Moving Caregivers Around in MC?

ARIL · July 14

The MCF where my father lives has several discrete areas (“neighborhoods”), with a set of rooms, laundry, and dining room. These areas are not arranged by level of care; rooms are luck of the draw when moving in (whatever is open). Caregivers are assigned to one of the areas during a shift; nurses supervise two areas during their shifts.

For quite a while the same caregivers have been assigned to my dad’s area, and we have good relationships with some of them. One in particular has worked hard to understand my father, and he has a lot of trust in her. Things have been fairly stable lately.

Today I found that all of the caregivers have been assigned to different areas. Not just moving one or two, but it’s like musical chairs, and everyone has wound up in a new place. There was a fair bit of chaos during my visit this afternoon.

I am trying not to overreact to this, but I am not seeing the advantage of the change. I thought routine and a stable environment were the gold standards in dementia care.

Is this something you’ve seen before? Do you know what the possible rationales might be?

I may ask directly, but I have two other inquiries going already, about meds and missing items, and I am trying not to appear to be a chronic complainer.

JulietteBee · July 14

I've never been a charge nurse in a MC facility, but I assume staffing needs are the same as at hospitals. Patient assignments are based on acuity. Continuity of care is the ideal for best patient outcome. However, assignments do get changed to accomodate the staff. If not, the same staff member may get an unfair number of higher acuity patients/residents.

harshedbuzz · July 14

@ARIL

This sounds very like the facility in which we placed dad.

FWIW, I was told it's not luck-of-the-draw by a long shot. Care is taken to balance the care needs so staff in no one neighborhood is overburdened by the more challenging levels of care.

Continuity of care is important, but changes do happen at times. Some places are forced to staff with floaters and traveling nurses on weekends. A particular resident might be triggered by a carer who can be/was aggressive. Vacations and PTO happen as well as retirements. Dad's main daytime caregivers had been together 15 years and worked well together; I could see where the DON would keep them paired.

He'll likely adapt to new people since the routine should be set.

HB

ARIL · July 14

Thank you both. Very helpful. I see what you are saying.

By “luck of the draw”, I meant that when a person moves in, they go wherever there is an empty room. The place has a waiting list, so usually there is only one room open at a time.

Yesterday I arrived to find my dad needing to be changed, a wet bed, dirty clothes piled in the corner, and two caregivers across the hall with a resident who was screaming at top volume and did so for 45 minutes.

I helped Dad get cleaned up myself and brought the dirty laundry home to wash. This has happened before, but rarely in recent months, since regular caregivers had him on a bathroom routine. I am discouraged at the idea of having to get to know new people when caregivers who know him well are still employed at the same place but are elsewhere in the building. I have seen staff turnover a lot, and occasionally individual caregivers moving elsewhere in the facility. But now for the first time ALL the caregivers have been rotated to a different area, most accompanied by the same staff they were working with already. It is as if we are at a new facility.

That said, I did see conversations taking place among caregivers from different areas. So maybe it will work out. It is just hard to see why and for whom this is a good plan. Honestly it would make more sense if every staff member was changing areas every week, so all the caregivers would work with all the residents. But I have no healthcare experience, so I don’t know protocols.

Yesterday, though, when I was helping my dad, he said, “You are good at this. You should get a job doing this kind of work.” 🤣❤️

j2025 · August 7

I find it is extremely difficult for the patient when the aides and med techs are changed around especially with short staffing and floats come on board. My mom has adjusted well, but I find it very stressful to stay on top of them and make sure they continue with med times and care.

caregiving daughter · August 9

It's not ideal but I could see where it would upset the apple cart. Perhaps the more important issue is the overall quality of care. Remember too that folks with dementia may have trouble making sense of a situation. My mom mostly had female caregivers but a male was assigned to her. Because of his gender, she somehow reasoned that he was the boss which was very intimidating to her. In that situation, I would have welcomed an overall rotation.

jen ht · August 9

Hi @ARIL

I'm sorry that you're dealing with this. I've had something similar. At one point not long ago the MC staff completely turned over. It was bumpy for a while and sometimes it still is. This is at the place dad recently moved away from.

It was hard, too, because dad was sorta between stages and so he was changing a lot. This made it harder for him to connect with the new people and especially the floaters. The ED held her office in MC for several weeks and he really liked her, so that helped him during her shifts.

I just wanted to express my solidarity. I wish I had a solution. Ours seemed to be more about labor shortages as they tried to replace the staff that was no longer employed there.

We definitely had some chaotic days too, particularly on weekends.

With you in spirit, 💜

Jen

ARIL · August 10

Thanks so much for all your thoughtful and supportive responses.

Since I posted this concern last month, a few things have happened. First, the staff turnover has continued. I now think the moving of stable staff had to do with permanent staff departures in other areas. I asked the DON (politely, I promise!) if I could better understand the staffing strategy and was brushed off—with an AI-generated email. Sigh. THAT really gives me confidence in human compassion!

For a couple of weeks I was going to visit every day, just to ensure my dad was clean and looked after. Only about half the time did I find things OK. I was helping him clean up and change clothes, changing the bed linens, and bringing home dirty laundry. (He is paying HOW much $$? Argh.) I have backed off daily visits but am still there 4-5 times/week. And the laundry loads have diminished. Some.

But in the staff shakeup we have (for now) got the most competent and compassionate nurse in the place assigned to his area. On days when she works, everything is great—and better than before. So that has been an unanticipated blessing.

At the same time I have also gotten to know two other women with family on the same hall (a daughter, a wife), and I happened to fall into conversation with two EMTs who were leaving (not urgently) as I was yesterday. For different reasons these encounters have reminded me that (a) this place is good overall, and better than available options, and (b) this disease is relentless, and I cannot through effort or force of will make it stop—as much as I want to, and try to. I fear that I am the one raging against the dying of the light.

We soldier on.

jen ht · August 10

Those last few sentences. Yup. Hugs @ARIL 🫂 💜 Ugh. So relatable.

May we be well,

jht

Moving Caregivers Around in MC?

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