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 acvann@optonline.net.
Published in Annals of Long-Term Care, February 16, 2017. Access online only
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