Consistency of Assignments

Being regularly cared for by the same caregiver is essential to quality of care and quality of life for each resident. To maximize quality, as well as resident and staff relationships, the Home will employ consistent assignment of PSWs and registered staff. What is consistent assignment and why is it important? Consistent assignment refers to the same caregivers consistently caring for the same residents every time they are on duty. Building strong relationships between residents and staff in order to improve residents quality of care and quality of life is at the heart of consistent assignment. Many residents are more comfortable with caregivers who know and understand their personal preferences and needs. Consistent assignment is also referred to as primary care and primary assignment. The opposite of consistent assignment is staff rotation in which staff are often moved from resident to resident, caring for different residents throughout the nursing home. Rotation of staff results in poor continuity of care and lowers staff accountability of resident care. Rotating staff means that each time there is a change in assignment, the staff person has to take the time to figure out the needs of each new resident they are caring for and how to best work with their co-workers for the day. This constant changing is hard for both residents and staff. Most of the care being done is very intimate personal care. Residents find it hard to have strangers caring for their intimate needs, and having to explain their needs time after time to new caregivers. When staff is unfamiliar with each other it is often harder for them to have good teamwork. Consistency of assignments begins with constancy of scheduling that includes regular scheduled days on and off, minimal shift rotations, and dependable allocation of personnel to specific home areas. The teams assigned to a resident home area are accountable for all residents on the home area and responsible to ensure completion of care to a specific group of residents living on the home area and a selection of assigned tasks. Consistent assignment results in the following outcomes: Residents: Residents receive better care as a result of improved stability and familiarity in care giving leading to staff being more knowledgeable about residents needs and preferences. Residents feel more secure knowing that they will receive care from someone who they know. Residents dont have to explain to new staff how to care for them day after day Residents feel more comfortable with the intimate aspects of care. Residents with dementia are much more comfortable with familiar caregivers Residents and their families develop relationships with staff over time. Staff: Staff see how their skill, experience and knowledge of the residents makes a difference in residents lives. Staff are better able to implement care plans and are more likely to notice changes in residents health, which can prevent larger health problems in the future. Risk of injury for staff is lessened as staff are more knowledgeable about resident needs Work becomes easier because staff are more accustomed to the residents schedule, needs and wishes. Staff can give individualized care and are more organized in their work.
Relationships are strengthened between individual residents, their families, friends and the caregivers. Consistent assignment allows staff to develop closer relationships with residents in their care and with co-workers. Staff who take care of the same residents are happier in their jobs and tend to stay in their jobs.

Staffing is stabilized through increased job satisfaction

Home: Staff get to know routines and develop a relationship with assigned residents and others. This makes a better workplace and a better home for residents. Caregiver absences are reduced. Staff are more likely to stay in the job when meaningful relationships develop as they know they are being counted on by others in the home. Consistency in resident assignment is a health quality indicator that is being measured in LTC homes across the province by the Health Quality Council. Reporting on this indicator will be mandatory by next year. How do long term care homes achieve consistent assignment? Stop rotating PSWs and nurses from one neighbourhood, wing or floor every few weeks. Staff assignments are for longer periods of time ranging from 3 months to permanent. Assign staff to one area of the home so that they can serve one group of residents. These consistent assignments apply to nurses and PSWs. This also can apply to housekeeping, dietary and other members of the team. For time off of the primary staff member, there is the same shadow staff member to consistently cover these days, thus ensuring the resident still has staff they are familiar with on weekends, days off, and holidays. Whenever a primary staff member is reassigned, the shadow staff member is also reassigned. How can staff help implement consistent assignment? Work with the homes leadership in developing an educational program on the benefits of consistent assignment. Participate in meetings with other staff about consistent assignment. Collaborate with the homes leadership to develop a process that will ensure that PSWs have input when resident assignments are given. The goal is to have everyone feel that their assignment is fair. Meet regularly to discuss how consistent assignment is working, including reviewing assignments to ensure that relationships with the residents are going well. Associated Principles Relationships are the cornerstone of culture change. Residents who are cared for by the same staff members come to see the people who care for them as family. Staff that care for the same residents form a relationship and get great satisfaction from their work. When staff care for the same people daily they become familiar with their needs and desires in an entirely different way and their work is easier because they are not spending extra time getting to know what the resident wants, they know from their own experience with the resident. When staff and residents know each other well, their relationship makes it possible for care and services to be directed by the residents routines, preferences, and needs. Relationships form over time we do not form relationships with people we infrequently see. To encourage and support relationships, consistent assignment of both primary staff and ancillary staff is recommended. When staff members routinely work together, they can problem-solve and find creative ways to reorganize daily living in their care area. Consistent assignment forms the building block for neighbourhood-based living. This is the framework around which long term care homes in Ontario are now built

Adapted for use from Fast Facts: Consistency of Assignment, www.nhqualitycampaign.org