Not long ago, I had one of “those” travel days — the kind where you brace for the worst and hope for a miracle. What made all the difference? Cross-training. A single airline staffer managed to be both the calm voice at the service desk and the confident boarding supervisor hours later.  

Same person, two roles, seamless care. Her flexibility turned a chaotic scene into something almost dignified.

It got me thinking about our industry. Why can’t long-term care embrace that same kind of flexibility without getting dinged?

The old staffing lens doesn’t fit anymore

Since public reporting on staffing began, the focus has been laser-locked on nurses and CNAs. CMS’ Five-Star Quality Rating System, still the gold standard in the eyes of many, clings to that metric. Two staff types. One narrow lens.

Is it often bogged down at the nurses’ station? What about the physical therapists, occupational therapists, speech-language pathologists, social workers, activity professionals — the full team that helps a resident achieve their optimal level of functioning?

Mental health staff: Present but not accounted for  

Several providers I know work with residents who live with serious mental illness. They invest heavily in behavioral health specialists, licensed mental health counselors, psych NPs, social workers, and more. Most of these professionals show up in PBJ datasets. They’re real. They’re paid. They’re essential.

But because they’re not “nurses” or “aides,” they don’t count in HPRD metrics. And Five-Star doesn’t reflect their presence at all.

So let’s say you hire a trauma-informed behavioral team to help stabilize your residents and reduce hospitalizations. Fantastic. But guess what? Your Five-Star staffing rating might drop. Try explaining that to your state surveyors, board, lender or REIT — or, most importantly, to your residents’ families.

New study, same old problem

A recent working paper from the Pension Research Council at the Wharton School looked at the relationship between staffing and antipsychotic use. They found that fewer staffing hours were correlated with higher use of antipsychotics.  

But here’s the rub: They only counted nursing and CNA hours. Once again, we’re drawing big conclusions from a partial picture.

Would the correlation hold up if mental health professionals were counted, or if case mix were considered? Almost certainly. Would the insights be more actionable? Absolutely.  

Cross-training: A strength we don’t credit

Residents are fed, safe and seen.

But those minutes, or hours, spent performing these duties are often impossible to report properly under PBJ rules — which means they vanish. Quality is happening. Care is being provided. It’s just not counted.

Time to change the equation

We are in urgent need of a new staffing model, one that:

• Recognizes the full interdisciplinary team

• Reflects case mix and resident needs

• Gives providers the freedom to design care models that actually work for their population

Let’s stop pretending that quality care begins and ends with nursing. It begins with people: the right people, doing the right work, for the right residents.

When an airline service desk agent becomes the support supervisor at the gate and helps a frazzled customer feel confident and seen in a moment of crisis, we celebrate it as great customer service. But when a recreational therapist feeds a resident in the dining room, we call it a “compliance risk.”

That’s backward. And it’s time we move forward.

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.