(800) 973-1540

How many aides per resident are required in an assisted living facility?

18 answers | Last updated: Sep 09, 2014
64px-hh6b80fd52d1
Q
A fellow caregiver asked...
How many aides per resident are required in an assisted living facility?
 

Answers
Caring.com User - Nan Hayes
Caring.com Expert
A
Nan Hayes is founder of MoveSeniors.com, the national resource network of Certified Relocation and Transition Specialists for seniors, and President of RightSized Living...
answered...

The Assisted Living Federation of America (ALFA) leaves the issue of staffing flexible so each individual facility may decide what is best for their residents and resident focused programs. Due See also:
What's an assisted living community fee and how much is it?
to differences in specialty or types of care, which may range with the resident population, ALFA states the following:

"ALFA supports staffing requirements that allow assisted living communities to hire staff in sufficient numbers to adequately meet the needs and preferences of the resident population."

Most states housing regulations also do not dictate the staff-to-resident ratio, except in the cases of specialty units providing memory care. There are typically requirements for 24-hour staffing and additional criteria for education, experience and security background clearance for all staff members. You should consult your local Area Agency on Aging for details and state regulations that apply to you.

 

More Answers
25% helpful
www.NASMM.org answered...

Actually, assisted living regulations are state specific as in some states, assisted living care falls under the nursing home care act which does have staffing regulations/requirements. Check with your state regulating agency for details.

 

38% helpful
ElleTheresa answered...

I don't know but being a CNA myself I think they should make regulations due to facilities under staffing. Its dangerous for the patients/residents and the caregivers :(

 

60% helpful
Proactive! answered...

Why? This is the obvious question to be posed here. Why are there not requirements with regard to this issue? As stated by another visitor to this page, this is a dangerous situation for patients/residents and staff. Since we all are acutely aware of this problem, why isn't something being done about it. I guess my question is, who is in a decision making position to implement this change? There clearly needs to be standards and requirements in place for Assisted Living facilities as the care received by residents in no way measures up to the amount of resources being dumped into these businesses. Someone is making a bundle off of our elderly and it needs to stop. Those in need of this type of care are basically prisoners. Truly. I state this as they have lost control over their environment and most live in fear of retribution for bringing concerns to management. What I have observed personally is that even when complaints are brought to the table, no one makes an effort to rectify the situation. I have found myself left with only one conclusion - many facilities are counting on their residents to be too deaf, too blind and too old to put up much of a fuss and then if the facility is lucky enough to have residents with no family or family members who prefer to remain at a distance, all the better. I don't know about the rest of you out there, but I'm ready to see a change and would be happy to invest my time in something constructive rather than this constant torment I find myself in over what is happening out there. If anyone knows where to start and who I should contact, please advise. I'm tired of hearing myself complain and even more tired of hearing excuses from administrators and caregivers for the countless infractions. Let's do something about this and let's do it now!

 

75% helpful
Beyond Frustrated answered...

Dear Proactive, Thank you! I have been feeling alone and frustrated with this issue since November of last year, regarding the very issues you described above, with regard to the Assisted Living Facility where my parents live. I had another frustrating day today, dealing with the same issues I have dealt with for almost year in this facility and had another frustrating interaction with administration just this morning. I have voiced the concerns above over and over and over. And it falls on deaf ears as the same issues continue to present themselves on almost a daily basis. I am very involved in my parents' day to day care and live close by. I am often at the facility and have had meetings upon meetings upon meetings with management and nursing. My parents will be at this facility a year this November and the manager has changed already three times, the facility has been bought by a new company recently, hence the third manager, and countless change in staff. I am so tired of hearing myself address the same issues, over and over, and hearing the same excuses over and over and over, I am beside myself. I see no other family members involved that I know of as I do not physically see them there, except for family dinners when just a handful show up. I am desperate for feeling that i am not alone in this struggle and desperate for a change. This facility gives multiple duties to their caregivers, including serving in the dining room, along with their assisted care,and transporting residents to the dining room and activities, leaving small windows available for the individual services we pay for and need. I can not understand why caregivers are also required to serve meals, etc., taking them away, from other assistance needed? Is this a common practice these days in these facilities? Is this to save money? They seem to be almost full and we pay a lot of money! I am beside myself with frustration and now I feel the caregivers are all united against Management in some kind of power struggle and I feel my parents are the losers in this power struggle! They are in their 90's with mom in a wheelchair and dad with a walker. I would love to try and find out how to deal with this problem. I was trying to find out ratio of caregivers to residents in California, but sounds like there is none!!!! This is obscene, considering these residents are vunerable and the amount of money being paid to these facilities. I cannot believe how your comments sound identical to mine, and I was just saying the very same thing to my husband just before i saw your comments!!! What can we do?

