Consistent assignment in long‐term care homes: Avoiding the pitfalls to capitalise on the promises

Abstract

BackgroundConsistent assignment (CA) is the practice within long‐term care (LTC) by which care staff work with the same residents almost every shift for an indefinite period of time. CA is considered by many to be essential to person‐centred care.ObjectivesThis paper explores how staff assignment practices impact the caregiving experience from the perspectives of resident care aides (RCAs), residents and family members and, by doing so, describe the nuanced conditions under which CA may or may not be beneficial to all, and why.MethodsData are drawn from 40 in‐depth interviews conducted as part of a larger institutional ethnography exploring the social organisation of care in three purposively selected LTC homes in Western Canada. Data analysis was based on the principles of constant comparison.ResultsRCAs, residents and family members described the primary benefit of CA as being able to ‘get to know’ each other well and form meaningful relationships. However, the RCAs also indicated that CA can contribute to feelings of isolation, which has negative effects on worker comfort and satisfaction, care team dynamics and communication, and resident care.ConclusionsManagement initiatives are needed to ensure that the implementation of CA does not result in the unintended consequences of decreasing RCAs' experience of teamwork, decreasing RCAs’ exchange of individualised resident care information, or negatively impacting RCAs’ ability and desire to care for each other as well as the residents.Implications for practiceThe staffing practice of consistent assignment in long‐term care homes provides increased opportunities for the development of stronger staff‐resident and staff‐family member relationships. Findings from this study enable us to offer several, evidenced‐based recommendations for ensuring the successful implementation of consistent assignment, such that it may be beneficial to all.

Poor and Lost Connections: Essential Family Caregivers’ Experiences Using Technology with Family Living in Long-Term Care Homes during COVID-19

“…The understaffing in LTCHs led to instances of inadequate resident care; therefore, the additional demands for staff to facilitate virtual visitations were not possible in many cases ( Ontario Health Coalition, 2020 ). Familiarity with the residents’ needs may be best approached through the consistent assignment of staff to facilitate stronger relationships with the residents and their families to engage in shared decision-making ( Caspar et al, 2021 ; Chu, Quan, Gandhi, and McGilton, 2021 ), which was not possible during staffing crises. Resources and support are needed to shore up the structures of LTC to enable staff to collaborate with families.…”

Unintended Consequences of Pandemic Management Strategies on Residents and Family in One Long-term Care Home in British Columbia: A Patient-Supported Qualitative Study

“…Additionally, we found that other approaches, such as consistent staff assignments, allow families to better advocate for their loved ones, creating a realistic sense of control. Previous studies have been inconclusive as to the effectiveness of consistent staff assignment on improving quality of care in LTC ( 26 ). However, the inconclusive nature of these studies was attributed to methodological inconsistencies such as lack of conceptualization of consistent assignments ( 27 ).…”

What COVID-19 Innovations Can Teach Us About Improving Quality of Life in Long-Term Care

“…Unfortunately, research has documented pervasive failure to achieve consistent assignment due largely to longstanding problems with staff recruitment and retention. 22 , 23 …”

“…Unfortunately, research has documented pervasive failure to achieve consistent assignment due largely to longstanding problems with staff recruitment and retention. 22,23 Fear of COVID-19 spread inside LTC homes has inspired innovations to limit the number of staff interacting with each resident. Consequently, many homes previously "unable" to achieve consistent assignment have found ways to do so.…”