Massachusetts requires assisted living facilities to staff at levels sufficient to meet residents' scheduled and unscheduled needs at all times. Administrators must assess resident needs regularly and adjust staffing as those needs change over time.
Facilities should document staffing plans and confirm coverage across all shifts, including nights, weekends, and holidays throughout the year. Staffing must reflect the actual acuity and needs of current residents, not a fixed headcount alone. Sudden changes in a resident's condition can require quick staffing adjustments at any hour of the day.
Adequate staffing protects resident safety and supports compliance during state surveys. Facilities should review staffing plans whenever resident needs shift or admissions change the population mix. Regular review keeps staffing plans realistic, current, and defensible whenever a state surveyor asks for documentation during an inspection.
Appropriate staffing levels
All of us in the “industry” understand the difficulty we face with appropriately staffing our facilities. These positions are tough and consuming for people (especially during the time of writing this article; see COVID-19) and can leave many burnt out. But it is also an incredibly rewarding experience for employees to share their compassion for others and provide care to seniors! The state of Massachusetts mandates the following regulation as to the staffing ratio and requirements of said staff for all assisted living facilities:
12.06: Staffing Requirements
(4) Staffing Levels.
(a) Each Residence must develop and implement a process for determining its staffing levels. The plan must include an assessment, to be conducted at least quarterly but more frequently if the Residence so chooses, of the appropriateness of staffing levels.
(b) The Residence shall have sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled Resident needs as required by the Residents’ assessments and service plans on a 24-hour per day basis. The Residence’s staffing shall be sufficient to respond promptly and effectively to individual Resident emergencies. The Residence shall have a plan to secure staffing necessary to respond to emergency, life safety and disaster situations affecting Residents.
(5) Special Care Residence Staffing.
(a) A Special Care Residence shall have sufficient staff qualified by training and experience awake and on duty at all times to meet the 24-hour per day scheduled and reasonably foreseeable unscheduled needs of all Residents of a Special Care Residence based upon the Resident assessments and service plans. A Special Care Residence’s staffing shall be sufficient to respond promptly and effectively to individual Resident emergencies.
(b) For the purposes of 651 CMR 12.05(5)(b), it shall never be considered sufficient to have fewer than two staff members in a Special Care Residence.
(c) Exemption.
- At his or her sole discretion, the Secretary may grant an exemption from the requirement set forth in 651 CMR 12.06(5)(b) and allow one staff member and one Floater to be on duty during an overnight shift if it is determined that:
- the physical design of the Special Care Residence is conducive to the provision of sufficient care to all Residents;
- staff members possess the means to conduct immediate communication with each another;
- the waiver request is not based on a fluctuation in Residence occupancy; and d. the safety and welfare of residents are not compromised.
- The Applicant/Sponsor shall request such an exemption in writing and shall enclose supporting documentation. The Secretary may grant such an exemption at his or her sole discretion, and may, at any time, revoke such an exemption. Such decisions made by the Secretary are final.
(6) Emergency Situations. The Residence shall have a plan to secure staffing necessary to respond to an emergency, safety, and disaster situations affecting Residents.
Top Takeaway:
- (b) The Residence shall have sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled Resident needs as required by the Residents’ assessments and service plans on a 24-hour per day basis. The Residence’s staffing shall be sufficient to respond promptly and effectively to individual Resident emergencies. The Residence shall have a plan to secure staffing necessary to respond to an emergency, life safety and disaster situations affecting Residents.
While the EOEA does not provide residences with the exact number of staff they are requiring to be present in the community, you should base your staffing levels on the number of staff that is required to perform the needs of residents as determined by their service plans.