Managing Unplanned Staff Absences in Residential Long-Term Care in Viet Nam: Resident-Needs Prioritization, Competency-Based Coverage and Safe Escalation

Managing Unplanned Staff Absences in Residential Long-Term Care in Viet Nam: Resident-Needs Prioritization, Competency-Based Coverage and Safe Escalation

At the beginning of an evening shift, the supervisor of a residential care facility learns that two employees will not be coming to work. One has become ill, while the other is dealing with a family emergency. Several residents need assistance with meals and personal care. One requires close supervision because of cognitive impairment, and another depends on staff for nearly all daily activities.

The remaining workers know the residents well, but they cannot simply take on every additional responsibility without considering the consequences. Some activities require particular skills or assistance from more than one worker. Others cannot safely be delayed. A visiting nurse is expected to complete an agreed clinical task, but the facility is uncertain whether the nurse will arrive as scheduled.

The supervisor begins contacting replacement staff while the team continues working. Yet the immediate question is not simply how quickly the vacant shifts can be filled. It is whether the facility can still meet residents' essential needs safely with the personnel, competencies, and support actually available.

Unexpected absences occur in every organization. Employees become ill, experience personal emergencies, or encounter circumstances that prevent them from attending work. In residential long-term care, however, even a short-term staffing disruption can have immediate consequences for people who depend on assistance throughout the day and night.

For organizations caring for older people in Viet Nam, managing unplanned absences requires more than maintaining a staffing roster or finding someone willing to work additional hours. It requires a practical system for recognizing changes in care capacity, reassessing residents' needs, assigning responsibilities according to competence, and obtaining additional support before a temporary shortage results in avoidable harm.

The objective is not to prevent every absence. It is to prepare for foreseeable workforce disruptions and respond without unnecessarily compromising residents' safety, dignity, or continuity of care.

A Staffing Roster Does Not Always Reflect Actual Care Capacity

Residential long-term care facilities operate continuously, but the demands placed on employees vary considerably throughout the day.

Morning routines may involve helping residents get out of bed, wash, dress, eat breakfast, and receive scheduled care. Mealtimes can create periods of concentrated demand, particularly when several people need direct assistance with eating or drinking. Evening and nighttime care may involve toileting, repositioning, supervision, and responding to unexpected changes in health.

The number of employees listed on a roster provides only part of the information needed to determine whether these activities can be delivered safely. The skills, qualifications, responsibilities, and actual availability of those employees are equally important.

A facility may have enough workers numerically but lack someone qualified to perform a particular clinical activity. Another team may have experienced care assistants but insufficient capacity to support several residents with substantial care needs simultaneously.

An employee may also be on duty but temporarily unavailable because they are accompanying a resident to hospital, responding to an emergency, or performing another essential responsibility.

These situations illustrate the difference between planned staffing and actual care capacity. A meaningful assessment considers who is available, what each person can lawfully and competently undertake, which residents require assistance, and how competing demands can be managed without creating further risks.

Recent research supports this broader perspective.

A scoping review by Nicholson and colleagues, published in June 2026, examined nurse and caregiver staffing levels, skill mix, and staff allocation in long-term care facilities. The review included 20 studies and highlighted the importance of aligning staffing arrangements with residents' care needs and the professional responsibilities of the workforce.

Another scoping review by Almazan and colleagues, published in the Journal of Nursing Management in October 2026, examined registered nurse workload and resident outcomes in nursing homes. Its primary synthesis included 20 studies, with seven additional studies considered separately as contextual evidence.

The review found that staffing ratios and hours per resident do not fully capture workload complexity, interruptions, supervisory responsibilities, resident needs, continuity of care, or working conditions.

Much of the available evidence is observational, and the findings do not establish a universally safe staffing threshold for every residential care setting. Nevertheless, they reinforce an important operational principle: counting employees is not the same as determining whether residents can receive safe and appropriate care.

Recognizing a Staffing Shortfall Before Essential Care Is Affected

An unexpected absence should trigger an assessment of care capacity, not merely an administrative effort to replace the employee.

The facility needs to understand which responsibilities are no longer covered, when those activities must be performed, and whether the remaining workers can safely undertake them.

One absent employee may have been responsible for several residents requiring extensive personal assistance. Another may have held a professional qualification necessary for a clinical activity or supervisory responsibility. These absences may have very different consequences, even if each represents only one vacant position.

An initial assessment should consider residents' needs during the affected period, including time-sensitive activities, tasks requiring more than one worker, and responsibilities that cannot lawfully be transferred to another professional group.

Managers should also determine whether assigning additional work to available employees would create unsafe workloads or leave other residents without necessary support.

This assessment needs to happen promptly. Waiting until essential activities have already been missed may reduce the options available to prevent harm.

Facilities should have clear arrangements for reporting absences, identifying who coordinates the response, and communicating changes to the relevant employees. Staff should not be expected to negotiate potentially unsafe coverage arrangements among themselves without appropriate management oversight.

