A resident-centered staffing model that works

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Daniel Nimon
Daniel Nimon

As an administrator with almost 25 years of experience in post-acute care, I would dare say that if someone offered me a staffing model that promised to reduce employee turnover (eliminate any agency staffing), increase employee, resident and family satisfaction, while at the same time substantially reducing labor expenses, I would jump—no, wait—leap at the opportunity. 

Approximately four years ago, with the assistance of Dan Gray and Continuum Development Services of Signal Mountain, TN, Westminster Canterbury of Lynchburg began a journey with an entirely new staffing model concept called "Resident Centered Staffing" (RCS). The RCS model is truly unique in that it focuses entirely on improving resident care and outcomes. A side benefit, if you care to think of it that way, is that the staffing model also increases employee job satisfaction and substantially reduces overall labor costs!

The RCS model utilizes only full-time staff working 12-hour shifts. There are two teams and both teams have a 7 a.m. to 7 p.m. and 7 p.m. to 7 a.m. group. The teams work a 14-day cycle schedule that never changes and allows each staff member to know their schedule indefinitely and plan their personal and family life. The staff love knowing their schedules will never change and, at the same time, only need work seven out of 14 days, instead of the old eight-hour shift schedule of needing to work 10 days out of 14.

The benefits to staff are too numerous to entirely review but here are a few: only seven trips to work in a 14-day period, guaranteed overtime every pay period, the ability to work a standardized part-time position elsewhere, and knowing months ahead of time what days they will have off.

Residents benefit greatly on the weekends, days traditionally challenged with staffing issues. With RCS, you have the same staffing seven days a week with minimal part-time staff and no part-time weekend positions. This enhances an organization that is filled with staff who have daily knowledge of the residents. RCS does require some "out-of-the-box" thinking when it comes to meal service and medication administration times, but with minor changes, it can be easily accomplished.

Cost savings arise from being able to reduce the number of nurse managers, the elimination of shift overlap for CNAs, reducing staffing from 7p to 11p, and eliminating weekend and evening shift differentials.

The Resident Centered Staffing care model has improved our overall quality of care and resident satisfaction as each resident has only two certified nursing assistants in a 24-hour period and each team is supervised by the same team leader (charge nurse). This year, our health services team has been able to reduce our staff turnover to under 20% annually, a number of which most DONs and administrators would be envious! Our health center is restraint-free and has been for almost two years. The best news is that for the past two years, our health center has had only two level "D" deficiencies each year and in December 2009 CMS recognized our health center with a 5-Star designation! 

Continuum Development Services recently assisted Lutheran Life Communities in Illinois to convert all of their senior living communities to the Resident Centered Staffing model. Steve Duchene, regional director of Operations for Lutheran Life Communities, also sees very positive results. Once Lutheran Life Communities made the decision to convert from a traditional staffing model to Resident Centered Staffing for its five senior living communities, it took only two days of on-site assistance from Continuum Development Services to create an eight-week Implementation Plan for the site leadership to convert to the new staffing plan.

Roger W. Paulsberg, president and CEO for Lutheran Life Communities endorses the RCS model. In a recent interview, Roger remarked of the model: "We strive to constantly enhance a positive experience for residents and staff. The RCS model has greatly benefited our operations. The residents and families enjoy consistent care delivery, our full-time staff enjoy a consistent schedule that allows them even more days off, and we are saving several hundred thousand dollars annually."

The Lutheran Home, Lutheran Life Communities' flagship is a CMS 5-Star skilled nursing facility with assisted living, shelter care and a care continuum.

Daniel Nimon is vice president of health services at Westminster Canterbury in Lynchburg, VA.


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