Consistent Staffing for Long‐Term Care through On‐Call Pools

Abstract

Nursing home managers are increasingly striving to ensure consistency of care, defined as minimizing the number of unique nurse aides who care for a resident during at least one shift over the course of one month. Unfortunately, managers often struggle to provide consistent care, primarily due to last‐minute nurse aide absences and choosing to staff these absences with aides from an external rental agency. We are the first to study the use of an “on‐call” pool—aides on staff who may be called in to work in the event of absences—as an operational strategy to improve consistency. We provide structural results for the relationship between the number of aides in the on‐call pool, staffing cost, and inconsistency level. We also show that a “restricted” on‐call pool—in which the slots in the pool are distributed as evenly as possible across units—outperforms an “open,” or unrestricted, on‐call pool. We further demonstrate that converting full‐time positions to part‐time positions can improve consistency of care if the part‐time aides’ on‐call pool participation rate is sufficiently high. Numerical results for a typical 100‐bed and a 200‐bed facility demonstrate that an on‐call pool can (a) reduce the staffing costs due to absences by 24% while also (slightly) reducing the inconsistency level, or (b) significantly reduce the inconsistency level without increasing costs.