When an absence affects a worker with specialized responsibilities, the supervisor should determine whether those responsibilities can be lawfully covered, whether the activity can safely be rescheduled following appropriate professional assessment, or whether an alternative service arrangement is needed.

The purpose is to understand the consequences of the shortage early enough to make informed decisions rather than discovering the problem only after a resident's care has been delayed.

Prioritizing Resident Needs Without Making Essential Care Optional

When staffing is temporarily reduced, some activities may need to be reorganized.

A planned recreational activity might be rescheduled, certain administrative tasks may be deferred, and nonessential meetings may need to be postponed. These adjustments can help preserve staff capacity for more urgent responsibilities.

However, prioritization must not become permission to omit essential care.

An older person who requires assistance with eating, drinking, toileting, personal hygiene, mobility, or another fundamental activity continues to have those needs even when fewer employees are available. Some activities may also be time-sensitive because delaying them could lead to significant deterioration or another safety concern.

A resident who cannot eat safely without trained assistance may require timely support during meals. Someone with substantial mobility limitations may need appropriate help to move or change position. A person receiving scheduled clinical treatment may have needs that cannot be altered by non-clinical staff.

A resident living with dementia may require individualized supervision or support because changes in the environment or routine could increase distress or create safety risks. Such needs should be assessed rather than assumed solely from the diagnosis.

These examples show why a generic task list is not enough. Prioritization should reflect the individual's assessed needs, the urgency of the activity, the consequences of delay, and the competence required to provide assistance.

An activity that can be postponed safely for one resident may be essential for another. Where changes to the timing or manner of care are proposed, staff should consider whether they are consistent with the person's care plan and whether professional assessment or authorization is required.

International quality improvement approaches sometimes distinguish activities requiring immediate attention from those that can be safely rescheduled. Such methods can support operational decisions, but they should not be treated as universally applicable clinical triage systems for residential care.

Residents should not experience avoidable neglect because their needs are less visible, they are unable to complain, or the facility is experiencing a temporary workforce shortage.

The purpose of prioritization is to preserve safe care during disruption, not to normalize inadequate assistance.

Care Capacity Can Change During the Same Shift

A staffing assessment completed at the beginning of a shift may no longer be accurate several hours later.

A resident who was stable in the afternoon may become acutely unwell in the evening. Someone recovering from illness may need more assistance than expected. Another person may become distressed or temporarily unable to perform familiar activities.

These changes can increase care demands even when the number of residents remains unchanged.

Facilities should therefore reassess staffing capacity when residents' needs change significantly. Workers need clear arrangements for communicating these changes and obtaining additional assistance rather than assuming the original allocation will remain appropriate until the next handover.

For example, a resident who unexpectedly becomes unable to stand may need clinical assessment and a different moving and handling arrangement. A worker should not attempt an unsafe transfer simply because staffing shortages make additional assistance difficult to obtain.

Similarly, sudden deterioration in health requires appropriate clinical escalation rather than an automatic decision to wait until normal staffing resumes.

Managers should also consider whether moving an employee to address a new concern leaves another important responsibility uncovered.

The same worker cannot safely be treated as available for two simultaneous activities simply because both are listed among their assigned duties.

A flexible response involves more than transferring employees from one area to another. It requires understanding how each decision affects the safety of residents throughout the facility and reassessing arrangements when circumstances change.

Competency-Based Coverage Matters More Than Filling a Vacancy

When an employee is unexpectedly absent, managers naturally look for someone available to cover the shift.

Availability matters, but it is not sufficient.

The replacement worker must have the necessary skills and competence and the lawful authority to perform the assigned activities.

An experienced personal care worker may be capable of assisting residents with many daily tasks. That does not automatically authorize the person to perform regulated clinical procedures or make decisions requiring qualified healthcare professionals.

Similarly, a licensed healthcare professional may not be familiar with the facility's residents, equipment, emergency procedures, or internal communication arrangements.

Professional qualifications and familiarity with the care setting are different considerations. Both may affect safe deployment.

Australia's strengthened Aged Care Quality Standards provide a useful international example. Outcome 2.8 addresses workforce planning, including the number and mix of workers, necessary competencies, and arrangements for reducing the impact of workforce shortages, absences, and vacancies.

Outcome 2.9 addresses human resource management, including qualifications, competence, appropriate deployment, supervision, and access to support.

These principles are relevant to quality improvement in Viet Nam, although the specific Australian regulatory requirements do not automatically apply.

A safe staffing decision should establish what the replacement employee can actually do, what preparation or supervision is necessary, and whether the arrangement resolves the relevant gap in care.

A shift should not be described as fully covered merely because the total number of employees matches the original roster. The important question is whether essential care functions remain adequately supported.

Preparing Temporary and Replacement Workers

Facilities may use employees from another unit, returning part-time workers, or suitably qualified temporary personnel to manage unexpected absences.

These arrangements can restore capacity, but they may introduce new risks if replacement workers are unfamiliar with residents or the care environment.

