Nurse and caregiver skill mix, staffing levels, and staff allocation in long-term care facilities: A scoping review

Abstract

Background: More older people require healthcare services, increasing the demand for nursing care. Long-term care facilities (LTCFs) are required to avail nurse staffing, a skill mix and allocation that is aligned with residents’ acuity and within prescribed legislation. However, facilities struggle to maintain the prescribed nurse staffing.
Aim: A scoping review was conducted to map the available literature on implementing nurse and caregiver staffing models within LTCFs regarding skill mix, staffing levels, and staff allocation aligned with residents’ acuity.
Setting: Studies conducted in formal long-term care settings for older people.
Methods: The review followed the Joanna Briggs Institute’s methodological framework. The search included four databases: PubMed and MEDLINE, CINAHL, Cochrane Library–Wiley, and Sabinet African Journals, for studies published from 2010 to 2024. Trustworthiness was ensured by applying principles such as credibility, dependability, confirmability, and researcher reflexivity. The final sample comprised 20 studies.
Results: Staffing levels for all categories of nurses and caregivers were often lower than recommended by experts. The number of registered nurses versus caregivers in the total staff mix was low, with caregivers providing most of the resident care. The use of acuity-adjusted staffing was not often reported.
Conclusion: The appropriate type and number of staff in LTCFs are essential. In addition, allocating the correct type and number of staff according to residents’ acuity levels may improve resident outcomes.
Contribution: This review may inform policymakers regarding the implementation of staffing models and the importance of aligning the allocation of tasks with the nurses’ scope of practice, the caregivers’ job descriptions, and the residents’ acuity.