 

Chagrined answered...

Dear Proactive and Frustrated, I'm guessing there are a lot of us family out there, banging our heads against the walls of these facilities. I can totally relate to both of you, the same issues again and again,caregiver ratios repeatedly ignored. I was trying to find out if there was a legislated ratio in Washington State, and I guess not. I have seen 1:12 this week, with some very needy residents, both mentally and physically, one poor caregiver with all the multiple duties. We were hit with a 30% increase this year for all the 'extra care' and still feel the need to be there daily? We are in a small town with few local options.

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

Dear Proactive, Beyond Frustrated and Chagrined: All of your responses fell receptively on my outraged psyche today. I have just received a 30 day notice from the director of my 93 year old Mother's ALF, outlining the cost increases effective January 1, 2013. Room, medication management and level of care costs will increase a total of 50%! This will be the third increase in the fifteen months she has been in residence. We have watched through this past year, major cosmetic upgrades to the interior, while staffing continues to be reduced. I too visit my mother daily to engage her in games, particularly in the evenings as most activity stops at 6:00, however, the need for Assistance (!) continues. I also assist her in preparing for bed as many times her call button is never answered. I hear regular comments from the few compassionate care givers that make me shudder - hours being cut to the bone, punishments for sharing any information with family, medications being administered wrongly, etc. My complaints over the year, earned me a badge of troublemaker. Discussions usually produce denials, excuses, promises, all resulting in maintaining their status quo. I am outraged and fed up, however, with few alternatives. So, I've spent the last hour going through state documents only to find that ALFs are loosely monitored, and mostly self regulated - not in the sunshine. I have made appointments to visit another facility next week, however, their wait list makes for even more uncertainty. I am sure that you all share my feelings of anger and frustration at being powerless to affect change. I know the problems are intrinsic to the industry, however, it is a pitiful commentary on the malaise our legislators extend to the care of our aging population in Florida.

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

A nursing facility is required by law to maintain "sufficient staff to provide nursing and related services (1) in accordance with each resident's plan of care; and (2) to obtain and maintain the physical, mental, and psychosocial functions of each resident at the highest practicable level, as determined by the resident's assessment and plan of care." While no specific number or ratio is required, the National Citizens' Coalition for Nursing Home Reform has concluded that minimally acceptable ratios of direct caregivers to residents, for three daily work shifts, are as follows: Day: One direct care giver to five residents Evening: One direct care giver to 10 residents Night: One direct care giver to 15 residents

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

Dear Proactive, Beyond Frustrated and Chagrined, I feel your pain. In order to affect change you must lobby with legislation to make these changes. However, in Florida, AHCA or the Agency for Health Care Administration can come in and assess these facilities for certain issues. Basically there is no ratio, however, there are guidelines like: call lights should be answered (not turned off with a promise to return) within 7 minutes and so the facility must provide enough staff even at night for this to occur. In Florida you may also call your local Ombudsman as they are resident advocates and can assist with getting your issues with the facility resolved.

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

I agree with all of the above. Having recently entered the bizarro world of "Assisted Living" that should be called Minimal Assisted Living because the residents who need assistance are the ones who get the least help. My mother has only been in her facility for 3 weeks and every time I go to see her, I become more and more upset. The state of MD does not require a ration of caregivers to residents, but only rely on the care plan. They justify the fact that they have one caregiver to every 20 residents by saying that some residents don't need much care, sot that frees up other caregivers for those needing more. The wait time if one presses the pendant is supposed to be 15 minutes or less. I have seen wait times of 45 minutes! I am also beyond frustrated and chagrined. It seems one can only get good care if one hires a private duty nurse and that can be unaffordable in the long run.

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

I think it is a conflict of interest to let the individual facilities decide how much staff is required for the residents needs...their only interest is making as much money as possible. When staff complain about this problem we are ignored. The state certainly doesn't care, the less staff the facility has... the more problems they find ...the more tags they can give and the more money they get.

