Unlike many aspects of finding a facility suitable for an elderly loved one, staff to resident ratios are concrete numbers. The staff to resident ratio can go a long way in determining if an assisted living facility is the right one. Staff to resident ratio is a simple reflection of the number of staff members on the clock. This number is compared to the residents in need of care at the same time. Determining this number, comparing it to what is required by state and local laws, and identifying whether that number is right for an elderly loved one often tips the scale. Good staff to resident ratios often result in significantly better care.
Staff to resident ratio – understanding the numbers
Some assisted living facilities may offer their staff to resident ratios; for others, care seekers may have to ask directly. Either way, family members should ask for specifics on paper (just in case there are concerns down the road).
There are several ways that the staff to residents ratio may be given. A ratio may look like Number:Number, such as 1:4. Family members should ask for clarification as to which number is which. In this case, it might be one staff member for every four residents or one resident for every four staff members. The order makes a big difference. The ratio can also be shown as a simple number, typically less than one. A ratio of .5, for example, means there are half the number of staff members as there are residents.
Another important inquiry regarding this number is whether it includes administrative or secretarial staff. Although these people are vital to the day-to-day operations of a given facility, often they do not interact with or provide direct care for residents. Some facilities will include these staff members in the ratio, which can be misleading. Family members may think there will be more people providing social interaction and handling health care needs than actually do. It is important to ask for the number of administrative, secretarial, and custodial staff separately, if possible, and note it. Only one secretary for a large facility, for example, may indicate potential problems with processing paperwork or getting hold of an administrator when necessary.
Time as a factor
This part is crucial: identify what the staff to resident ratio is at all times of the day. For some facilities, the numbers will vary only slightly, especially if residents require frequent care at night. However, in most places, the ratio changes quite dramatically during the nighttime hours. This makes sense since most residents will need significantly less care while sleeping. There will be no meals to cook and fewer medications or health needs to monitor. Yet if a particular elderly person is in need of night care, lower night staff numbers could raise concerns. In the case of an emergency such as a fire or flood, there should be enough night staff to get residents to a safe location quickly.
Assisted living facilities are regulated less strictly than nursing homes. These regulations vary by state. Most states require that assisted living facilities are current on state licensing. They must also maintain certain standards of care, which varies depending on the facility’s location. Web resources and the local area agency on aging will have the most comprehensive listings of local and state regulations.
There is no national law or standard for staff to resident ratios. There are laws holding facilities accountable if they are at fault for neglect or abuse in their buildings. It is always good to know and review these just in case the worst happens.
In a perfect world, there would be one or more staff members dedicated to each resident. These staff members would provide individually appropriate activities, health care, and companionship. Unfortunately, this is not usually the case. Yet high staff to resident ratios can maximize the amount of personal attention given to each resident. This can reassure family members that their elderly loved ones in assisted living facilities are safe and healthy.
AssistedLiving.com. Assisted Living Laws by State: Know Your Rights. AssistedLiving.com. Available at http://www.assistedliving.com/laws-by-state/. Retrieved September 5, 2016.
California Advocates for Nursing Home Reform (CANHR). (April 14, 2016). Overview of Assisted Living/Residential Care Facilities for the Elderly (RCFEs). CANHR. Available at http://www.canhr.org/factsheets/rcfe_fs/html/rcfe_needtoknow_fs.htm. Retrieved September 5, 2016.
Department of Elder Affairs, State of Florida. Minimum Staffing Requirements. Department of Elder Affairs, Florida. Available at http://elderaffairs.state.fl.us/faal/operator/minimum.php. Retrieved September 5, 2016.
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National Center for Assisted Living. Assisted Living State Regulatory Review 2011. National Center for Assisted Living. Available at https://www.ahcancal.org/ncal/resources/documents/2011assistedlivingregulatoryreview.pdf. Retrieved September 5, 2016.
National Center for Assisted Living. Assisted Living State Regulatory Review 2012. National Center for Assisted Living. Available at https://www.ahcancal.org/ncal/resources/documents/final%2012%20reg%20review.pdf. Retrieved September 5, 2016.
Thompson, A. C., and Jones, J. (July 31, 2013). Life & Death in Assisted Living: “A Sinking Ship.” FRONTLINE and ProPublica. PBS. Available at http://www.pbs.org/wgbh/frontline/article/life-death-in-assisted-living-a-sinking-ship/. Retrieved September 5, 2016.