timely care response times etc. If there are concerns regarding these quality indicators, then it’s time to review staffing practices.

Within this multi variant environment, an argument can be made that staffing levels should be assessed against ACFI income. i.e. the greater the ACFI/resident acuity the higher the staffing level.

However, staffing levels alone do not guarantee appropriate care delivery. The standard of care depends on many factors including; experience, the level of casual or agency staff, morale, clinical leadership, quality of the physical environment and equipment.

Because some facilities do not claim ACFI effectively this should not be the only measure of staffing. Another factor that needs to be considered is whether there is disproportionate staffing in a wing or in an area of the facility, e.g. hospitality services, management etc.

As we conduct independent staffing reviews for clients we commonly find high staffing levels in one wing, this often relates to the resident mix at a prior time with the roster not being revisited when the mix changed.

Generally, care staff don’t mind working hard – it’s part of the nursing culture, however, staff can become embittered or disengaged if there is a disproportionate level of staffing in different wings or if they are continually having to train new or casual staff. Another factor affecting staff morale is a lack of work continuity – staff want to work with the same people, same residents, the same shifts and income. Generally, we find morale issues are associated with higher levels of casual or agency staff, overtime, workers’ compensation claims or where staff feel there is an absence of procedural fairness.

To help the PrideLiving Community assess whether they may have staffing issues we’ve developed a check list that highlights potential issues with your staffing level or mix. If you answer yes to more than 3 of these issues, then we suggest it’s time to review your staffing model.

Are you concerned with your care outcomes e.g. number of pressure ulcers, falls, skin tears, infections, weight loss, behaviour & continence management?
Increase in complaints with specific areas being raised such as care issues, staff or a combination of both
Is it more than 3 months since you reviewed staffing levels relative to ACFI funding
Your staffing ratios are set independently of resident acuity (ACFI funding)
Do you have a high level of casual or Agency staff, workers’ compensation and overtime?
Is staff turnover greater than 30%
Is sick leave greater than 3%
Was your last Staff Satisfaction Survey low – happy staff do good care!
Are your wages more than your ACFI income?

James Saunders is a Senior Operational Consultant at PrideLiving, he specialises in acuity based rostering. You can contact James on 0407 703 795 or by sending him a message.