A temporary employee may not know which residents require assistance with eating, who needs specialized moving and handling equipment, or how to obtain urgent clinical support. The worker may also be unfamiliar with care records, communication systems, emergency arrangements, or the location of essential supplies.

Orientation should therefore be proportionate to the person's responsibilities and the risks associated with the assignment.

Relevant preparation may include information about residents' essential care needs, safety precautions, authorized tasks, available equipment, communication arrangements, and the person responsible for supervision.

Where professional qualifications or licenses are required, these should be verified through appropriate processes. Previous experience does not automatically establish competence to perform a regulated activity, particularly when the worker has not been assessed for the specific task or environment.

Managers should also consider whether temporary personnel can safely undertake their duties independently or require additional support.

A worker who is competent in a familiar setting may still need orientation before using different equipment or providing care to residents with complex needs.

Pressure to fill a vacancy quickly should not result in unfamiliar employees being assigned responsibilities without essential preparation.

The purpose of temporary staffing is to restore safe care capacity, not simply to place another person on the roster.

Cross-Deployment Must Respect Professional and Practical Limits

Residential care facilities may employ people in administration, food services, activities, housekeeping, maintenance, rehabilitation support, and other functions.

During a shortage, managers may consider temporarily assigning some of these employees to different duties.

Cross-deployment can be useful when tasks are clearly defined, workers have the necessary competence, and the arrangement is lawful. However, employees should not be assigned personal care or clinical activities merely because they are present in the building.

A worker who normally organizes social activities may be able to assist with suitable practical arrangements. This does not automatically establish competence to undertake complex transfers, swallowing-related assistance, or other higher-risk care activities.

Administrative staff cannot replace qualified healthcare professionals for regulated clinical tasks.

Any reassignment should consider existing skills, relevant training, lawful responsibilities, and necessary supervision.

Managers must also consider the work being left behind. Moving someone from food services may disrupt meal preparation or delivery. Reassigning an employee from another residential unit may leave residents in that unit without sufficient assistance.

A decision that appears to resolve one staffing problem may create another elsewhere.

The effect of cross-deployment should therefore be assessed across the organization rather than solely in the area where an absence occurred.

Maintaining Clear Shift Leadership and Communication

Unplanned absences can create confusion when several people attempt to reorganize work at the same time.

One manager may contact replacement employees while another changes resident assignments. Workers may receive conflicting instructions, and essential tasks may be duplicated, delayed, or overlooked.

The facility should identify who coordinates the immediate response and who has authority to make relevant operational decisions.

That person needs an accurate overview of the available workforce, residents' changing needs, uncovered responsibilities, and any limitations in service capability. The coordinator should also know when to obtain support from senior management or appropriately qualified healthcare professionals.

Clear communication is particularly important when duties are reassigned.

Employees need to know which residents they are responsible for, which activities remain outstanding, and when additional assistance is necessary. An informal assumption that another worker will complete a task may be insufficient when the consequences of delay are significant.

The coordinator should also check whether changes have been understood by the relevant employees, particularly when temporary workers or staff from another unit are involved.

Facilities should establish alternative leadership arrangements when the designated supervisor is absent or unavailable.

A contingency plan that depends entirely on one individual may fail precisely when it is needed.

The objective is to maintain clear responsibility and reliable communication without creating unnecessary bureaucracy during a time-sensitive situation.

Night Shifts and Weekends Need Realistic Backup Arrangements

Residential care facilities operate at times when finding replacement employees may be difficult.

An absence discovered during a weekday morning may be easier to manage than one reported shortly before a night shift. Managers, external healthcare professionals, and temporary staffing providers may also be less accessible outside normal working hours.

Contingency arrangements should reflect these practical limitations.

Nighttime care may involve fewer scheduled activities, but residents still require supervision, assistance with toileting and mobility, responses to calls for help, and access to emergency care.

Some needs may become more significant at night. A resident with cognitive impairment may become distressed or disoriented. Another may require assistance moving safely. An unexpected health problem may arise while the remaining workers are responsible for several areas of the facility.

Managers should consider whether planned night staffing reflects residents' actual needs and whether credible backup arrangements exist.

They should also determine what happens when an employee with a particular responsibility becomes unavailable.

A plan that assumes replacement workers can always arrive within a few minutes is unreliable unless the organization has arrangements capable of meeting that expectation.

Emergency contacts, managerial escalation, access to external healthcare, and suitable temporary staffing options should be established before a shortage occurs.

The plan should reflect the facility's actual resources rather than an idealized staffing model.

Using Overtime Without Creating Additional Safety Risks

One common response to unexpected absences is to ask existing employees to extend their shifts.

Overtime may sometimes provide temporary relief, but it should not be treated as an unlimited workforce resource.

Long working hours, inadequate rest, and sustained workload pressure may affect employees' physical and psychological wellbeing and their ability to perform demanding tasks safely.

Someone who has already completed a physically and emotionally challenging shift may struggle to maintain the same level of attention during several additional hours of work.

Managers should therefore consider fatigue, the nature of the proposed duties, and the risks associated with extended working time.

