Personnel reorganization as valuable lever in long–term care provided by nursing homes

International demographic trends indicate general aging population worldwide (UN, 2022). Rapidly aging populations with chronic dis- abling conditions have increasing demand of Long–Term Care (LTC) (Katz, 2011; UN, 2022) that is defined as a range of medical/nursing care services, personal home care and assistance consumed with the aim of alleviating pain and suffering, reducing or managing deterio- ration of health status in patients with a degree of long–term depend- ency (OECD, Eurostat and WHO, 2017). In many countries, people who require LTC receive assistance in a “nursing home” commonly intended as a facility with a domestic–styled environment that pro- vides 24–hour functional support and care (Sandford et al., 2015). Staffing levels have not kept pace with this demand increasing which continues to evolve (OECD, 2020). This increased pressure has spilled into the workforce, the main cost item of LTC services (Madritsch et al., 2008). Direct care workforce is facing multiple chal- lenges such as shortage of staff, high physical and emotional issues, heavy workloads, scheduling challanges, lack of supervision, minimal career prospects (Gandhi et al., 2021). Budget constraints and the un- attractiveness of the sector have made it difficult to recruit and retain staff, particularly nurses and personal assistants who form the key fig- ures in the LTC services skill mix (Dellefield et al., 2015). Thus, shortage of personnel has stimulated scholarly contributions on sev- eral aspects: the quality of nursing homes (Castle & Anderson, 2011; Backhaus et al., 2018), sustainable employability of LTC workers (Cooke, 2015; Fan et al., 2014), identification of appropriate nurse stuffing levels to meet patients care needs (Harrington et al., 2020), the recruitment and retention of personnel (Bourgeault et al., 2022; Nishikawa, 2011), the need for short–term reorganization in the face of the Covid–19 epidemics (Eltaybani et al., 2022; Jepsen & Barker, 2022). Nevertheless, little attention has been paid from the academy to the key factors of those organizational processes and staffing mod- els that tend to maximize the cost–effectiveness ratio of LTC services performance. Processes and models generally adopted in the sector of acute care could be inadequate; LTC facilities serve different popula- tions, are organised differently and staffing models differ significantly from those in acute care (Kane et al., 1998). Accordingly, this contri- bution intends to answer the following research question: what would be a staff assignment model, drawn from operational flows reorgani- zation, able to provide effective LTC services in order to overpass the shortage of personnel in nursing homes?