Barriers and facilitators to implementing staffing models in South African long-term care facilities: a qualitative study

TL;DR

This study explores the challenges and supports in implementing staffing standards for elderly care in South Africa.

Contribution

It identifies specific barriers and facilitators to staffing model implementation in resource-limited settings.

Findings

High caregiver staffing and relief staff availability facilitated model implementation.

Inadequate nurse staffing and lack of training were major barriers.

Low nurse numbers reduced skilled staff and increased caregiver workload.

Abstract

South Africa has a staffing model with mandatory staffing standards for long-term care facilities for older persons. This article reports on the barriers and facilitators encountered during the implementation of the staffing model in long-term care facilities within resource-constrained contexts.

A multiple-case study design was employed, comprising multi-methods for data collection, including interviews and a document review. This article concerns the findings from the interviews. Nineteen nurses and caregivers were purposefully sampled and interviewed using a semi-structured interview guide. Ethical and principles that were maintained included ethical board clearance, institutional permission, voluntary participation, beneficence, anonymity, and confidentiality. Trustworthiness was ensured through applying principles such as credibility, dependability, and confirmability. The data were analysed following a thematic analysis process and reported in narrative form. The findings are organised according to two themes: Human resource practices influence staff management, and A perceived indifference to and neglect of residents’ acuity.

Facilitators in implementing the staffing model were high caregiver staffing levels and the availability of relief staff for caregivers. Barriers to implementing the staffing model included inadequate nurse staffing levels, the unavailability of relief staff for nurses, facilities’ neglect to provide in-service training, and an inadequate skill mix. The small number of nurses employed seemingly led to fewer nurses with higher educational levels and skills in the total staff mix and the overuse of caregivers.

Policies should inform facilities’ staffing decisions to ensure adequate baseline nursing staffing and include support systems for nurses and caregivers to promote staff well-being.

The online version contains supplementary material available at 10.1186/s12912-025-03959-0.