For long-term care to succeed in delivering on its promise of providing person-directed experiences, each touchpoint between residents and teams need to be optimized. This cannot happen if we don’t consider how essential staff wellbeing is.

There are many ways to attract and retain excellent staff. One essential key involves attending to both residents’ and staff’s wellbeing and understanding their experiences of trauma.

Jean Hartnett, founder of Radical Sabbatical, addressed this in a LifeLoop webinar. She said, “Trauma is a Greek word for ‘wound’ and is a psychic wound that hardens a person psychologically and interferes with our ability to grow and develop.”

The regulations require skilled nursing facilities to provide trauma-informed care for residents, and this is significant, she noted, as “over 90% of the older adults that we care for in our nursing homes have experienced at least one traumatic event in their lifetime.” However, she stressed that staff have traumas that need to be addressed as well. 

Hartnett observed that many of us have stories with their origins in trauma we experienced as children or adults.

“These stories of past trauma often stay hidden from people in our families, our spouses, and our coworkers,” she said. Keeping these stories secret can have a negative impact on us throughout our lives. 

Some interesting insights came out of a survey Hartnett conducted live with the webinar participants. The results suggested that organizations need to pay more attention to staff and trauma.

In the survey, three-quarters of participants said that their organization has not talked about the traumatic events of COVID-19, although the vast majority of respondents said the pandemic was a traumatic event. A similar number said things have not gone back to “normal” since the pandemic, and 86% said they feel different about their job in senior care since COVID. Hartnett said, “I think this was a really telling exercise.”

Trauma-informed care acknowledges that long-term care and senior living organizations and care teams need to have a complete picture of both residents’ and employees’ entire life situations to provide exceptional services or services that have a healing orientation,

Hartnett said. She added, “I’m really encouraging organizations to embrace compassion as a strategic initiative. I remind leaders [in long-term care] to understand that they don’t have to be a therapist to be therapeutic.”

Raising staff resilience

Our teams are amazingly resilient, and that helps them survive and move on after a trauma or disaster such as a pandemic. However, as Hartnett observed, they may employ some coping mechanisms that can be problematic or even destructive, such as drinking or smoking. It is important to identify behaviors that people use to cope but that they want and need to change. 

“We can start building a care plan around each individual that moves them away from those maladaptive behaviors into behaviors that can sustain them in a positive manner,” said Hartnett. She added, “I really like this idea of taking a case management approach to our employees like we do our residents, so can we look at what’s happening in their lives, whether they’re food insecure, lack reliable transportation, or have unstable housing. Then we build a social care plan around them so that we can connect them with access to those types of services from the mental health and EAP standpoint.”

It is important, she noted, to do a better job of leveraging employee health so that we can screen for mental health issues and understand the kinds of struggles our team members are dealing with.

Realities of the rule

Even before the proposed final staffing rule was published in May, everyone was talking about how to improve staff recruitment, retention and engagement in long-term care. However, the rule created a sense of urgency.

In a LifeLoop webinar on the proposed final rule, Sherry Thomas, director of clinical services at LeaderStat, talked about the basics of the rule, but she also talked about the implications.

For one, the rule is expected to cost about $43 billion over 10 years; and there are no provisions requiring Medicare, Medicaid or other payors to increase the payment rates to providers for any of the rule requirements. The estimated numbers make some assumptions, such as RN and nursing assist wages growing annually at a rate of 2.31% and the resident population remaining stable over 10 years. In their reporting, providers must address the link between staffing and quality; and states must report to CMS the percentage of Medicaid payments for services in nursing facilities and ICF/IDDs that is spent on compensation for direct care workers and support staff. 

Surveyors will be closely looking to determine if there is sufficient or competent staff, specifically in relation to several Ftags, including F636 (Comprehensive Person-Centered Care Planning), F725/F726 (Nursing Services Not Related to Behavioral Health or Dementia Care, F741 (Sufficient/Competent Staff Caring for Residents with Behavioral Health Needs), F801 Qualified Food and Nutrition Staff), and F826 (Specialized Rehabilitation Services).

Thomas stressed, “You cannot staff only to the numerical standards. Sufficient staffing is really in the eye of the beholder, so you have to ensure not only that the numerical standards are met but that you have sufficient staff with the appropriate competencies and skill sets to ensure that you are attaining and maintaining the highest practicable physical mental and psychosocial well-being of each resident. Our goal is always to attain and maintain those parameters as determined by your resident assessments in accordance with the facility assessment.”

Clearly, there is no one answer to staffing challenges and addressing the staffing mandate. However, when we work together, collaborate with community and other resources, and prioritize the wellbeing of our staff as well as our residents, we can take steps forward. We can create communities where people want to live and work and where residents belong and thrive.

Charles de Vilmorin is the General Manager, Linked Senior with Lifeloop.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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