Dedicated Staffing: Can it deliver better care and save money

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Much of the commentary surrounding the age services workforce points to a challenge that is overwhelming. Questions arise as to how we will ever attract enough staff, how to attract the right staff, the value of caring and the lack of government funding to match care needs. On top of this, the often arduous nature of aged care work results in injuries across age services outstripping those of the mining sector.

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To date, workforce development has been an ad hoc process where a philosophy of ‘think globally, act locally’ has not been embedded in funded workforce development programs thus far.
As chair of the ministerially appointed Aged Care Workforce Advisory Committee I am interested in promoting innovative programs that have the ability to be rolled out nationally. It seems I did not need to go further than LASA member, Arcare.
Arcare is a significant provider with 13 sites across Victoria and Queensland with new development in NSW; they have embarked on what many would consider an unusual and brave service delivery and workforce model. In 2012 when they surveyed stakeholders, the overwhelming majority of responses highlighted one key thing, the power of relationships. As Arcare merged its thinking around business development and excellence in care they found:
“The development of quality initiatives which generate greatest satisfaction are where business interests intersect with the interests of families and residents.” Arcare evaluation of dedicated staffing, Nov 2014.
The model established is called dedicated staffing and sees one carer provide exclusive care of a resident. Staff were required to commit to a minimum of three shifts per week. Arcare implemented the model in their dementia specific community in their Greenhill facility in Victoria. They now have collected the first 12 months of data with some excellent results, both quantitative and qualitative. They have compared 12 months of dedicated staffing with the previous 12 months of traditional operations. To date their outcomes have not been fully costed but they are certainly positive and worth exploration on an industry level.

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“As chair of the ministerially appointed Aged Care Workforce Advisory Committee I am interested in promoting innovative programs that have the ability to be rolled out nationally.”

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Resident Experience
For residents living with dementia the first 30 days of the model saw an 82 per cent reduction in the numbers of staff attending an individual resident (from 28 to 5). This continuity in care allowed a relationship and high levels of trust to develop between staff and residents, developing in greater efficiency, through the understanding of residents’ needs and individual preferences. Gerald, an 85-year-old-resident, compared traditional and dedicated staffing having experienced them both. “I wouldn’t go back to when I first started here without Sally. I don’t trust everyone with – you know- my condition. I used to have very bad panic attacks, now I don’t have them.”
It is not difficult to see the intrinsic value of a high level of continuity in care provided. This can only be amplified when communication is difficult, especially in the cases where a resident is non-verbal. Clinical improvements were made in key areas such as pressure injuries, skin tears, respiratory and gastrointestinal infections. A reduction in falls, weight loss and the use of psychotropic medications was also achieved. A series of validated questionnaires administered to staff showed improvements in important quality indicators such as hope, recognition of personhood, and the achievement of more constructive staff-family relationships.
Staff Experience
Despite the challenges of working in residential aged care, especially for those in a dementia specific unit, staff satisfaction rates increased by nearly four times that of staff working in rotating care. Quite astoundingly, in a second survey, 100 per cent of staff working in the dedicated model reported job satisfaction and this was revealed by a 27.5 per cent reduction in sick leave and a 50 per cent reduction in staff turnover.
Family Experience
Again as part of the evaluation, family members of residents were surveyed. Outcomes included a 44.5 per cent increase in compliments and a 100 per cent reduction in complaints. Arcare reveal the most informative data was the qualitative response with comments from family members including ‘I can’t be happier’ and using phrases such as ‘peace of mind’. This is so positive when all too often we hear negative experiences of residential care.
Business Experience
An assessment of weekly staffing hours for Personal Care Assistants, taken 12 months apart to compare traditional operation with the dedicated staffing model found a 23 per cent reduction in PCA hours (from 689.35 to 530.45), Nursing staff, both ENs and RNs remained the same. The business impact in relation to marketing and reputation is also likely to have financial benefit to Arcare.
Nursing staff revealed “less time was wasted on investigations” and “staff are more organised with work load and time management”.
Carers reported: “The system made me more knowledgeable of the residents and their needs, thus requiring me less time to respond to their needs”.
This is a workforce solution that provides high quality care with an enhanced consumer experience, meets family expectations, improves staff job satisfaction and reduces costs. While this seems too good to be true Arcare’s dedicated staffing model has ticked all of these boxes. As the voice of the age services industry I believe LASA has a responsibility to present innovative models to government and bureaucracy in order to assess the merits of further development.
For too long there has been a disjointed approach to workforce development and industry attraction schemes. LASA has consistently advocated that much of the innovation and thought leadership comes from within our membership. As always I will work alongside our members to maximise their innovations and practice development. The wheels of government sometimes move slower than we would like; however I believe with such positive outcomes dedicated staffing should be explored as a quality improvement, workforce development and industry attraction model.
Patrick Reid
Patrick Reid is the CEO of Leading Age Services Australia.
Leading Age Services Australia
P 02 6230 1676
W lasa.asn.au

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“As the voice of the age services industry I believe LASA has a responsibility to present innovative models to government and bureaucracy in order to assess the merits of further development.”

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