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Staffing levels within Assisted Living

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Things are changing in the world of senior living and care. Just 10 short years ago, assisted living meant something entirely different than it does today. Consumer demands and preferences are shaping what services are offered. Regulatory agencies and laws also shape what services can and cannot be offered within these communities.

Additionally, the industry is working to support the changing needs of older adults. As people receive better treatments, as new medications come into the market and as people are living longer and longer, the assisted living industry also is evolving.

Each senior living community must decide how they intend to staff their building. Some communities use a "per resident" formula. For instance, one caregiver may be scheduled for each 12 to 16 residents. Other communities use level of care to determine staffing levels. For instance, a nurse manager may compute the number of projected hours that are needed to meet all resident needs and schedule based on those projected numbers. In such instances, the community may add or change staffing levels, based on the intensity of services needed by current residents.

Internally, senior living communities discuss the concept of resident mix. This term defines how many residents require no care, light care, moderate care, or heavy care. Managers of assisted living communities manage their staffing based on the resident needs. If a community does not monitor resident needs and staffing levels, there can be a shortage of staff to adequately meet residents’ needs. A community that does not monitor resident mix and does not meet residents’ needs is in violation of regulations and can face a fine or even lose their ability to admit new residents. If a community repeatedly violates regulations, they will lose their license.

Fortunately, providers have become savvy to the ever-changing needs of older adults. Systems have been implemented which help monitor the amount of time it takes to appropriately care for each resident, and care plans are written and maintained for each resident. Care plans outline the specific needs of each resident, along with an accompanying list of tasks to meet each specific need.

Consumers may have higher expectations of senior housing and care providers than what can truly be offered. Broadly speaking, consumers hold a belief that a senior living in an assisted living community is taken care of, and that the management and staff of the community will meet that person’s every need. This is not the case. Family members, friends, advocates, or legally appointed responsible parties, need to be available to help make decisions regarding the older adult’s care. The community is there to provide shelter, meals, social interaction, and emergency response. Beyond that point, the community may not be able or willing to provide a higher level of service than this.

Consumers should also be aware that it is very common to have the belief that an older adult needs more personal monitoring than he or she truly wants or needs. Keep in mind that, on average, an assisted living community is budgeting total personal care time at one to two hours per resident per day. Except in cases where an older adult is frail or has memory loss, the average amount of time of one to two hours is quite adequate for the majority of people requiring assisted living services.

It is particularly important for you to consider the specific needs of the older adult. If a person is able to do well on their own for a majority of the day, then assisted living is likely a tremendous option. If a person is at risk for fall, or needs sporadic help throughout the day, or if the person has memory loss such that daily tasks are difficult or impossible, then other services may be required. Some assisted living providers specialize in the care of frail elderly. Other providers specialize in the care of people with memory loss.

Staffing ratios during the 8PM at night to 8AM in the morning are as equally important as staffing levels during business hours and in the early evening. If the community is caring for a resident mix of residents with higher care needs, they are likely to, or should, staff accordingly. If current residents rarely need assistance at night, then staffing level may be more at one staff member per 50 to 60 residents.

If the community offers a la carte services, or it believes in meeting each resident’s need on a specialized and unique basis, then the rates for services are likely to be higher; this may also be an indication that the community will be willing to change their staffing ratios to meet the needs of their residents.

If a community offers levels of care, if the community chooses to only offer a certain type of care, or is not willing to change their staffing ratios, the older adult and their responsible party must realize that an additional move may become necessary to get the assistance required.

All assisted living providers are required by law to determine whether they can meet a specific resident’s needs. They are also required to discuss the plan of care with the older adult as well as the legally responsible party.

Older adults and their families need to work alongside the assisted living provider to meet the older adult’s changing needs. Housing providers do endeavor to provide quality services, but there is a narrow scope within which they must operate. They cannot act as a guardian for residents and so family members and friends still need to remain involved; or consideration should be given to hiring a professional care manager to oversee the care.

CHOICE Advisory Services is a FREE senior care referral agency.

We help define the options that will be of greatest interest to you.

call 7 days a week: 800-361-0138 or email us at

Link to information about CHOICE Housing & Care Advisors:

Last update: 2013-02-16 23:01
Author: Tech Support
Revision: 1.6

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