Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts
Date
2024-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
Background: The exponential ageing of the world population and corresponding care needs indicate a need to plan for the long-term care of older people. With residents in long-term care facilities (LTCFs) having higher acuity levels, the health workforce must comprise adequate and suitable staff appropriately allocated to meet residents' needs despite scarce resources. However, LTCFs find it difficult to maintain adequate staffing levels and provide a skill mix to ensure quality resident care while staying within the framework of the nurses' scope of practice and caregivers' scope of work. This study focused on exploring the implementation of nurse and caregiver staffing models in LTCFs. The aim of the study was to develop a framework to inform staffing models for LTCFs in resource-constrained contexts.
Methods: The study was conducted in three phases from a critical realism perspective. Phase 1 included the concurrent completion of a scoping review and holistic multiple-case study. In the scoping review, four databases were searched using specific search terms, and the final sample comprised 20 studies. The holistic multiple-case study included a document review and interviews in one state-subsidised and one private for-profit LTCF in the Cape Metropole, South Africa. Purposive sampling was employed to select 45 documents for review and nineteen participants for semi-structured interviews in the two LTCFs. All the data was analysed through an inductive thematic analysis process. The scoping review and holistic multiple-case study findings were triangulated in Phase 2. In Phase 3, the triangulated data were used to develop a framework to inform staffing models for LTCFs in resource-limited contexts. Seven experts were purposefully selected, and they validated the framework.
Findings: More caregivers and fewer nurses were employed in the LTCFs. This led to fewer qualified nurses in the skill mix and shifting tasks to less qualified nurse categories and caregivers beyond their scope of practice and work scope. Consequently, caregivers provided most of the resident care, overburdening ths category. Staff allocation practices did not consider residents’ acuity levels. Thus, residents received the same basic care regardless of needing more skilled care. Managers, nurses, and caregivers seemed oblivious to the legal implications of working beyond a designated scope of practice or job scope or of failing to meet legal staffing requirements. Additional barriers to implementing a staffing model that influenced the nurses’ and caregivers’ wellbeing were overly harsh disciplinary measures, a lack of management support, managers’ verbal communication which suggested bullying, and the absence of staff meetings and in-service training.
Conclusion: The LTCFs implemented aspects of the prescribed staffing model by seemingly using a low-cost one. By over-employing caregivers but fewer nurses, vulnerable older persons were often deprived of care provided by more qualified staff and potentially higher-quality care than they were entitled to. This framework provides a roadmap for role players in LTCFs to ensure adherence to legal requirements, balance cost-effectiveness with quality resident care, and facilitate staff wellbeing.
Description
Thesis (PhD)--Stellenbosch University, 2024.