The quality effects of agency staffing in residential aged care

Ma, Nelson; Sutton, Nicole; Yang, Jin Sug; Rawlings‐Way, Olivia; Brown, David A.; McAllister, Gillian; Parker, Deborah; Lewis, Rachael

doi:10.1111/ajag.13132

Cited by 4 publications

(3 citation statements)

References 16 publications

(50 reference statements)

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“…Both NHAs and CNAs found this stopgap relief of little help because of the “quality risks” associated with agency/contract staff who were “unfamiliar with the facility workflows or residents’ needs and preferences” (Franzosa et al, 2022, p. 910). These observations are consistent with research linking agency staff to service discontinuity, poorer service quality, and by logical extension, managerial worries (Castle, 2011; Ma et al, 2022; Shen et al, 2022), and actual NHA turnover (Geletta & Sparks, 2013). Consistent with the NASEM (2022) workforce recommendations to improve NH quality, we recommend that NH policy administrators and industry leaders prioritize a strategy to address the staffing standards and expertise that are beyond the NHA’s ability to control.…”

Section: Discussionsupporting

confidence: 86%

Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic

Nelson,

Yang,

McSweeney-Feld

et al. 2023

J Appl Gerontol

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The COVID-19 pandemic created challenges for U. S. nursing home administrators (NHA) and staff. This study explored organizational and psychological factors associated with NHA stress, dissatisfaction, and turnover intent (TI) during the third year of the pandemic. Results from a nationwide, cross-sectional survey of 1139 NHAs were merged with Centers for Medicare and Medicaid Services nursing home survey deficiency, staffing, complaint, and other operations data. A hierarchical, generalized estimating equations model with ordered logit link found that NHAs with higher COVID stress (AOR = 1.65, 95% CI = 1.22, 2.23), higher use of agency/contract staff (AOR = 1.50, 95% CI = 1.08.2.09) and higher role conflict were more likely to indicate TI. NHAs with higher job satisfaction in workload, work content, and rewards were less likely to hold TI. Industry leaders should create strategies to reduce NHA’s job stress and role conflicts and provide opportunities for improving staff recruitment and retention, reducing reliance on agency staffing.

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Section: Discussionsupporting

confidence: 86%

Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic

Nelson,

Yang,

McSweeney-Feld

et al. 2023

J Appl Gerontol

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“…Aged care across Australia has a workforce deficit at baseline [ 35 , 36 ], so this is further exacerbated when large numbers of staff are furloughed due to COVID-19. [ 37 ] Reliance on agency staff is suboptimal for both staff transmission [ 38 ] and resident outcomes [ 39 ] but even this resource was limited during the peak of each COVID-19 wave, with multiple facilities facing concurrent staffing shortages. [ 40 ] While this is a systemic issue beyond the scope of PHUs [ 8 , 41 ], it is crucial to remain mindful of both acute and chronic staffing concerns, given the implications it has on the feasibility of desired risk mitigation strategies.…”

Section: Discussionmentioning

confidence: 99%

Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective

2023

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Background From a Public Health Unit (PHU) perspective, this review aimed to examine factors associated with adverse outbreak outcomes, to identify evidence based focal strategies of managing COVID-19 outbreaks in aged care settings. Methods A retrospective review of PHU documentation examined all 55 COVID-19 outbreaks in Wide Bay RACFs across the first 3 COVID-19 waves in Queensland, through thematic and statistical analysis. . Results Thematic analysis using the framework approach identified 5 themes associated with outcomes of COVID-19 outbreaks in RACFs. These were analysed for statistical significance against outbreak outcomes including duration, attack rate and case fatality rate. There was a significant relationship between memory support unit (MSU) involvement and adverse outbreak outcomes. Attack rate was significantly associated with communication frequency, symptom monitoring and case detection approach, staff shortages and cohorting. Staff shortages were also significantly associated with a prolonged outbreak duration. There was no statistically significant relationship between outbreak outcomes and resource availability or infection control strategy. . Conclusions This emphasises the importance of frequent communication between PHUs and RACFs during active outbreaks, as well as the need for regular symptom monitoring and prompt case detection, to minimise viral transmission. Staff shortages and cohorting are also crucial factors to be addressed during outbreak management. Implications for Public Health This review adds to the evidence basis of COVID-19 outbreak management strategies to improve PHU advice to RACFs, to mitigate viral transmission and ultimately reduce the burden of disease associated with COVID-19 and other communicable diseases.

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“…(9,19) Aged care across Australia has a workforce de cit at baseline (35)(36), so this is further exacerbated when large numbers of staff are furloughed due to COVID-19. (37) Reliance on agency staff is suboptimal for both staff transmission (38) and resident outcomes (39) but even this resource was limited during the peak of each COVID-19 wave, with multiple facilities facing concurrent sta ng shortages. (40) While this is a systemic issue beyond the scope of PHUs (8, 41), it is crucial to remain mindful of both acute and chronic sta ng concerns, given the implications it has on the feasibility of desired risk mitigation strategies.…”

Section: Discussionmentioning

confidence: 99%

Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective

Hodge

Oversby

McClure

et al. 2022

Preprint

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Background: From a Public Health Unit (PHU) perspective, this review aimed to examine factors associated with adverse outbreak outcomes, to identify evidence based focal strategies of managing COVID-19 outbreaks in aged care settings. Methods: A retrospective review of PHU documentation identified 55 COVID-19 outbreaks in aged care facilities in Wide Bay during 2022. Results: Thematic analysis using the framework approach identified several themes and subthemes associated with COVID-19 outbreaks in aged care. These were analysed for statistical significance against outbreak outcomes including duration, attack rate and case fatality rate. There was a significant relationship between memory support unit (MSU) involvement and adverse outbreak outcomes. Attack rate was significantly affected by communication efficiency, case detection and staff cohorting. Staff shortages were also significantly associated with adverse outcomes regarding attack rate and duration. Conclusions: This emphasises the importance of frequent communication between PHUs and RACFs during an active outbreak, as well as the need for prompt case detection, to minimise viral transmission, staff shortages and cohorting are also crucial factors to be addressed during outbreak management. Implications for Public Health: This review adds to the evidence basis of COVID-19 outbreak management strategies to improve PHU advice to RACFs during future periods of viral transmission, to ultimately reduce the associated burden of disease.

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The quality effects of agency staffing in residential aged care

Cited by 4 publications

References 16 publications

Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic

Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic

Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective

Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective

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