What do you think about universal workers in LTC?

Specialties Geriatric


Just curious. Have talked with some people in LTC who are enthusiastic about the idea of universal workers---meaning employees who could work dietary, nursing, housekeeping---whatever the needs are for the day. Others are skeptical. What are your opinions about and your experiences with universal workers?

Thanks for the input.

Specializes in Gerontology, Med surg, Home Health.

I work in a facility that believes in the small house model. We have one CNA to five residents. We are going to be rolling out universal workers soon. If you lived in your own house, you wouldn't have one person to cook, one to clean, and one to help you with your daily care. You'd have ONE person doing everything. I think it's a great concept. The dietary and housekeeping people who want to join will all be trained as CNAs. It's a wonderful idea.

This is happening where i work where the stna's are also becoming waitresses

With the new restaurant style dining service. They're so burned out the moral is so low

And the lights are ringing like it's christmas. With change their's always a catch to save dollars while they continue to ride our backs for more bucks.

Cape cod, I too work in a facility that believes in the small household model. We have 11 residents in a household and I think the care they recieve by the universal workers is better than the old model of care. I think it is very beneficial to a resident to only have to learn maybe 8 workers names, faces, etc. versus what 14, 15 or more people. In our households we cook 3 meals a day, do laundry, clean, bathe, activities & restorative nursing. Yes the nurses to do all of that as well. What better way to know your people by giving them a bath and seeing their skin or sitting down at a meal, eating & visiting with them to learn about them or their families. I am for universal workers. As the QIS survey promotes culture change and person centered care in LTC facilities, the universal worker is the way of the future. Not some way to cut costs for facilities, but to make the facility BETTER for those who live here. I would invite anyone to come to the facility I work at tour and see how we work.

My experience with this sort of thing has been in ALFs and I have to say I am appalled at the lack of nurses these places employ and it is only for mazimizing profits. The people I now see in ALFs would have been in skilled nursing facilities 10 years ago. A lot of the folks in SNFs would have been in the hospital 10 years ago.

Now, the idea of neighborhoods with one aide to five patients is fabulous. And except for the most expensive private pay facilities will never be implemented.

Specializes in Gerontology, Med surg, Home Health.

I have a 1:5 or 1:6 ratio of CNAs to residents. I have at most 3 private pay residents in my very large facility. It's all about the company's philosophy of care.

I have a 1:5 or 1:6 ratio of CNAs to residents. I have at most 3 private pay residents in my very large facility. It's all about the company's philosophy of care.

Agreed. But you will concede that your facility is in the minority, no?

The facility I work in is also 1:5 ratio for CNA's, no assisted living where I am. We do not have a lot of private pay people either. I would agree with Cape Cod. It is the company's philosphy.

Specializes in LTC.

Where I work, they call the housekeeping staff "universal workers" but they aren't trained as CNAs so they don't help with resident cares. They are trained as feeding assistants so they help with feeding and passing out food at meals, but the rest of the day they are doing housekeeping tasks.

Specializes in Geriatrics.

We are looking at going with versatile workers. They spend 80 percent of their time in a designated role such as NA and then 20 percent of their time in a role of their choosing be it dietary, housekeeping, and activities(but will also have employees spending 80 percent of their time doing this). We are also going into a household model of 20 residents per household. I would have a 1:6 ratio for the aides. It will just allow the household team to understand each others responsibilities and "pitch in when needed" as more of a blended role. An aide would be able to assist in a cooking activity and a dietary aide could assist in a knitting class(if that is their gift).

I have also seen the universal worker at a facility I visited in MN. They use the household model too and everyone is trained as a NA so they can help answer lights and provide resident care. It promoted team work as they would come in every morning and decide together who was going to complete what task or job for the day. Management didn't decide it for them. It promoted job satisfaction so you didn't feel like you just did the same thing day in and day out. We decided not to make everyone be trained as NA's which is why we are going with a blended role or versatile worker versus a universal worker.

To me it's not about saving money, I am actually adding staff to do this. I think it is better for the resident, promotes staff decision making and satisfaction, and gives an all around improved quality of life. But that's just my opinion.

Specializes in geriatrics, dementia, ortho.

I'd be curious to try this in a setting like some of you have described, with small pods of patients and great ratios.

The only experience I've had with it was in assisted living, where I was working noc and expected to change/turn/toilet 30-40 residents by myself as well as do their laundry, put it away, answer call lights, and mop some rooms and clean the dining room. It was pure hell.

In a smaller, home-care like setting, I could see it working well. When I've done in-home care in the past, there was a lot of downtime (even if it was for 2 people at once, like an elderly married couple) so I could see adding 2 more people to that load as long as there was someone to supervise my patients when I was tied up with say, showering one of them.

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