Vietnamese labor law is also relevant.

The Labor Code No. 45/2019/QH14, as amended, establishes requirements concerning working hours, overtime, rest periods, and shift arrangements. Consolidated Document No. 18/VBHN-VPQH, issued on February 12, 2026, brings together the applicable provisions and amendments.

Articles 105–110 address important matters relating to working time, overtime, breaks, and rest.

Article 107 establishes conditions for overtime, including worker consent and applicable limits, subject to the exceptions provided by law.

Article 108 addresses legally specified exceptional circumstances involving national defense and security duties or certain urgent work to protect life and property in connection with natural disasters, fires, dangerous epidemics, and other disasters, subject to applicable occupational safety protections.

These exceptional provisions should not be interpreted as granting residential care providers unrestricted authority to require overtime whenever a scheduled employee is absent.

An ordinary staffing shortage does not automatically satisfy the legal conditions for exceptional compulsory overtime. The relevant circumstances and occupational safety protections must be considered.

Providers should ensure that staffing decisions comply with applicable law and do not create avoidable risks for workers or residents.

Employees should not be routinely pressured to surrender necessary rest or continue demanding duties when fatigue makes safe performance doubtful.

Overtime, where lawful and appropriate, may form part of a contingency response. It should not become the foundation of the organization's staffing model.

Protecting workers from excessive fatigue is also part of protecting residents.

Managing Illness-Related Absences Without Increasing Infection Risks

Some staffing shortages occur because several employees become ill around the same time.

This may happen during periods of increased respiratory illness or an infectious disease outbreak.

Facilities may be concerned about maintaining services, but asking potentially infectious workers to continue providing close personal care can create additional risks for residents and colleagues.

Workers who are unwell should receive appropriate occupational health advice and follow applicable requirements and disease-specific guidance concerning work exclusion and return to duty.

The organization should not treat working while ill as a dependable solution to absenteeism.

Where infection prevention measures are necessary, staffing arrangements may need additional adjustments to reduce exposure while maintaining essential care.

However, not every illness-related staffing shortage requires the same measures as a confirmed infectious disease outbreak. The appropriate response depends on the circumstances, the suspected illness, and relevant clinical or public health guidance.

Workforce contingency planning should also consider whether employees are exposed to shared risks that could affect several workers simultaneously.

A replacement strategy relying entirely on colleagues exposed to the same infectious hazard may be ineffective.

Staff health, infection prevention, workforce capacity, and continuity of resident care should therefore be considered together.

Families Can Help, but They Should Not Become Unplanned Replacement Staff

Families often remain closely involved in the lives of older people receiving residential care.

They may visit regularly, provide companionship, help communicate personal preferences, or participate in agreed activities. During a staffing disruption, this involvement may offer valuable reassurance and practical support.

However, family participation should not automatically compensate for the provider's inability to fulfill its care responsibilities.

A relative may be willing to assist with a meal or another activity, but willingness does not necessarily establish competence to perform a task involving significant safety risks.

The older person may also prefer that intimate personal care remains the responsibility of trained workers.

Facilities should respect these preferences and the applicable contractual and legal arrangements.

Where family participation is proposed, it should be voluntary, appropriate to the activity, and consistent with the resident's rights and safety.

Providers should not expect relatives to undertake hazardous moving and handling, regulated medication administration, or other clinical procedures beyond their lawful role and competence simply because fewer employees are available.

Family support can complement professional care. It should not become an unplanned substitute for essential staffing.

The organization remains responsible for managing the services it has undertaken to provide.

Communicating Changes to Residents and Families

Residents may notice staffing changes before they understand why their usual routines have been disrupted.

A familiar caregiver may be unavailable, assistance may be provided by someone new, or a planned activity may be rescheduled. Certain services may take longer than usual.

These changes can be unsettling, particularly for people who rely on consistent routines or familiar relationships.

Facilities should explain relevant changes respectfully and in ways residents can understand.

There is usually no need to disclose the private circumstances of an absent employee. The important information concerns how the change affects the resident and what arrangements have been made.

Where assistance will be provided differently, staff should explain the adjustment as appropriate and offer reassurance without making promises that cannot be met.

Residents should also have opportunities to express concerns. Someone may feel uncomfortable receiving intimate care from an unfamiliar worker. Another person may become anxious when a familiar routine changes unexpectedly.

These concerns deserve consideration rather than being dismissed because the facility is experiencing a difficult shift.

Families may need information when a significant disruption affects their relative's care, especially where alternative arrangements require their appropriate involvement.

Communication should be accurate and proportionate. Organizations should neither conceal a serious limitation in care capacity nor create unnecessary alarm about a staffing absence that has been managed safely.

Transparency should focus on care arrangements, relevant risks, and actions being taken while respecting employee confidentiality and residents' personal information.

Recognizing When Available Staffing Is No Longer Safe

Some staffing shortages exceed what a facility can safely manage through routine adjustments.

Recognizing this limitation is an important aspect of organizational accountability.

