Implementation of national staffing standards in two South African long-term care facilities: a document review.

backgroundNurse and caregiver staffing for long-term care facilities in South Africa should be based on national legislative prescriptions regarding the number of all nurse categories and caregivers, the skill mix, and staff allocation aligned to the acuity of residents. This article provides a perspective on understanding the implementation of the national staffing standards in two South African long-term care facilities.

methodsThe larger study comprised a multiple-case study design using multi-methods (document review and qualitative interviews) to explore how such facilities implement nurse and caregiver staffing. Ethical board approval for the study and institutional permission were obtained. This article concerns the findings of the document review conducted in one private for-profit and one state-subsidised long-term care facility, as reviewed from forty-five purposefully selected documents. Sources were triangulated to verify the credibility and representativeness of these documents. ATLAS.ti aided the qualitative analysis of the main themes related to staffing levels, skill mix, and staff allocation. The findings are reported in narrative form.

findingsThe findings showed that fewer nurses were employed, resulting in an overuse of caregivers, as less qualified staff provided the bulk of resident care. An inadequate skill mix may lead to neglecting residents' acuity levels in staff allocations.

conclusionsThe overreliance on caregivers contribute to an inadequate skill mix and results in the neglect of residents' acuity levels in care provision. The staffing decisions of CEOs of long-term care facilities should adhere to legislative prescriptions.