Successful Implementation of Consistent Staff Assignment in VA CLCs

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Veterans Health Administration (VHA) Community Living Centers (CLCs; formerly known as "nursing home care units") are in the midst of cultural transformation aimed at providing resident-centered, home-like environments that promote optimal health and quality of life for older Veterans. One key objective of CLC cultural transformation is full implementation of consistent staff assignment. Consistent staff assignment minimizes the number of staff who provide care to a resident during his or her nursing home stay, which is thought to result in better, more sustained relationships between staff and residents. These in turn are thought to promote better health care and higher quality of life for nursing home residents. Based on these views, VHA Geriatric and Extended Care (GEC) and CLC leadership, as well as the national Advancing Excellence in America's Nursing Home campaign, all endorse and have taken concrete steps to encourage timely, full implementation of consistent staff assignment in all CLCs and nursing homes. However, the extent to which VHA CLC units have in fact attained this goal is not known. Nor do we know which CLC unit-level characteristics might be associated with earlier, more complete, and more sustained implementation of consistent staff assignment. To address these knowledge gaps, this project will use a Staffing Practices Survey to collect information from 300 VHA CLC units about the extent, duration, and stability of their implementation of consistent staff assignment practices, and about unit-level characteristics that might facilitate or interfere with implementation of consistent staff assignment. This information will be compiled and analyzed to achieve two aims: Aim 1: To document the progress of individual CLC units in implementing consistent staff assignment, as assessed by the extent, timing, and stability of goal attainment. Aim 2: To identify specific CLC unit characteristics, scheduling policies and practices, and staff scheduler attributes, as well as specific tools and innovations that are associated with earlier, more complete, and more stable implementation of consistent staff assignment. We will disseminate findings from this project throughout the VHA CLC network, to staff at all levels, to support augmentation and adjustment of current practices in ways that facilitate more timely, complete, and stable implementation of consistent staff assignment. Results of this project will identify CLC units that have made the least progress toward the consistent staff assignment goal and CLC units that have had difficulty sustaining consistent staff assignment over time and will suggest which of the evidence- and expert opinion- based predictive factors in our conceptual model are potentially fruitful loci of interventions to improve implementation of consistent staff assignment. These results will provide the foundation for a future project aimed at improving ongoing efforts to fully implement consistent staff assignment in VHA CLCs.