Managers should not assume that care remains adequate simply because no adverse event has yet been reported.

If essential activities cannot be delivered, required competencies are unavailable, or supervision is insufficient for residents' assessed needs, the facility must recognize the problem and respond.

The appropriate action depends on the seriousness and expected duration of the shortage.

Management may need to obtain additional competent personnel, seek support through lawful external service arrangements, adjust nonessential activities, or consider temporarily limiting new admissions where appropriate.

Where a resident requires care that cannot be provided safely, timely clinical or specialist assessment may be necessary.

Transfer to another service should not be used automatically as an administrative response to a short-term staffing shortage.

Any proposed transfer must consider the individual's needs, the receiving organization's capabilities, the risks associated with relocation, consent and representation requirements, and applicable legal procedures.

The facility may also need to seek guidance from competent authorities.

Decisions concerning regulatory notification, temporary suspension of particular activities, or other formal actions must follow the legal framework applicable to the organization and circumstances.

An internal contingency policy does not replace statutory reporting or regulatory obligations.

The critical issue is recognizing when the provider can no longer reasonably assure that essential care will be delivered safely.

A responsible organization escalates that concern before harm occurs rather than waiting for an adverse event to demonstrate that its capacity was insufficient.

Recording Temporary Changes and Unresolved Care Needs

During staffing disruptions, employees may be reassigned and ordinary routines adjusted. These changes can make it easier for important activities to be overlooked.

A worker may assume that another person completed an assigned task. A supervisor may believe a resident received assistance when the responsible employee was redirected to an emergency.

Reliable documentation and communication help reduce these risks.

Facilities should maintain practical records of significant staffing changes, temporary assignments, important delays, and unresolved care needs.

Records should describe what actually happened. An activity should not be marked as completed simply because it was scheduled or assigned. Where essential care has been delayed or could not be delivered, the circumstances and required follow-up should be documented appropriately.

The level of documentation should reflect the significance of the event.

Not every minor scheduling adjustment requires a formal incident investigation. However, significant unmet needs, safety concerns, and departures from essential care arrangements require appropriate management attention.

Handover between shifts is particularly important.

The incoming team needs to know which activities remain outstanding, which residents require additional attention, and whether temporary staffing arrangements will continue.

This becomes especially important when a shortage extends across several shifts or unfamiliar replacement workers are involved.

The purpose is not to generate unnecessary paperwork during an already difficult period. It is to preserve continuity and prevent unresolved needs from being repeatedly overlooked.

Viet Nam's Current and Emerging Regulatory Framework

The legal responsibilities of residential long-term care providers depend on their organizational classification, licensed or otherwise authorized activities, and applicable regulations.

As of November 3, 2026, Government Decree No. 103/2017/ND-CP, as amended, remains part of the framework governing social assistance establishments.

An important regulatory change is approaching.

Government Decree No. 395/2026/ND-CP, issued on October 23, 2026, establishes a new framework for the operation and management of social assistance establishments.

The Decree is scheduled to take effect on December 7, 2026, replacing Decree No. 103/2017/ND-CP from that date.

It distinguishes different types of social assistance establishments and specifies requirements according to their activities.

Appendix I addresses social protection facilities, while Appendix II applies to specified long-term care and advisory facilities for older people and long-term support facilities for people with disabilities.

This distinction matters for workforce planning.

Under Appendix I, the prescribed allocation for older-person care is one care worker responsible for a maximum of ten older people who can care for themselves or a maximum of four older people who cannot care for themselves.

Under Appendix II, the corresponding allocation is one care worker responsible for a maximum of ten older people who can care for themselves or a maximum of six older people who cannot care for themselves.

Both appendices also establish requirements for professional duty coverage 24 hours a day, every day, for facilities within their respective scope.

These are specific regulatory staffing provisions. They must be interpreted according to the legal classification and operational requirements of the facility concerned.

They should not automatically be treated as identical mandatory staff-to-resident ratios for every individual shift or as proof that any particular staffing arrangement is sufficient to provide safe care in all circumstances.

Likewise, the requirement for continuous professional duty coverage should be interpreted according to the actual wording and personnel requirements of the applicable provisions. It should not be assumed to create an identical registered nurse staffing requirement for every type of residential facility.

The distinction between regulatory staffing requirements and actual operational capacity remains important.

A facility may satisfy a numerical requirement yet experience an unsafe situation when employees with particular competencies are unavailable or several residents require intensive assistance simultaneously.

Conversely, having sufficient workers present during one shift does not remove the organization's responsibility to meet applicable workforce and service requirements.

Article 21 of Decree No. 395/2026/ND-CP also establishes transitional arrangements for facilities previously established and licensed under Decree No. 103/2017/ND-CP that meet the relevant conditions.

Under these provisions, eligible existing facilities may continue operating without completing the new initial activity notification procedure. They have two years from the Decree's effective date to review their operations, meet the applicable new operating requirements, and report the results to the competent management authority.

These arrangements should not be interpreted as permission to disregard existing responsibilities for resident protection or safe care.

