3 Critical Elements to Positive Outcomes in Nursing Home Administration

There are many elements in nursing home administration that are vital for the support of older adults in order to ensure that they attain the highest state of physical, mental, and psychosocial well-being.  Nursing homes have become a place where the fundamental aspects of these elements are combined in a holistic approach to resident care. While a holistic approach is necessary to successful nursing home administration, the three most critical elements to promoting positive outcomes include adequate staffing, appropriate environmental features, and addressing individual resident preferences.

Adequate Staffing

In order to meet the needs of residents, administrators must plan and allocate an appropriate amount of staffing for the facility.  However, proper staffing levels can be notoriously difficult to control, while administrators must consider key factors such as the ratio of staff to resident and staff turnover rate. 

A proper ratio is dependent upon what works for the facility, considering the type of facility, residents’ needs and facility funding.  For example, the nursing-home portion of a well-funded facility may have one skilled nurse per 27 residents, which staffing level adequately meets the residents’ needs.  Zimmerman and Cohen (2010) discuss the benefits of consistent staffing, asserting that staff are able to get to know residents on a more personal level, which can help to avoid the upset and confusion of residents that can result from a high turnover rate.   

The turnover rate in many nursing homes is between 30 and 120%, which does not allow for training, for familiarity, or for a sense of safety to develop on the part of residents.  This turnover rate causes remaining staff to operate at lower levels of confidence and experience, which, in turn, can slow the response times and effectiveness for the needs of seniors.

Recruiting and retaining quality staff is essential for ensuring adequate staffing in a nursing home and reducing turnover. Here are some tips to do staffing right:

• Offer Competitive Salaries and Benefits

  One of the most effective ways to attract and retain staff in a nursing home is by offering competitive salaries and benefits. Staff members who feel valued and fairly compensated for their work are more likely to stay with the organization long-term. In addition to competitive pay, consider offering benefits such as health insurance, retirement plans, and paid time off to make the job more appealing.

• Implement Flexible Scheduling Options

  Many nursing home staff members juggle demanding schedules both at work and at home. Offering flexible scheduling options can help employees better balance their work and personal responsibilities. Consider implementing options such as part-time schedules, job sharing, or telecommuting to accommodate the diverse needs of your staff.

• Provide Opportunities for Growth and Development

  Another key factor in reducing turnover is providing opportunities for staff members to grow and develop in their roles. This can include offering training programs, continuing education opportunities, and career advancement pathways. When employees see a clear path for growth within the organization, they are more likely to stay and invest in their careers.

• Cultivate a Supportive Work Environment

  A positive work environment can make a world of difference in staff retention. Nursing homes should strive to create a culture of support, respect, and teamwork. Encourage open communication, provide regular feedback, and recognize the hard work of your staff. By fostering a supportive work environment, you can boost morale and reduce turnover.

• Implement Flexible Scheduling Options

  Many nursing home staff members juggle demanding schedules both at work and at home. Offering flexible scheduling options can help employees better balance their work and personal responsibilities. Consider implementing options such as part-time schedules, job sharing, or telecommuting to accommodate the diverse needs of your staff.

• Listen to Feedback and Address Concerns

  It's essential for nursing home administrators to listen to the feedback of their staff and address any concerns that arise. Cultivate a supportive work environment. Conduct regular surveys or meetings to gather input from employees about their experiences and any areas for improvement. By actively listening to your staff and taking action to address their concerns, you can create a more positive and supportive work environment.

• Ensure that Staff Receives the Proper Training

  Staff that has received the proper training, as well as and the support of team members, are better able to do their jobs and to meet the needs of seniors.  Cross-training your staff can help ensure that you have the flexibility to cover shifts in case of unexpected absences. By training your staff to perform multiple roles, you can better manage staffing shortages and maintain quality care for residents.

Nursing homes should strive to create a culture of support, respect, and teamwork. Encourage open communication, provide regular feedback, and recognize the hard work of your staff. By fostering a supportive work environment, you can boost morale and reduce turnover.

Appropriate Environmental Features

Environment is especially important for residents, especially for those with cognitive or other physical issues that impair their ability to function normally.  Day, Carreon, and Stump (2000) state that design is an important therapeutic resource that supports the health and functionality of residents. 

Elements such as facility design and layout assist with orientation and resident safety, while modifications such as quiet rooms with soft colors and the removal of noisy paging systems help to prevent overstimulation (Day et al., 2000).  The modifications that provide orientation “cues” for residents reduce stress levels, lessen confusion and incontinence and prevent people from wandering, adding to the safety and emotional well-being of the resident (Sloane et al., 2002).

Administrators and staff can work with residents' family members to follow some simple steps to help the facility feel like home. They can:

• Personalize Their Space

  One way to make a nursing home feel more like home is to personalize the resident's living space. Bring in familiar items such as family photos, favorite blankets, and cherished mementos. This will help create a sense of familiarity and comfort in an unfamiliar setting.

