A defining characteristic of assisted living is the provision of person-centered services and policies promoting quality of life, privacy, choice, dignity, inclusion and independence. So why is it that those core principles of person-centeredness are not consistently applied to those who work in this setting?
The mission of the national Center for Excellence in Assisted Living (CEAL@UNC) is to advance the well-being of the people who live and work in assisted living through research, practice and policy. The success of assisted living hinges on the dedicated efforts of hundreds of thousands of various professionals, including building maintenance staff, dining services teams and direct care professionals, among others.
Direct care professionals in particular, who are majority women of color and disproportionately immigrants, often experience low wages, limited flexibility, few career advancement opportunities and high turnover rates – suggesting that the quality of life and other person-centered principles accorded to residents are not universally accorded to those who care for them.
The challenges faced by those professional caregivers, and related recruitment and retainment difficulties faced by assisted living providers, were brought to the forefront during the COVID-19 pandemic. Recent nursing home staffing standards released by the Centers for Medicare & Medicaid Services likely will create additional pressure by causing potential competition for this workforce from the nursing home industry.
Although many solutions to those challenges have been proposed, they largely lack fundamental grounding in person-centeredness. CEAL@UNC promotes the concept of person-centered employment practices, which applies the core principles of person-centeredness to the employer-employee relationship as the way forward. Examples of person-centered employment practices embodying this approach are outlined below, providing a foundation to balance the respect due to both residents and their professional caregivers.
- Individualized training and growth plan: Central to person-centered employment is offering individualized training and development opportunities. Just as an individualized service plan is tailored to a specific resident, a training and professional growth plan should be customized to each employee’s goals and passions. Focusing on what motivates a specific professional caregiver — whether it’s learning more about dementia care or earning certifications in medication administration — is person-centered.
- Flexible scheduling: Flexible scheduling, including self-scheduling, offers professional caregivers choice and independence, and research indicates that it helps alleviate the stress and burnout that comes from balancing personal and work responsibilities. Research also shows that employees across all industries highly prioritize scheduling flexibility to improve their work-life balance, and professional caregivers often cite flexibility as a key factor in choosing an employer.
- Fair compensation: Adequate wages and benefits reduce turnover, attract more individuals to the profession, and serve as a tangible acknowledgment of the indispensable role played by professional caregivers. Fair compensation provides workers more choice in where they live, access to healthcare and education, the ability to balance private and professional responsibilities without needing to work multiple jobs, and greater quality of life.
- Recognition and respect: To be a person-centered employer, an organization must codify recognition and respect for professional caregivers through its written mission and values, and it must enact those principles through business practices. Adopting the language of “professional caregiver” versus “aide” or “paraprofessional” recognizes the importance of the services provided by those individuals. Also, offering genuine opportunities to enact meaningful change through shared-decision making, as well as maintaining clear communication about decisions that affect them, provides dignity and creates an inclusive environment where each person’s input and skills are valued and considered.
Successfully adopting person-centered employment practices relies heavily on leadership. Just as professional caregivers are expected to demonstrate person-centered values in their interaction with residents, leaders and supervisors must exhibit respect, dignity and inclusivity in their interactions with employees. By modeling those principles throughout recruitment, onboarding and day-to-day work, leaders are responsible to create an environment that values the inherent worth of all who live and work in assisted living.
Implementing person-centered employment practices is an investment with considerable returns, including but not limited to preventing thousands of dollars in turnover costs and expanding service lines by improving employee capacity and capability. Investing in those and other person-centered employment practices, such as those recommended by the National Center on Advancing Person-Centered Practices and Systems and PHI, acknowledges the interconnected well-being of those who live and work in assisted living, and that a high-quality work environment leads to improvements in care and resident outcomes. To this end, CEAL@UNC calls for the extension of the principles of person-centered care to the dedicated individuals who support the nearly one million residents currently living in assisted living communities.
Sheryl Zimmerman, PhD, is the executive director of the Center for Assisted Living, CEAL@UNC.
CEAL@UNC Manager Walter Moczygemba contributed to this guest column.
The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.
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