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Consistent Assignment Study Criticized by Culture Change Advocates

March 6, 2014

A study showing that consistent assignment could have negative effects on nursing home aides has come under criticism from several key culture change advocates.

The study — published on the website of Western Journal of Nursing Research on February 11 — draws on interviews with 22 aides in five Canadian nursing homes that have adopted the Eden Alternative®, a culture change model that emphasizes person-centered approaches to care, including consistent assignment.

The researchers found that the aides felt constricted by the task of caring for the same residents day after day. Many reported feeling isolated from other residents and coworkers.

Care aides felt as though they were “discouraged from seeking assistance,” the researchers write.

Flawed Analysis

But consistent assignment, properly implemented, doesn’t preclude teamwork, and it definitely should not make aides feel voiceless and isolated, culture change advocates argue.

“When problems — such as a negative impact on teamwork — occur, it is important to strategize about ways to fix those problems, rather than throwing the baby out with the bathwater,” said PHI Coaching & Consulting Services Director Susan Misiorski.

Rather than concluding that consistent assignment is a flawed concept, the researchers should have concluded that “the organizations involved [in the study] did not do a very good job implementing these changes,” Eden Alternative CEO Chris Perna told McKnight’s Long-Term Care News & Assisted Living.

Misiorski also noted that it is difficult to draw conclusions about the efficacy of consistent assignment — or any practice — from such a small sample size.

She pointed to a 2011 study published by Nicholas Castle of the University of Pittsburgh‘s Graduate School of Public Health. Castle analyzed nearly 4,000 long-term care facilities that implement consistent assignment, and found a “significant” reduction in quality of life and quality of care deficiency citations among nursing homes with the “highest level of consistent nursing aide assignment.”

— by Matthew Ozga

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