LSM 412 Week 2 Organizing in the Lifespan Industry Example

Who Reports to Whom When the Center Stays Open Until 6:30: Organizing Structure, Roles and Staffing for an Adult Day Organization's Extended Hours

[Student Name]

University of Phoenix

LSM/412: Management within the Lifespan Industry

Week 2 Assignment

[Instructor Name]

[Date]

The organization, its roles and its staffing are composites written for a model paper; theory and workforce data come from the sources listed.

In the first week of extended hours at a composite nonprofit adult day center, a participant with diabetes seemed confused at 5:40 p.m. The late-shift aide called the center director's cell phone, which went to voicemail; the director had left at 4:30. The nurse had left at 4. The aide called the participant's daughter, who arrived to find her father's blood sugar low. He recovered with juice and a snack, but the organization's leaders saw that longer hours had outgrown its structure. This paper describes how the organization reorganized.

The Existing Structure

The executive director oversees a program director, a finance and administration manager and a development director. The program director supervises three center directors, one per site, and the in-home respite coordinator. Each center director supervises a nurse, a social worker, an activity coordinator, six to eight aides and two drivers. The structure worked when every center kept a standard daytime schedule and directors were on site the whole time it was open.

Diagnosing the Problem

Organization design research describes how organizations coordinate work through mutual adjustment among workers, direct supervision by a manager and standardization of work processes, outputs or skills (Mintzberg, 1980). The centers relied mostly on direct supervision: aides asked the director or nurse what to do. With hours extended by three and a half hours a day, directors were absent for a third of operating time, and no one had authority to decide after they left. The problem was not a shortage of staff but a shortage of someone allowed to decide.

Designing a Shift Lead Role

The redesign created a shift lead for the early shift, 7 a.m. to 10 a.m., and the late shift, 3 p.m. to 6:30 p.m., at each center. Shift leads are experienced aides or activity staff promoted with a raise, trained in first aid, emergency procedures and the center's policies. They report to the center director and act for the director when the director is absent.

Defining Authority

The shift lead may call 911, contact families, request a nurse by phone from the on-call rotation, adjust activities, reassign aides between rooms and send a participant home early with a family member. The shift lead may not change medications, discharge a participant or make disciplinary decisions, which remain with the director. A one-page authority list sits at every nursing station.

Staffing Ratios

State rules for this program require at least one direct care staff member for every six participants, and one for every four when a majority have moderate or severe dementia. Early and late shifts serve fewer participants, about 20 per center, so each needs a shift lead and three aides. The organization added eight part-time aides and one on-call nurse position shared across the three centers.

Scheduling and Overlap

Schedules overlap by 30 minutes at each change so the outgoing and incoming staff can hand off. Directors now alternate between a late schedule two days a week and an early schedule the other three, so each center has a director present for at least part of every shift during the week.

Coordination Across Shifts

A 10-minute handoff at each shift change covers participants who seem unwell, falls, behavior changes, family messages and supplies. Shift leads record the handoff in a shared log reviewed by directors each morning. This adds standardization of work processes to the direct supervision the centers already used.

Coordination Across Sites

Center directors meet weekly with the program director. Shift leads from all three centers meet monthly to share problems and solutions, which has spread practices such as a late-afternoon snack routine that reduced agitation.

Job Design and Retention

The organization's attention to job design reflects the workforce it depends on and the families it serves, who experience less daily stress when care is reliable and hours match their work (Zarit et al., 2011). A national workforce report found that direct care workers earned a median wage of $17.36 in 2024, with median annual earnings of about $26,000 because of part-time and unstable hours, and projected 9.7 million job openings in direct care from 2024 to 2034 (PHI, 2025). The shift lead role gives aides a step up, the overlapping schedules give predictable hours and the authority list reduces the stress of facing emergencies alone.

Span of Control

Center directors now supervise a nurse, social worker, activity coordinator, two shift leads and, through them, aides and drivers, reducing the number of people who report to each director directly from about 12 to six.

The Revised Organization Chart

Described in words: the executive director at the top; below, the program director, finance manager and development director; below the program director, three center directors, the respite coordinator and the shared on-call nurse; below each center director, the nurse, social worker, activity coordinator and two shift leads; below the shift leads, aides and drivers on their shifts.

Training Shift Leads

The first shift leads completed 16 hours of training over two weeks: emergency response and when to call 911, recognizing common medical changes such as low blood sugar and dehydration, de-escalating distress in people with dementia, communicating with families and completing the handoff log. Each shadowed a center director for two late shifts before leading one alone. The organization also wrote short scenario cards, such as a participant who will not board the van home, that shift leads review together at their monthly meeting.

The First Month

In the month after the change, no after-hours event occurred without a decision-maker on site, handoff logs were completed on 96% of shifts and two aides applied for shift lead positions at other centers. One shift lead resigned, finding the responsibility more than she wanted, a reminder that promotions should be offered, not assigned.

Conclusion

Extending hours exposed a structure built for an eight-hour day. Diagnosing how the centers coordinated work showed the gap: direct supervision without a supervisor. Adding shift leads with defined authority, ratios tied to participant needs, overlapping schedules and structured handoffs reorganized the work around when it happens, and attention to job design gave direct care workers a reason to stay.

References

Mintzberg, H. (1980). Structure in 5's: A synthesis of the research on organization design. Management Science, 26(3), 322-341. https://doi.org/10.1287/mnsc.26.3.322

PHI. (2025). Direct care workers in the United States: Key facts 2025. https://www.phinational.org/resource/direct-care-workers-in-the-united-states-key-facts-2025/

Zarit, S. H., Kim, K., Femia, E. E., Almeida, D. M., Savla, J., & Molenaar, P. C. M. (2011). Effects of adult day care on daily stress of caregivers: A within-person approach. The Journals of Gerontology: Series B, 66B(5), 538-546. https://doi.org/10.1093/geronb/gbr030