Staffing

Delivering high quality care is a top priority for administrators. But at the same time, every manager is also driven to cut costs. Since labor alone makes up 50 to 60 percent of total operating expenses, it is the one thing we can't ignore.

You may have already cut back on your staff or your staffing hours to reduce your costs, but you don't want to cut too much or your quality of resident care could suffer. Here's how to find the best balance-enough people to do a good job, but not too many to inflate costs.

Let's explore staffing your community based on changes in census and the actual acuity of the residents, using time standards. Many people think this acuity-based method is too complicated to implement, but it's actually easy and worth the initial effort. A simple spreadsheet that you update weekly can help get you started.

What to Do

The following system can help get you on your way to better staffing, shore up your costs, and actually increase your profits, without compromising quality care.

1. Start a spreadsheet, then take inventory of your services and create a column for each service your offer. If you offer partial bathing assistance, then that becomes one column.

2. Assign times associated with each activity. For example, partial bathing assistance may be set at 28 minutes per bath. If a resident needs two baths per week, you need 56 minutes of staffing. Simply add up all of the times for all of the services to get a precise measurement of the hours needed to deliver the services being promised. Build a row under the services to list the standard times. To start, you can estimate. Write down the minutes per month needed to deliver the service.

3. Keep track of these minutes. Giving away or missing just 10 minutes a day could cost you in lost revenue. Consider this: 10 minutes per day x 60 residents x 365 days/year x $25/hour revenue (labor, overhead, profit)/(60 minutes/hour)=$91,250/year.

4. Assess and reassess residents. While you may estimate that the standard time for ambulation assistance to and from meals is eight minutes, you may find that some residents take a little longer. Use the specific information as you learn it to get the real picture of acuity. As you assess, the feedback is important to train your community to think in terms of using time wisely.

5. Refine and revise to get it right. You may need to refine your standard times as you go to better understand your community and services that may be needed and to establish best practices.

For example, the service "partial bathing assistance" may include multiple steps: check the bathing area; get the resident; assist with undressing as needed and draw bath; assist with towel and dressing; let the resident return to room or escort as needed and clean the bathing area for the next resident.

Just writing down these steps will allow you to examine each service to pinpoint the total time required. Once you identify the steps, time and observe this process 30 times. Take the average as your normal time, then divide by 0.8 to get a standard time.

This will raise your standard times by about 20 percent over what you observe in your timing efforts. As you do more of the services, your tools will get more precise.

6. Compute the full-time equivalents. Total the time at the bottom of each column to see the total time needed per month for each service. Add all of the services that a caregiver will provide to get a total for caregivers, and then divide by the number of days in the month. Do the same for each job position. You can also divide the hours per day by eight to get FTEs.

7. Update weekly. As residents come and go, add them or drop them from your spreadsheet. As assessments are updated, adjust the times in the cells. As you refine your times and change your services, change the standard time you are using.

8. Expand your services. For example, if a resident needs two baths per week, he might also want one spa bath per month.Knowing what services residents are using can help promote the selling of additional services.

Doug Fullaway is president and CEO of Vigilan, Wilsonville, Ore. DISCLOSURE: Vigilan is an operational management systems company for independent living and assisted living providers.