Staff-to-Resident Ratios in Assisted Living: A Detailed Look

A staff-to-resident ratio in assisted living refers to the number of caregivers or staff members responsible for the care of each resident in a facility. For instance, assisted living communities typically have a 1:8 ratio of caregivers to residents. That means that one caregiver looks over eight residents during their shift.

A low staff-to-resident ratio means many residents will be 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, person-centered care since more caregivers are responsible for fewer residents at one time. This type of ratio is ideal for seniors who need more frequent assistance.

Understanding the care level your loved one is at can help you decide the safest type of staff-to-resident ratio for their assisted living situation. This is why knowing the staff-to-resident ratio of your prospective facility can help guide your decision when you’re choosing between different communities. Make sure you’re confident that someone will be able to help your loved one throughout the day if they need it.

Adria Thompson, owner of Be Light Care Consulting, knows that the staff-to-resident ratio can vary based on community and state regulations. She gave us her input on this important staffing feature and what you should expect of a typical staff-to-resident ratio on average in assisted living communities.

“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.”

Is assisted living the right fit?

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.

However, the ratio isn’t everything. Other factors can also affect the extent of care your loved one receives in a facility. Assisted living communities have a variety of roles on staff, including caregivers, administrators, cooks, activity directors, therapists, and even nurses. 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 care for your loved one, if ever needed.

Staff fluctuations can happen due to the following:

• Bad weather
• Caregivers being sick
• Staffing shortages
• A sudden increase in move-ins

Thompson notes that in these cases, it’s not uncommon for other staff members to step in and perform caregiving duties.

“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 who 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,” says Thompson.

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 not matter to them. On the other hand, if your loved one needs significant mobility assistance throughout the day, you want to feel comfortable about the number of caregivers who can help.

You may want to ask these questions while touring assisted living communities:

• What is the caregiver-to-resident ratio during the day?
• What is the caregiver-to-resident ratio at night? Are at least two caregivers on-site at all times?
• Are all caregivers CPR-certified, or is at least one CPR-certified individual available at all times?
• How often is a nurse on-site?
• Does the community have nurses and/or doctors on call in case of an emergency?
• How are the individualized care needs of each resident taken into consideration when scheduling staff? Are staff qualifications taken into account relative to the resident’s level of care?
• Do staff members have specialized training for conditions like Parkinson’s or diabetes?
• Do the staff members work consistently with the same group of residents?
• Does the ratio of caregivers to residents fluctuate?

“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 the facility may have a skilled nursing area on its campus.

Read more:Questions to Ask Assisted Living Facilities While Touring

Assisted living communities don’t typically have strict staffing requirements like nursing homes and memory care communities do. Many caregivers in assisted living communities receive on-the-job training, and some may be certified nursing assistants. Some assisted living communities follow federal nursing home staffing standards, which require a registered nurse to be on duty for at least eight hours a day, seven days a week.^[01]

Thompson notes that each state determines the caregiver requirements in assisted living, and many may not have caregiver staffing requirements outside of those for on-site nurses. It’s important to consult with your prospective community to learn their specific staffing qualifications.

To find out the most recent staffing requirements in your state, review the ​2023 Assisted Living State Regulatory Review and Report. These regulation summaries are maintained by the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL). They provide clear outlines of the state standards for assisted living communities, including necessary staff-to-resident ratios as well as mandatory training of caregiving staff.

Keep in mind that some communities may have more competitive staffing standards that exceed the state minimums in these reports.

Assisted living questions? Get expert help

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 are 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.