When choosing an assisted living community for a parent or loved one, you want to feel confident that their care needs will be met. Many families look at staff-to-resident ratios to help guide this decision. While that’s a good starting point, you should also consider the type of staff available throughout the day: Personal care assistants, licensed practical nurses, or registered nurses may be available depending on the community. You’ll also want to note staff changes from the day to night shifts. As you research communities, you may find that other questions are just as important as the staff-to-resident ratio.
A staff-to-resident ratio refers to the number of caregivers or staff members responsible for the care of each resident. A 1:8 ratio means that one caregiver cares for eight residents during their shift.
When you’re looking at different communities, a staff-to-resident ratio can help guide your decision. Luxury assisted living communities may offer a more desirable staff-to-resident ratio than other options. Make sure you’re confident that someone will be able to help your loved one throughout the day.
Adria Thompson, owner of Be Light Care Consulting, knows that the staff-to-resident ratio can vary based on the community and state.
“It’s generally around one staff member to every eight residents,” says Thompson. She also notes that at night this ratio may be higher since many residents sleep through the night and require less assistance. “It would [then] be probably one to 15.”
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With many caregiver-to-resident ratios set at the state level or even at the community level, you may see a wide range of staff-to-resident ratios as you tour assisted living communities. Consider the pros and cons of each.
A low staff-to-resident ratio places many residents under the care of one staff member. If your loved one needs minimal assistance, they can probably do well in this situation. A higher staff-to-resident ratio results in more desirable, personalized care since caregivers are responsible for fewer residents at one time. It’s ideal for seniors who need more frequent assistance.
However, the ratio isn’t everything. Other factors can also affect the care your loved one receives. Assisted living communities have a variety of people on staff, including caregivers, cooks, activities professionals, and more. As you tour communities, consider the friendliness and helpfulness of everyone working in the community. Some of these staff members may step in to help, if needed.
Staff fluctuations can happen due to the following:
Thompson notes that in these cases, other staff members, such as the activities director or a housekeeper, may step in to perform caregiving duties.
“We do have to have grace in situations when people get sick and they can’t come in. There will be moments,” says Thompson. “I have worked in places where the executive director will step down from her front office and she will care for people. When you see people who are in director positions that are willing and frequently do that, then that’s a good sign that they really do care about their residents. As long as the facility has a plan in place to keep the residents safe, that’s the biggest thing.”
When touring communities, you may want to ask the following questions:
Each community is different, and many offer a tiered model of care at different price points. If your loved one needs minimal assistance, a higher caregiver-to-resident ratio may make little difference. On the other hand, if your loved one needs significant assistance throughout the day to move throughout the community, you want to feel comfortable about the number of caregivers who can help.
“You might have a mom who is generally independent and she only needs help during showers, for example. I would encourage families to consider the supervision and support level of their loved one. And consider how that lines up with the number of staff that’s on-site,” Thompson says.
Consider, too, how your loved one’s care needs may change. They may need minimal help at move-in but require more assistance a year from now. Many seniors don’t enjoy moving unless they have to, so it’s a good idea to discuss future options with the community’s director during your tour. The community may be able to help during this transition or have a skilled nursing area on its campus.
You may want to ask these questions:
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Assisted living communities don’t have strict staffing requirements like nursing homes and memory care communities do. Thompson notes that each state determines the caregiver requirements, and many may not have caregiver staffing requirements outside of those for registered nurses.
To find out the requirements in your state, review the 2022 State Assisted Living Regulatory Summaries, maintained by the American Health Care Association and the National Center for Assisted Living.
Many caregivers in assisted living communities receive on-the-job training and aren’t necessarily certified nursing assistants. Most assisted living communities follow the same requirements of federal nursing home staffing standards. This requires a registered nurse to be on duty for eight hours a day, seven days a week.
Residents do face certain risks when there are fewer caregivers for each resident.
“There’s definitely going to be risks for residents who are incontinent, and that will probably also be a very important thing to consider for your loved one when you’re looking at ratios. If your loved one is incontinent, then if there’s going to be extended periods of time between the time that they are checked or changed, then that leaves them at risk for urinary tract infections and skin breakdown,” Thompson says.
Falls are also a higher risk when caregivers are responsible for too many residents.
“If there’s not very many aides available, then it’s going to be more time in between when each resident is checked on. If you have a loved one who is able to request assistance for themselves — if they have the ability to remember and use a call light — then that ratio is not going to be as important as if they don’t have the ability to [request assistance] either cognitively or physically,” says Thompson.
When you’re searching for the right fit, be sure to ask as many questions as you need to feel comfortable and confident with your community choice. Using a checklist of touring questions can help you compare communities and their staff. For personalized advice, you can always consult one of the Senior Living Advisors at A Place for Mom. At no cost to you, they’ll offer advice tailored to your needs, budget, and location.
The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.
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