• Encourage Social Connections

  Encouraging social connections is key to creating a homelike environment in a nursing home. Help your loved one make new friends by participating in group activities, dining with other residents, and attending social events. Building a sense of community can make the nursing home feel more like a close-knit family.

• Respect Their Independence

  Respecting your loved one's independence is crucial in creating a homelike environment. Allow them to make choices about their daily routine, activities, and meals. By empowering them to maintain a sense of control over their life, you can help them feel more at home in the nursing home.

• Bring in Home Comforts

  Bringing in home comforts such as their favorite snacks, music, or books can help make a nursing home feel more like home. Consider creating a cozy reading nook, setting up a TV with their favorite shows, or bringing in a pet to visit. These familiar comforts can go a long way in creating a sense of home in the nursing home.

• Stay Connected

  Staying connected with your loved one is essential in ensuring they feel at home in the nursing home. Visit regularly, call often, and involve them in family events and celebrations. Knowing they are loved and supported by family can make a big difference in how they perceive their new living situation.

An environment that is less “institutional” in nature is conducive to reducing negative behaviors such as agitation, isolation, exit-seeking and improving positive experiences like socialization and improved mental function (Day et al., 2000).  While nothing is exactly like being at home, a homelike environmental design is key to residents being comfortable and able to relax.

Addressing Individual Resident Preferences

Providing care that centers on the personal preference of the residents is an integral part of giving respect and ensuring healthier outcomes. 

A recent visit to a nursing home facility illustrated the relevance of seniors having a voice in their own lives and care.  For example, residents at this facility take part in a program that allows choice in the recipes used for meal preparation, effectively giving a voice to residents about the food served at their facility. 

Researchers Heid, Van Haitsma, Kleban, Rovine, and Abbott (2015) state that individual preferences shape how care should be delivered, allowing for higher levels of physical and emotional well-being.  Person-centered care states that preferences actually communicate psychological needs, and that individualized plans can be created and implemented that support these needs (Heid et al., 2015).  The more staff and residents are able to connect and get to know each other, the better the staff is able to meet resident’ needs (site visit, April 2016).  Details from food choices to favorite activities to resting options are integral to making a resident feel more at home and cared for. 

It is imperative to support older adults in ways that will maintain physical, mental, and psychosocial well-being.  As previously stated, the key elements necessary to provide good care are adequate staffing, appropriate environmental features, and the personal preferences of the senior.  Staffing needs to be provided at appropriate and consistent levels to provide well-trained, personable, and timely aid to residents.  Turnover rates have an effect on the care and comfort levels of both staff and residents.  It is important to provide environments that are homelike and provide features that help to reduce stress and confusion.  Finally, it is imperative that the personal preferences of residents help to shape care.  Person-centered care is instrumental in helping to connect to seniors as individuals and to tailor care to what is really needed.  Together, these elements support the effort to provide quality, practical care to older adults.

References

Day, K., Carreon, D., & Stump, C. (2000). The therapeutic design of environments for people with dementia: A review of the empirical research. The Gerontologist, 40(4), 397-416.

Heid, A. R., Van Haitsma, K., Kleban, M., Rovine, M. J., & Abbott, K. M. (2015). Examining clinical predictors of change in recreational preference congruence among nursing home residents over time. Journal of Applied Gerontology, 1-19. doi:10.1177/0733464815617288

Sloane, P. D., Mitchell, C. M., Weisman, G., Zimmerman, S., Long Foley, K. M., Lynn, M., … Calkins, M. (2002). The therapeutic environment screening survey for nursing homes (TESS-NH): An observational instrument for assessing the physical environment of institutional settings for persons with dementia. Journal of Gerontology: Social Sciences, 57(2), S69-S78.

Zimmerman, S., & Cohen, L. W. (2010). Evidence behind the green house and similar models of nursing home care. Aging Health, 6(6), 717-737. doi:10.2217/AHE.10.66

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Suggested Reading

Understanding the Basics for Nursing Home Administrators: A Guide to Success in Every Department

Understanding the Basics for Nursing Home Administrators will help you hone your craft, encourage you to improve your skills, and assist you in running a successful skilled nursing facility. Written by a highly accomplished and seasoned nursing home administrator who understands the daily struggles of the job, this book delivers insight into how to be effective in every aspect of your role and in every department. It offers helpful tips, tasks to expand your learning, and key takeaways to make sure you fully understand the most important aspects of the business.This book will help you achieve greater results and more easily meet the challenges of the industry. Most importantly, it will help you better serve those who count on you each day, propelling you to have a tremendous impact on the lives of all those you lead and serve. This book is a must-read for all nursing home administrators, those interested in becoming nursing home administrators, or anyone interested in the skilled nursing industry!

Our Founder

Jennifer Crane, MS, CDP, is a Gerontologist & Certified Dementia Practitioner® and founder of Age With Dignity. She provides education and consultation services for older adults, their family members and individuals who care for older adults, especially those with dementia.