Care providers spend more than half of their time at work doing tasks that do not involve resident care, indicating long-term care can become more efficient by delegating certain activities to non-regulated workers, according to new research.

Seven Canadian nursing home sites were observed for two months, for the study, which was published June 6 in the online version of the Journal of Nursing Studies. Registered nurses, LPNs and resident aides were observed to gauge how much time they spent doing certain activities.

The activities were put into three categories: Direct care for residents, indirect care and non-value added activities, such as restocking, searching for equipment and supplies, distributing linen; and looking for other providers. While results differed for each site, position and time of shift, care providers overall spent as much as 53.7% of their time performing non-care related tasks, said the researchers, who were primarily affiliated with the University of New Brunswick in St. John.

Aides spent 35.5% of their time in non-value added activities, which is more than other providers. RNs focused more on indirect care while LPNs tended to provide a combination of direct and indirect care.

These findings may be an opportunity to improve work quality and promote more time with residents, study authors wrote. Many facilities also had blurred lines in roles between RNs, LPNs and RAs, raising questions about defined tasks and use of resources. Other factors, such as facility design, organizational culture, practitioner skills and provider relationships also may change efficiency.

The quality of resident care was not evaluated in this study, and time spent away from residents does not necessarily reflect the quality of care delivered by providers, researchers pointed out.

Blogger comment:

Long term care isn’t the only provider that wastes the staff’s time.  I found this out in taking over a troubled SNF in 1987 then another in 1991 then others over the last 30 years.  Inefficiency can be traced directly to the lack of organizational skills and systems in hospitals, nursing homes and assisted living facilities.  In my book Restore Elder Pride, iUniverse 2011, I tell the story about the snowstorm and how it changed my view of nursing home staffing and assignments of workflow and workload.

I was the newly appointed Administrator effective April 7, 1987 and  five days later a patient drowned in the whirlpool when the physical therapist walked away from the tub to chart.  The facility was put on a conditional license and fined.  During the summer of 1987 we were struggling with getting the facility environmentally acceptable and solve the staff absentee and turnover problem. In August a record heat wave knocked out the air-conditioning system only to have a record snow storm in November 1987.

Therefore, the snowstorm story was created by a 16 inch snowstorm in Elgin Illinois at Fox Valley Skilled Nursing Facility on November 16, 1987 … I lived in Hoffman Estates about 20 miles from the nursing home.  I got a phone call at home from my acting Director of Nursing saying that only half the staff had gotten there and what should she do.  We decided to organize the staff into teams for getting patients basis needs met.  When I got  there the teams were functioning and the facility seemed more focused than ever before.  For 72 hours we managed the care and environment better than the mess that I had inherited.  The beds were made, the patients clean, fed and dressed.  From that day forward we retained the teams and the staff showing up after the 72 hours were inserted into these teams as our census rose due to the improved appearance of the facility and its staff.

The care plans were utilized to assign the work load and the Caregiver Management System used to manage the workflow and document the outcomes.  During the next survey we scored high on needs met and during the quality incentive program (QUIP) survey we got 5 of the six stars of quality.  This replaced the no star rating for the year before.  We also got recertified for Medicare after the Medicare survey and got a VA contract.  During that time the census increased from 169 to 195 based on our Medicare admission policies.

To this day I am most proud of that turn-a-round than any other in my career.  Jerry Rhoads