How many aides per resident are required in an assisted living facility?
How many aides per resident are required in an assisted living facility?
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 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.
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.
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 :(
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!
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?
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.
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.
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
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.
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.
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.
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.
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
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.
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.
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!!!!!!
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???
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.
I personally work in an ALF in Florida and I completely agree! We have 36 residents and one person on staff at all times. During our night shift 10pm to 6am one person is perfectly fine to be there alone without problems but during the day especially 6am-2pm it is so hard to give all of our residents the attention they need and deserve. That is my biggest issue, because all residents deserve to be assisted and talked to not just the ones who need more attention. We have our days where it's slow and easy but the majority of the time we get fussed at because all of laundry didn't get done or we weren't in the dining room passing out meals. If we had at least two people on staff at least half of the 8 hour shifts then things would be a lot easier not only for staff but for our residents. I've discussed this with my boss so many times but it isn't in his budget to do so which is complete crap. It irks the hell out of me because some of these residents deserve better than what they are getting.
i agree with all that caregivers have voiced here. the elderly desire better care.- those which push for profits only - will face the same delema - if they will not die young. worst are attorneys - beware - make your wills - for if you do not have one - you are declared dementiated - so you cannot make one - the lawyer collects all.
It seems every state is having this issue. And why it's not being addressed appropriately, I will never understand. The facility I currently work at in Ohio is also greatly understaffed. Today, b/c my job had to send me home for an illness I caught at their facility, the other caregiver is stuck working by herself, taking care of 60 residents (15/hall-4 halls). The nurses have refused to call in extra help. And in return, not only does the aide have a stressful day ahead of her, but the residents will not get the proper care they need. I view this as resident neglect. Not on the caregivers behalf, but the nursing staff and schedulers behalf. It does not take much to look at the schedule when you are writing it to determine that you would or would not have enough staffing. They do this so that they can cut costs on employee wages. I would rather them pay the proper employee wages, than for the residents to suffer b/c of it. You would think they staff would be happy to have enough people present to take care of their residents. But they have proven otherwise. My question is, why isn't the state doing anything about this problem? Why don't they step in and make regulations about the minimum number of staff? They need to.
I both worked for an assisted living, and had a parent in one. No matter what it looks like from the outside, these places are greedy and they short staff which places everyone at risk. It is horrifying. I no longer work in the industry and have found a wonderful adult family home for my father. The cost is less and my dad is always clean, healthy and well fed consistently.
I too concur with the frustration and same experiences with an assisted living facility run now by a mega corporation. It has made my life a living hell. Lack of legislation and regulation has indeed let the foxes run the hen house. Money is the bottom line not care. Although I have resorted to formal complaints with the state agency, there is little they can do for positive change without better laws. We all here know that our loved ones are paying for services they are not getting as promised. Staff ratios and required training are key for residents with the very same issues covered in nursing care facilities, yet in ALFs they are not regulated. Without regulation the ALFs can continue to make empty promises for change and continue to charge higher and higher prices for it. In our facility Med Techs regularly do CNA duties while passing meds, meds are not passed at doctor's specified times. They quote an hour before/hour after guideline as law. It is not a law, yet state agencies allow the ALF to set their own guidelines, and inexperienced untrained Med Techs with no supervision are allowed to make judgments regarding when clinical/time sensitive medications are given because it means less visits for the staff who are overwhelmed, underpaid, and threatened about losing their job. I've yet to see administrators who are nurses themselves help out when short staffed. There is no plan for dealing with short staffing, especially on weekends. That reflects poor administration scheduling and poor leadership. We've seen six administrators in three years and four heads of "wellness", not to mention a revolving door of Med Techs and CNAs. Continuity of care is undermined with this approach. So we all agree the situation is toxic, chaotic, and unforgivable for our loved ones, yet there is no place to go if they are all the same. I continue to look for a facility that can address my loved one's needs better, knowing that a move to a less home like setting will be traumatic. I can only share what I am doing. I have educated myself about the laws and regulations in my state. I am vocal about the facility and it's short comings. I have met with slick administrative staff only to document complaints, I made formal complaints to the state agencies over the facility and nursing board for investigation. Violations have been cited, but the facility gets months to correct, when daily the go unresolved. I educate residents who can advocate for themselves who to contact to register complaints. I am writing legislators and hope to finish an editorial piece for local publishing. I document infractions, and my communications. I've yet to see if a plaintiff attorney can instigate legal action, but I want to do it every single day. I support whenever possible the good work that some of the Med Techs and CNAs are doing in impossible circumstances. If ever there was a situation screaming for advocacy and change for our aging population who cannot advocate for themselves, this is it! Write honest feedback about facilities on rating websites to belay their ratings. Tell your story to elected officials, local, state, and federal. Because this situation needs to see the light of day beyond frustrated family members and caregivers. I know you are exhausted, angry and frustrated but don't let mega corporations dictate sub standard care.
My loved one has a rare brain disease with muteness. Facility is AL with 100% memory care in residence. They made false representations/lies about the training & professional expertise of caregivers. Tell me to trust them-do not visit him every day. Because I see the deficiencies they want me to stay away- try to make me the problem- adhering to his care plan makes me unreasonable. Corp is huge part of the problem- director is LVN over her head. Now they are focusing on my sick loved one- want me to feel threatened that they'll throw him out. They know I transitioned him because I needed help caring for him(I cared for him alone for 3 1/2 years.) Ombudsman is a farce- a sick joke.