Nor do they provide a universal exemption for every type of provider.

Organizations should establish their legal classification, review the relevant requirements, and prepare for implementation accordingly.

Labor, Occupational Safety, and Professional Responsibilities

Managing unplanned staff absences involves more than compliance with social assistance regulations.

The Law on Occupational Safety and Hygiene No. 84/2015/QH13, as amended, provides relevant requirements concerning workplace safety, occupational risk prevention, employer responsibilities, and worker protections.

These duties should be considered when extending shifts, changing assignments, or asking employees to perform physically demanding activities.

The Labor Code No. 45/2019/QH14, as amended, establishes the framework for working time, rest, overtime, and employment arrangements.

Providers must ensure that temporary staffing decisions comply with applicable requirements and do not expose employees to avoidable risks.

Where regulated medical examination and treatment services are provided, the Law on Medical Examination and Treatment No. 15/2023/QH15 and relevant implementing regulations may also apply.

Tasks requiring professional qualifications, licensing, or authorized clinical competence cannot simply be transferred to non-clinical employees because a qualified worker is absent.

The organization must distinguish the lawful responsibilities of care assistants, healthcare professionals, supervisors, and other personnel.

A staffing shortage does not create new professional authority.

When necessary expertise is unavailable, the appropriate response is to obtain competent support or arrange a suitable lawful alternative care pathway.

Staffing arrangements and related records may also involve personal information about residents and employees.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Government Decree No. 356/2025/ND-CP, both effective from January 1, 2026, are relevant to the lawful processing of such information.

Access to sensitive care records and employee information should be appropriately controlled, including when temporary workers are introduced or staffing changes are communicated.

Operational urgency does not remove the need to respect privacy and confidentiality.

What International Frameworks Can Contribute

International standards and regulatory experience offer useful approaches to staffing contingency planning.

Australia's strengthened Aged Care Quality Standards, effective from November 1, 2025 for providers within their scope, include Outcome 2.8 on workforce planning.

This outcome emphasizes understanding workforce needs, maintaining an appropriate mix of workers, identifying role-specific competencies, and mitigating the effects of workforce shortages, absences, and vacancies.

Outcome 2.9 addresses human resource management, including qualifications, competence, deployment, supervision, and access to appropriate support.

In England, the Care Quality Commission addresses staffing through Regulation 18 and its assessment framework on safe and effective staffing.

The guidance emphasizes having sufficient suitably qualified, competent, skilled, and experienced personnel to meet individual care needs, with staffing arrangements reviewed when circumstances change.

These principles are relevant to residential care quality improvement in Viet Nam, but the detailed legal obligations of England and Australia remain specific to their respective jurisdictions.

In particular, Australian requirements relating to registered nurse coverage and minimum direct-care minutes should not be imported automatically into Vietnamese residential care services.

The World Health Organization's October 2026 publication, Development, Management and Support of Care Workers — Towards an Integrated Health and Care Workforce: Policy Options, offers additional guidance on workforce planning, preparation, working conditions, and support across home, healthcare, and residential settings.

The document emphasizes the importance of integrating paid and unpaid care workers into wider workforce policy while addressing training, employment conditions, and sustainable support.

WHO Europe's 2024 publication, Promoting Quality Management in Long-Term Care: Principles, Key Components and Directions for Policy Action, provides a broader perspective on connecting service quality, organizational oversight, and continuous improvement.

ISO 25557:2026, Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities, offers an additional international reference for person-centered care, workforce responsibilities, organizational quality, and continuous improvement.

The standard does not establish a universal staffing ratio applicable to every care facility or replace national labor, healthcare, and social assistance requirements.

Together, these references reinforce the importance of building staffing arrangements around residents' actual needs rather than relying exclusively on workforce numbers or administrative compliance.

Measuring Whether Staffing Contingency Arrangements Work

A facility may report that all vacant shifts were eventually filled while residents still experience important gaps in care.

The effectiveness of staffing contingency arrangements should therefore be assessed through more than the proportion of vacancies covered.

Useful information may include differences between planned and actual staffing, the availability of employees with necessary competencies, and the time required to arrange appropriate replacement personnel.

Organizations should also examine whether essential care activities were delayed, modified, or left unresolved.

The significance of these changes matters.

Postponing a recreational activity and failing to provide a time-sensitive care intervention have very different potential consequences. Quality review should therefore consider the effect on residents rather than treating every deviation from the normal schedule as equivalent.

Staff feedback can reveal important operational problems.

Employees may report recurring situations in which they are expected to perform several competing tasks simultaneously, undertake activities beyond their competence, or continue working without adequate rest.

These observations may indicate that the contingency arrangements are not sustainable.

Incident and near-miss reports can provide additional information, although the number of reports alone does not establish the quality of care.

An increase in reporting may reflect greater awareness or confidence in raising concerns rather than deterioration in safety.

Residents' experiences should also be considered.

Someone who regularly waits too long for assistance may experience the service as unreliable even when staffing records show that every shift was covered.