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

I agree with all of you. Tampa Bay is where both sets of our parents reside . I can bet that Proactive etc... parents live in the same facility as ours. The updating and refurbishing never ends. My dad is now in the ALF and still has a great mind and sense of humor and I'm there almost daily. Sadly, we rarelysee other familys visiting regularily. It is frustrating and very sad especially for the $$ they are paying on a monthly basis. Thanks for the information that was provided.

 

64px-hh6b80fd52d1
100% helpful
An anonymous caregiver answered...

As a Certified Nursing Assistant in Wisconsin, I have compassion for every single one of you who have expressed your concerns here for your loved ones. Until the staffing issue is changed, (it will be, nation wide!), to family members I can suggest that you continue to stay close to your loved one, take detailed notes of issues and situations as they arise. Log whom you talked to by name, date and time of day, and don't be afraid to log this information in front of the person you're speaking with. In every state, there is a Department of Health and Family Services, or, The Bureau of Quality Assurance. These entities may have different names depending on the state, but you can find them online in your area. Please, do not stop your efforts to make change.

The staffing to resident ratios that exist in every state right now are nothing short of negligence. I was proud of being a CNA. now I'm almost ashamed of my profession.

Some families opt to bring their loved ones home and hire home-care agencies, often for 24/7 care. I do this type of care giving now and I'm never left feeling that I didn't meet my client's needs.

Best wishes to all

 

64px-hh6b80fd52d1
100% helpful
An anonymous caregiver answered...

I work in an assisted living facility that is 100% memory care! understaffing is by far the most complained about issue there is. due to it mainly being memory care they don't remember they cannot walk when someone else walks past them. it's sad but being under staffed means we can't keep eyes on them all the time. 90% of our injuries are from this. 25 resident's with 2 cnas doesn't add up to me. Showers don't always get done but we try the best we can some days are just absolutely insane. Fl state people come in all the time but nothing changes. I myself have been on workmans comp twice in 6 months from pushing myself. UNFAIR to every one in the situation.

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

I work in an assisting living facility and I am SO frustrated and angry. We now have 60 residents and only 3 caregivers for all of them AND they have now dictated that one of us has to go home halfway through the shift. They will only pay for 4 hours for three caregivers. It's insane. We also have to set up the dining room for breakfast AS we get people up, toileted, dressed and wheeled down to the dining room. (They cut dietary staff also!) The caregivers are responsible for serving meals, room trays, making beds, changing sheets, doing laundry, giving showers and, of course, answering call lights. Not only that, recently we have had 3 Alzheimer patients admitted into the Assisted Living wing even though we have a Memory Care unit. There is no way we can keep up with those residents when we have 57 others than need our care. We are not regulated in my state that I know of and not unionized. I am ready to get out of the business altogether.

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

I am a CNA and am finding it to be horrifying as I can relate to and agree with everything stated! It is upsetting to me that I can NOT meet the clients needs like I they need. I see aggravated familes and residents. I think it is a sin and should be against the law to have ONE 1 caregiver to 38 that's right 38 residents!!!!!!! That's been frequently happening to have that amount with only 2 cnas staffed!!!!!!! Furthermore we are required to set up the dining room, assist them down there, be a waitress, housecleaner and nurse!!!! It is impossible and should be against the law!!!!!!!! Americas elderly are literally hanging by a thread in the system, and so are the caregivers as the facility has to be making a decent profit!!!!!!

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

I am an LPN in an assisted living facility. We have over 50 residents and there is only one charge nurse for 2 shifts a day (no overnight nurse) Its impossible to safely administer meds to all these people in 2 hours that I am alloted to do so in! So I basically have 1 minutes to go on several differents floors per person! Someone please tell me why this is NOT regulated???

 

64px-hh6b80fd52d1
An anonymous caregiver answered...

It's hard to be rational when you are personally involved. Number of staff does not equal better care. The qualifications of staff matter and in an ALF, the quality of the administrator goes a long way. The level of care needed, that is what the resident needs should drive staff requirements. The Registered Nurse staff of the ALF can pretty much advise on staffing needs based on assessment of the residents. Depending on what State you live in, there may be staffing regulations, however it is arbitrarily determined and does not help anyone. Money is a major factor in smaller facilities staffing well. Don't channel your frustration to just the ALFs, challenge your congress person to the needs of ALFs and the residents.

 

 
Ask a question Ask a question | Add an answer Add an answer