In my opinion, no responsibility is more important for administrators at any long-term care (LTC) facility than staff supervision. The best and most evidence-based strategies, programs, and interventions may be used at a facility, but if the frontline staff are not following the prescribed procedures and protocols, these endeavors will not succeed, and quality of care will decline. Supervisors and directors need to establish their behavioral expectations and ensure that all staff are implementing policies, rules, and standards properly each day. The only way to guarantee this is happening is to make staff supervision the number one priority.
As a dementia care advocate and a past caregiver for my late wife, Clare, who was diagnosed with Alzheimer disease and eventually went to live in a LTC facility, I have experienced both the highs and lows of LTC staffing and care for dementia patients. I believe that there are generally two main reasons for occasional instances of less-than-outstanding care in otherwise outstanding LTC facilities: lack of sufficient staff training and absence of ongoing supervision and evaluation of staff. I would make the following suggestions to LTC administrators and supervisors in facilities.
Ensure staff are properly trained and receive ongoing training
For excellence to be the norm in any LTC, ongoing staff training and retraining must be provided, and evaluation of staff must be the highest priority. Staff should be periodically reminded of the high standards and expectations set for them and understand that they will be evaluated when it comes to implementing those standards. Resident care plans should be implemented appropriately, consistently, and with genuine care—not just during the shift when the unit supervisor is present but during the other 16 hours of the day as well.
This may require hiring more supervisory personnel or paying stipends to other certified personnel to shoulder this supervisory responsibility.
Make sure there are enough supervisors to observe and evaluate personnel
One major problem for LTC facilities is simply the 24/7 work schedule and lack of 24/7 supervisory personnel. When I was a principal, I was able to supervise all staff during my workday—even if that workday extended to 10 or 12 hours. In LTC facilities, dementia patients receive care 24/7, but rarely is there a supervisor present 24/7. There are supervisors present in the facility, but not in the dementia unit itself. One nurse or aide in the dementia unit may be designated as the person “in charge” during the absence of a certified supervisor, but that nurse or aide is not usually expected to supervise or evaluate other unit personnel.
For example, in the very early morning or late evening hours when aides are getting residents washed and dressed, undressed, administering medication, and doing various other activities with them, how can management be sure that their high standards and expectations for care are being met? The short answer to this question is they cannot. They cannot be sure if they are not personally there to supervise staff at such times.
Remain vigilant about how personnel care for dementia residents each day
One aspect of life in a LTC facility is that in any given 24-hour day, a caregiver’s loved one will be seen by many different doctors, nurses, aides, and therapists. After each 8-hour period, there are usually shift changes with different personnel responsible for resident care. Fortunately, my experience as a caregiver/advocate was very positive most of the time. However, even in Clare’s excellent LTC dementia units, there were occasional incidents of insufficient, unsatisfactory, or complete lack of care. Some employees always treated dementia residents lovingly and with a smile; others were sometimes rude or indifferent. What bothered me most, however, was that their supervisors always seemed surprised when I brought matters of unsatisfactory care to their attention.
As a retired public school principal, I am very much aware of how paperwork, meetings, and bureaucratic realities can easily keep administrators chained to their desks for long periods of time. However, LTC administrators must view supervision of staff as their single highest priority and spend the largest share of their time directly supervising employees. During many of my daily visits to see Clare, whether in her ALF or NH, there were times when no supervisor was ever present. Supervisors should try to find more time to supervise staff on a daily basis to determine if any personnel issues need to be addressed.
Dr Vann writes a bi-monthly Commentary blog column for the Annals of Long-Term Care journal, one of the brands housed on the Managed Health Care Connect website. He has also written frequently for caregiver magazines, other medical journals, and major newspapers. After his wife, Clare, was diagnosed with early onset Alzheimer’s disease, Dr Vann made it a point to increase public awareness of Alzheimer’s and to help fellow caregivers. You can read more than 90 of his other articles about Alzheimer's at www.allansvann.blogspot.com. If you would like Dr Vann to respond to questions or comments about this article, please email him directly at email@example.com.
Published in Annals of Long-Term Care, February 16, 2017. Access online only