A meaningful review examines whether temporary staffing decisions actually preserved safe, dependable, and respectful care.

Learning From Repeated Absences Without Blaming Employees

An isolated unexpected absence does not necessarily indicate an organizational problem.

Repeated difficulties covering shifts, however, may reveal weaknesses that require attention.

A facility may depend too heavily on a small number of workers, maintain insufficient contingency capacity, or have limited access to employees with particular qualifications.

High workloads, inadequate recovery time, and unfavorable working conditions may also contribute to illness-related absences and staff turnover.

Managers should examine these patterns without automatically blaming employees who become ill or experience legitimate personal emergencies.

Workers should not feel compelled to conceal illness or attend work when doing so could create risks for residents and colleagues.

A constructive review asks whether the organization has prepared adequately for foreseeable disruptions and whether its staffing model remains realistic.

The findings may indicate a need for improved scheduling, broader competency development, more dependable replacement arrangements, or changes in workload distribution.

Some problems may require longer-term investment in workforce development. Others may be addressed through clearer communication, better records, or more practical escalation arrangements.

The important distinction is between managing the immediate absence and understanding why the resulting disruption was difficult to control.

A reliable contingency system should improve as the organization gains experience.

Building a Practical Staffing Contingency System in Viet Nam

Residential care organizations in Viet Nam differ in size, financial resources, workforce composition, care models, and access to external support.

A larger provider may be able to redeploy appropriately trained employees between units or facilities. A smaller organization may depend on a limited workforce and a few established professional relationships.

The same staffing model will not be appropriate everywhere.

Nevertheless, every residential care provider should understand how it will respond when expected personnel become unavailable.

A practical starting point is to identify who coordinates the staffing response, how actual care capacity will be assessed, and which responsibilities require particular qualifications or competencies.

The organization should determine how suitable replacement personnel can be contacted and what will happen if additional support cannot be obtained.

These arrangements should be tested against realistic situations.

Could the facility maintain essential care if two workers were absent from a night shift? What would happen if the only available person with a required clinical qualification could not attend? How would management respond if replacement staff could not arrive before residents needed assistance?

Such questions are more useful when considered before an actual shortage.

Contingency planning should also examine whether the proposed arrangements rely on unrealistic assumptions.

A list of replacement workers is not a dependable staffing resource if those individuals have not agreed to be available, lack the necessary competence, or cannot reach the facility when needed.

Similarly, an escalation procedure is ineffective if the responsible manager cannot be contacted.

Plans should remain proportionate to the organization but operationally credible.

They need to be reviewed as residents' dependency levels, workforce capabilities, service arrangements, and legal requirements change.

The goal is not to create a complicated plan that looks satisfactory during an inspection. It is to establish arrangements that staff can understand and managers can implement when ordinary staffing is disrupted.

From Filling Shifts to Protecting Continuity of Care

Unexpected staff absences are a foreseeable part of providing services that depend on people working around the clock.

What should not become routine is a loss of essential care whenever the planned workforce changes.

A reliable residential care organization understands its residents' needs, knows the competencies required to meet those needs, and can recognize when the available workforce is no longer sufficient.

Its response begins with an accurate assessment of the shortfall. It continues through appropriate prioritization, safe allocation of duties, timely escalation, and clear communication about care that remains outstanding.

When temporary measures cannot maintain safe care, the organization must acknowledge its limitations and obtain appropriate assistance.

For residents, effective contingency planning should mean that an employee's unexpected absence does not leave essential needs unattended or expose them to avoidable harm.

For workers, it should mean realistic expectations, respect for professional boundaries, appropriate rest, and access to management support when the demands of a shift exceed their capacity.

For residential long-term care providers in Viet Nam, strengthening staffing contingency arrangements offers an opportunity to connect workforce planning with everyday care quality, resident rights, and organizational accountability.

A facility's reliability is not demonstrated simply by how quickly it fills a vacancy or how few absences appear in its records.

It is demonstrated by whether the organization can recognize a change in care capacity, respond before residents are harmed, and maintain essential care through appropriately qualified, competent, and supported personnel.

Ultimately, workforce contingency planning is not about filling empty spaces on a roster. It is about ensuring that older people continue to receive the care they need when the ordinary arrangements for providing that care are disrupted.

Key References and Regulatory Context

World Health Organization. (2026). Development, Management and Support of Care Workers — Towards an Integrated Health and Care Workforce: Policy Options. Published October 20, 2026.

World Health Organization Regional Office for Europe. (2024). Promoting Quality Management in Long-Term Care: Principles, Key Components and Directions for Policy Action.

International Organization for Standardization. (2026). ISO 25557:2026 — Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities.

Australian Government Department of Health, Disability and Ageing. (2025). Strengthened Aged Care Quality Standards. Effective November 1, 2025. Particularly Standard 2, Outcome 2.8: Workforce Planning, and Outcome 2.9: Human Resource Management.