I am and have been a caregiver in Arizona since 1995. I'll be honest I'm not as familiar with the rules and regulations here as I probably should be. So this is mostly just from my heart, our elderly population should be cherished. The stories they have, the history they have lived through & the memories that they can share are worth more than almost anything I can imagine. All too often I find myself working with a caregiver that is just "going through the motions", you now the ones they barely speak to the resident, hurry through the care they have to provide & only do the care they "have" to. Most the time they don't even realize that instead of caring for the resident they start finishing the job they have to do. Sad thing is nobody became a caregiver for the money, because honestly the money isn't that good. I think if they had federal regulations regarding staffing ratios in assisted living it would help prevent this type of "burnout" that I see far too often. Maybe I'm naïve, maybe I want to believe that every caregiver really does care about what they are doing, or maybe AL resident-staff ratios could help ensure that our elderly population receives the care that they need and the love and respect they deserve.
Do what I did! Place Dropcam cameras in your loved ones' rooms - including bathroom. Then collect the evidence of abuse and neglect. That gives you leverage against the facility and helps to bring about change.
These assisted living corporations do not want the video on the Internet or being seen by potential new move-ins.
As a caregiver I can attest to the increasing staffing problems in assisted living / nursing homes. In my 3 yrs doing this kind of work I have reported several instences of abuse, neglect, medication errors...ect. yet nothing gets done about it. I'm so fed up with the lack of care and compassion both by management and caregivers. The reason I stay is because only a handful of us actually care and it worries me sick to think of how my residents would be trated if I wasn't here 40+hrs a week to prevent it. The problem that I see is that all management cares about is bodies in the rooms and on the floor. Meaning they admitted any resident that's willing to pay even if their care requirements are beyond what we are legally and physically able to provide. And they are so understaffed because they will hire anybody off the streets. They hire young and unreliable people who don't know what responsibility is and have no work ethic. Most people either stop showing up to work after a few days or the ones who stay have no desire to be here accept to collect a paycheck so they can get wasted over the weekend. They don't do proper care and they are extremely neglectful. And because of the high turnover, theses are the people training other new employees. And btw, the training programs are a joke. Something needs to be done about the quality of care our senior citizens are recieving. Especially considering the outrageous and ever so increasing prices they pay for it.
Dear Proactive, when I read your comments I thought I had written it. I am exactly like you, I go every day to see my father and I have also complained continually and the same things keep happening. Unfortunately, it comforts me somewhat to know I am not alone. Everyone makes me feel that I am being unreasonable when I am enraged at their lack of concern. I am just ignored which makes things even worse. I have been told by the Director at every meeting that most family members don't care. I think all assisted livings are the same so have been reluctant to move my father but I am so stressed I may. He is in a large facility and I am considering moving him to a 16 bed assisted living. Has anyone had experience with smaller facilities? Proactive you have my deepest sympathy and support.
I work in a facility and was hoping to find a law that would get me some more help. I'm a medtech with a good amount of experience and I make only a little over minimum wage but that really isn't my issue. We recently expanded and my duties have more than doubled but the number of medtechs has actually decreased. I was hoping to find a law that would make it so I don't have to care for over 20 residents medication by myself. Not going to lie, I feel like they government doesn't really care what is going on. My caregivers have lots of love to give but we are so overworked and we make so little that they end up quiting in favor of jobs at fast food chains. Funny thing is our company says we are overstaffed...I think that is ridiculous. Before you move into any facility ask the ratio and keep in mind a lot of places fudge it a bit. They will include maintenance and housekeeping so be sure to specify caregivers/CNA.
I am a caregiver in the southern california area and recently left my job due to stress. It broke my heart to do so but I was seriously dying. It has been a week and my residents are calling me to come back. There are over 45 residents who receive 100% care as well as another 60 to 70 with more coming daily who need random assistance. I worked in this facility for a month, yes 1 month and lost 10lbs due to constant running to check call lights, assist with showering, serving, running residents to the dining room and housekeeping. I am drenched in sweat the entire day and begged management for help constantly. I have been the only person on the floor but most days there are two of us. The constant stress of worrying if a resident is on the floor while having another in the shower and no one to check on their light broke me down to the core. One morning I found a hospice patient on the floor, bleeding and it had taken me 25 minutes to get to him because I had another lady in the shower. When his daughter came in she approached me in the hall and stated he said he was on the floor for an hour and a half. My heart broke as I imagined how he felt. It was in fact 25 mins but the fact that he felt it was longer almost brought tears to my eyes. I take pride in my work and feel each and everyone of these people deserve the best care and due to lack of staff that is not guaranteed. Most days I was forced to make trays for my room orders and then yelled at by other staff members for not being on the floor. The thing is, If breakfast orders must be out by 9am but the kitchen staff is short than that means my resident will not eat and that doesn't sit well with me considering dinner was at 6pm the night before. I really want to do something about staffing regulations and now that I see so many others feel the same way, I am going to seriously look into making a change. We are court mandated to report poor care to these residents and I feel this should be a crime.????
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