This is a story of staffing, substandard staffing in memory care homes. It’s an attempt to offer evidence of what life is like in a memory care home and to document why staffing guidelines are missing the mark, are ignoring the ramifications of residents’ symptoms and CNAs’ workloads. In memory care, the gold standard of care is ‘person-centered care.’ But we cannot provide person-centered care without the personnel! In a hospital setting, administrators use something called a Patient Classification System to plan care. This is a method for determining how serious the medical condition of a patient is, what level of care the patient needs, and how many nurses they must have on duty to ensure that patients get the care they need. The severity of a patient’s medical condition and needs is known as acuity. In long-term care homes this notion of patient or resident acuity doesn’t seem to have the same imperative that it does in hospitals. It should.
We hardly use the term ‘nursing home’ nowadays, it’s almost politically incorrect. We speak of long-term care ‘homes.’ It’s to the credit of the nursing home industry and consumers of that industry that if our loved elders become too frail to remain at home, people want to make their final residence more homelike. Not an institutional, hospital-like environment—with all the sterility and standardization and disregard for individuality that the word ’hospital’ ironically implies. And so we move our family members to long-term care homes: skilled nursing facilities, assisted living communities, or personal care homes. Still, residents of these homes, whatever we call them, are there because of declining health. They need care. Maybe not the kind of care that calls for physicians, medical specialists, hi-tech equipment and RNs to be on hand on a daily basis. But they do need attention paid to their declining physical and/or cognitive health.
The area of long-term care I’m involved in is dementia care. I challenge everyone reading this page to name one memory-care home that has the staffing it needs to ensure a high level of person-centered care for every resident on every shift, every day. Not perfect care; just consistent high-quality care. (And if you know of such a place, please let us all know about it. I’m signing up for their waiting list!) Long term care homes simply don’t have the staff they need. CMS and state regulators don’t set specific standards that could ensure better care. The sad standards they do establish don’t come with penalties that encourage compliance.
I first became interested in this kind of tool while working in a memory support home. When we CNAs asked for more staff, the Administrator would respond, “Document that you need more help.” I began putting charts together to demonstrate the time CNAs actually had to do ADLs. One reason legislators don’t pay more attention to staffing levels is that they just don’t understand what the symptoms of more serious dementia are and how these symptoms impact aides’ workload throughout the day. A Resident Acuity Assessment tool could, I believe, help us educate administrators, families and legislators about the staffing we need. In Part Two I’ll present one suggestion for a Resident Acuity tool, hoping that other CNAs will find ways to improve it. Use your own tool to persuade your employers and regulators to require improved staffing of memory care homes.