Workforce Issues in Long-Term Care

An area of significant research interest is the way in which family members of care recipients relate to long-term care workers. Clearly, cooperation is essential to optimal resident care. However, research indicates that structural barriers to cooperation between the two groups exist. In the most influential theoretical approach to this problem, Eugene Litwak noted fundamental differences between large-scale formal organizations and primary groups, such as families. In nursing homes, the potential for family conflict with staff is heightened because long-term care facilities represent the classic case of a formal institution seeking to take over primary group tasks, and to fit the performance of such tasks into a bureaucratic, routinized, organizational framework.

Consistent with Litwak’s view, one line of research has pointed to discrepancies between staff and family perceptions of appropriate tasks for each group Although studies vary in their estimates of the extent of such differences, it is clear that ambiguity regarding the division of labor between staff and relatives exists, particularly in the performance of nontechnical tasks, and can lead to conflict (Duncan and Morgan).

Even when families relinquish the technical aspects of care to the staff, they nevertheless feel compelled to monitor the quality of service delivery. Stephens and colleagues found that over one-third of relatives reported feeling that they had to remind staff to do things for their resident, and that they needed to tell the staff how to care for the resident.

Research has also identified poor communication between staff and families as an important problem. Many residents, especially those with cognitive impairments, are unable to give accurate, factual information about their experience in the facility. There is often little sharing of detailed information about residents, and families frequently feel that there is no one to whom they can bring their concerns. Further, relatives are sometimes hesitant about offering suggestions and criticism, out of fear that such comments might negatively affect the care provided to the resident. Additional barriers to communication include the fact that staff work under intense time pressure, which limits their availability for conversations with families. In addition, nursing home staff—and nursing assistants in particular—receive little or no training in communication skills (Pillemer et al.).

As a result of these problems, studies have found that both staff and family members were frequently annoyed, and sometimes very angry, during and after interactions with each other. Studies of nursing home staff have shown that problems relating to family members are a major source of stress.