Senior Care Risk: Inadequate Staff in Quantity, Quality, Experience, and Training

Susan Lucot, MSN, RN, MLT (ASCP), CPHRM

One of the most influential contributing factors in senior care medical malpractice claims is inadequate staffing — and not only in quantity of staff but also in dedication, knowledge, experience, and skills. Competent, committed, and compassionate staff members are invaluable. Simply hiring someone to fill a position is not sufficient. The role of the direct caregiver requires delivery of high-quality and consistent care rooted in evidence-based practice along with empathetic customer service.

When caring for residents with dementia, having a “one-size-fits-all” approach to staff training and education does not truly address resident needs. For example, dementia has several forms (i.e., Lewy body, vascular, frontotemporal, and Alzheimer’s disease) and several levels within each form. Understanding the different forms and levels enables a caregiver to select appropriate tools and approaches if they are confronted with an angry, distrustful, isolated, or fearful resident.

When caring for residents with behavioral health disorders, understanding the characteristics of each disorder and the potential triggers for negative behavior is essential. Training needs for staff include effective communication skills and de-escalation techniques. Like any other care skill, these must be learned and rehearsed through role playing, group discussions, and simulation scenarios. Having staff simply do a computer-based module on behavior management is counterintuitive. Just like with dementia care, having a variety of tools and strategies to apply in behavioral health situations can affect the outcome for both the resident acting out and the staff member trying to de-escalate the event.

From a medical perspective, treatment for behavioral health disorders should consider both psychotherapeutic and medication interventions. Medications alone often are not recommended for residents to obtain optimum function. The combination of ongoing psychotherapy techniques and psychotropics has the potential to provide a much greater effect on managing negative and inappropriate behaviors.

Managing the risks associated with staffing requires ongoing diligence and a commitment to workforce development. The following strategies can help senior care organizations assess and improve their approaches to staffing:

• When recruiting new staff, be sure to:
  • Confirm credentials (i.e., education, licensure, certifications).
  • Verify past work experience (including references from previous employers).
  • Assess soft skills (e.g., communication, teamwork, empathy, adaptability, critical thinking, problem solving, professionalism, self-motivation, emotional intelligence, and conflict resolution).
  • Review prior on-the-job training and professional duties, including confirming capabilities and competence.
  • Conduct state and federal criminal background checks as well as national sex offender registry checks.
  • Screen for red flags associated with substance abuse (including drug testing in accordance with organizational policy).
• Develop comprehensive onboarding and orientation programs, or review existing programs to determine areas for improvement.
• Offer thorough skills training for nursing care and activities of daily living.
• Incorporate role playing and simulation activities to improve skills related to communication, behavioral management, and de-escalation.
• Establish an interorganizational behavioral health and dementia care program that is overseen by psychiatric and psychology professionals. Ensure the program has the capacity to provide guidance at every senior care and senior living center within the organization, regardless of geographic location.
• Include robust guidance on topics such as prospective resident admission reviews and placement recommendations, continuous monitoring of resident behaviors in relation to prescribed therapies and treatments, issues and strategies associated with transferring residents, and approaches for managing resident behaviors to ensure continuity of care.

For additional insights on providing care for residents who have behavioral health disorders and/or dementia in senior care settings, click here.

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