Australian Aged Care Quality and Safety Commission. Strengthened Quality Standards Guidance — Outcome 2.8: Workforce Planning.

Australian Aged Care Quality and Safety Commission. Strengthened Quality Standards Guidance — Outcome 2.9: Human Resource Management.

Care Quality Commission, England. Regulation 18: Staffing. Guidance updated May 16, 2025.

Care Quality Commission, England. Safe and Effective Staffing. Assessment Framework.

Nicholson, E. C., Baron, J. C., van der Heever, M. M., Young, C., & van der Merwe, A. S. (2026). Nurse and Caregiver Skill Mix, Staffing Levels, and Staff Allocation in Long-Term Care Facilities: A Scoping Review. Health SA Gesondheid, 31, Article 3137. DOI: 10.4102/hsag.v31i0.3137.

Almazan, J., Zhakupova, A., Baimagambet, Z., Nurmukhambetova, N., Montegrico, J., Bolla, S., & Adolfo, C. S. (2026). Registered Nurse Workload and Resident Outcomes in Nursing Homes: A Scoping Review of Workforce Sustainability and Nursing Management. Journal of Nursing Management, 2026, Article 6082303. Published October 13, 2026. DOI: 10.1155/jonm/6082303.

National Assembly of Viet Nam. (2009). Law on Older Persons No. 39/2009/QH12, as amended.

Government of Viet Nam. (2017). Decree No. 103/2017/ND-CP on the Establishment, Organization, Operation, Dissolution and Management of Social Assistance Establishments, as amended and applicable on the review date.

Government of Viet Nam. (2026). Decree No. 395/2026/ND-CP on the Operation and Management of Social Assistance Establishments. Issued October 23, 2026; scheduled to take effect December 7, 2026. Particularly Articles 9, 10, 20, and 21, and Appendices I and II.

National Assembly of Viet Nam. (2019). Labor Code No. 45/2019/QH14, as amended.

Office of the National Assembly of Viet Nam. (2026). Consolidated Document No. 18/VBHN-VPQH — Labor Code. Issued February 12, 2026.

National Assembly of Viet Nam. (2015). Law on Occupational Safety and Hygiene No. 84/2015/QH13, as amended.

National Assembly of Viet Nam. (2023). Law on Medical Examination and Treatment No. 15/2023/QH15, as amended, and applicable implementing regulations.

National Assembly of Viet Nam. (2025). Law on Personal Data Protection No. 91/2025/QH15. Effective January 1, 2026.

Government of Viet Nam. (2025). Decree No. 356/2025/ND-CP Detailing Certain Articles and Measures for Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

About Healthy Longevity Vietnam

Healthy Longevity Vietnam (HLVN) is an independent initiative focused on advancing quality, safety, and implementation in age-friendly, integrated, and long-term care for older people in Viet Nam. Through evidence-informed approaches, quality improvement, measurement, and collaboration, HLVN supports healthcare and care organizations in developing safer, more coordinated, and person-centered care across settings.

Disclaimer

This article is intended for general education, quality improvement, workforce safety awareness, and organizational development. It does not constitute individualized clinical advice, legal advice, professional staffing certification, an official regulatory interpretation, or a mandatory national staffing or emergency staffing standard for residential long-term care in Viet Nam.

The appropriate number and mix of workers depend on the provider's legal classification, applicable regulatory requirements, residents' assessed needs, the services being delivered, and the qualifications and competencies of available personnel.

Prioritizing resident needs during a staffing shortage must not be interpreted as permission to omit essential care, ignore clinically significant needs, disregard residents' rights, or undertake regulated healthcare activities without the necessary professional authority.

Workforce redeployment, overtime, temporary staffing, and revised shift assignments must comply with applicable Vietnamese labor, occupational safety, healthcare, and other relevant laws. Staffing shortages do not automatically permit employers to disregard requirements concerning worker consent, working hours, rest, professional scope, or workplace safety.

No universally safe staff-to-resident ratio, task prioritization category, overtime arrangement, or escalation threshold should be inferred from this article.

Government Decree No. 395/2026/ND-CP was issued on October 23, 2026, and is scheduled to take effect on December 7, 2026. Its staffing provisions vary according to the type of social assistance establishment and must not be treated as already effective on the review date.

The Decree's workforce requirements and transitional provisions must be interpreted within their defined legal scope. They do not independently establish that a particular staffing arrangement is clinically or operationally safe for all residents or circumstances.

Where personnel or competencies are insufficient to meet essential care needs, providers should obtain appropriate professional and management support, arrange lawful alternative care when necessary, and comply with applicable notification and regulatory requirements.

International research, standards, and foreign workforce regulations are provided as references for evidence-informed quality improvement. They do not replace Vietnamese law or automatically establish equivalent staffing, professional licensing, or operational requirements in Viet Nam.

Organizations should develop facility-specific staffing contingency procedures with input from appropriately qualified care, healthcare, occupational safety, human resource management, quality management, and legal professionals, and seek clarification from competent authorities where required.

Information and regulatory context reviewed as of November 3, 2026.