Appropriate Staffing Standards in Post-Acute and Long-Term Care

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

AMDA (The Society for Post-Acute and Long-Term Care Medicine – Medical Directors) has posted a position statement on appropriate staffing standards for PAC and LTC.  It’s a thoughtful and interesting 4-page read.  The position statement is dated July 22, 2021.  I’ve added bolding to highlight the major points.

AMDA’s Positions:

AMDA recognizes that while having a sufficient number of staff is critical, staffing levels based only on resident-to-worker ratios will not adequately assess or meet resident needs.

  • AMDA supports continued research regarding staffing levels (number and skill mix) that will optimally meet the individual needs of residents in nursing homes
  • AMDA support all options to recruit and train staff and continues to work with other stakeholders to address the current staffing crisis.

AMDA also recognizes person-centered and evidence-based dementia care requires 24-hour caregiving. As more residents in PALTC are diagnosed with dementia or other cognitively impaired related diagnosis, facilities should have the flexibility and resources to staff adequately based on needs specific to this population.

  • Furthermore, adequate evening/night staff may greatly reduce the inappropriate use of higher risk medications such as anxiolytics, narcotics, and antipsychotic medication regimens.

AMDA highly values direct caregivers in PALTC. Their continued involvement supports a resident achieving his/her highest goal of optimizing functional levels. The quality of a resident’s life is significantly affected by care that is competent, compassionate, and responsible.

The development of staffing levels or ratios should be done cautiously, to avoid unintended consequences. For example, a shortage of available workers to achieve compliance with a federal mandate could lead to challenges with access to nursing home care, particularly in rural areas. AMDA recommends building on existing relevant regulations, such as the F838 Facility Assessment that was included in the 2016-2019 updated OBRA regulations, instead of creating new federal or state mandates.

AMDA strongly supports increasing PALTC staff compensation (salary and benefits) to match the ongoing competitive market of other health care delivery sites.

Any decisions about staffing need to consider the broader issues, including:

  • the complexity and acuity of a facility’s population;
  • the functional level of residents and services required; 
  • creating consistent work schedules that are flexible to accommodate the changing needs of the residents along with improving consistent communication and documentation regarding the care needs of residents;
  • the existence of staffing shortages for some types of staff in some geographic locations, and temporary staffing shortages due to such events as employee illness or termination;
  • defining and including other categories of caregivers, such as medication aides, feeding assistants, restorative aides, family members, and activities professionals; 
  • the quality, competence, and engagement of staff leadership and supervision;
  • addressing adequacy of training and skills development, and

the career and educational development of staff (especially among newly licensed nurses).