Page 49 - Tale of Transformation

Artifacts of Culture Change Categories and Items
Outcomes (cont’d)
Many culture changing homes deliberately try to reduce and eliminate the use of agency staff knowing that care is impacted by staff who are strangers to residents versus consistent facility staff who know the residents. We conferred with the homes in our focus group and other culture change leaders about the best way to calculate a number for the use of agency staff. It was pointed out by Anna Ortigara that agencies typically bill the nursing home monthly for the number of staff shifts that were covered by an agency staff member, with separate totals for CNAs and nurses. A staff shift is defined as one person serving on one shift on one day no matter the length of the shift.
We have adopted this method of calculation in the hope that it will prove to be the least burdensome way of a home answering the question. If the home has, for example, 10 CNAs for day, 7 for evening, and 5 for night shifts per day, then they have a total of 22 CNA shifts for the day. Since weekdays and weekends may typically have a different number of CNAs scheduled, we are asking the home to figure, for the previous month, how many total CNA shifts they had scheduled. Then the next step is determining how many of those shifts were covered last month by agency CNAs, and finally dividing agency shifts by total shifts to result in a percent. The same process is done for nurse shifts, which includes LPNs and RNs grouped together, excluding the DON.
Increase in census is another positive outcome experienced by culture changing homes. According to the most recent data, from the CMS Nursing Home Data Compendium 2005, the average occupancy rate in 2004 was 84.2 %. A two year study of Eden homes showed an 11% increase in census (Ransom, 1999). An increase in private pay census has been experienced by pioneering homes as reported by the Pioneer Network (Culture Change in LTC, 2003, pg. 136). An Artifacts item of occupancy rate is included as an Outcome.
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