Appropriate staffing in the ALF

Ensuring proper staffing ratios is one of the administrator’s most difficult daily task. There are always
going to be instances when you are fully staffed when the schedule is made, only to find out at 7:30 AM
you had three call-offs for the 7-3 shift and now you must scramble to find help. Budget restrictions also
play a role in staffing issues due to the low census not allowing you to properly staff the community.
Although the OHCQ provides us with minimum ratios for staffing, it is highly recommended to develop a
plan based upon the services provided to your current residents and the required persons to do said
services.

.14 Staffing Plan.

A. Following an analysis of the number of residents that the assisted living program intends to serve and the
individual needs of each resident, the licensee shall develop a staffing plan that identifies the type and number of
staff needed to provide the services required by this chapter.

B. The staffing plan shall include on-site staff sufficient in number and qualifications to meet the 24-hour
scheduled and unscheduled needs of the residents. When a resident is in the facility, a staff member shall be present.

C. Awake Overnight Staff. An assisted living program shall provide awake overnight staff when a resident’s
assessment using the Resident Assessment Tool, as provided in Regulation .21A or .26B of this chapter, indicates
that awake overnight staff is required according to instructions on that tool. If a physician or assessing nurse, in the
physician’s or nurse’s clinical judgment, does not believe that a resident requires awake overnight staff, the physician
or assessing nurse shall document the reasons in the area provided in the Resident Assessment Tool. The licensee
shall retain this documentation in the resident’s record.

D. Electronic Monitoring Systems.
(1) Upon the written recommendation of the resident’s physician or assessing nurse, the assisted living program
may apply to the Department for a waiver in accordance with Regulation .09 of this chapter to use an electronic
monitoring system instead of awake overnight staff.
(2) If an electronic monitoring system is approved by the Department for the assisted living program to use, the
licensee shall document the approval of the electronic monitoring system in the area provided on the Resident
Assessment Tool.
(3) When a resident is assessed or reassessed using the Resident Assessment Tool, as provided in Regulation
.21A or .26B of this chapter, the physician or assessing nurse shall review and document:
(a) The need for awake overnight staff if the resident’s previous assessment or review of an assessment
indicated awake overnight staff was not necessary at the time; and
(b) The continued appropriateness of a waiver to use an approved electronic monitoring system instead of
awake overnight staff.

E. On-Site Nursing Requirements.(1) An assisted living program shall provide on-site nursing when a delegating nurse or physician, based upon
the needs of a resident issues a nursing or clinical order for that service.
(2) If an assisted living manager determines that a nursing or clinical order should not or cannot be
implemented, the manager, delegating nurse, and resident’s physician shall discuss any alternatives that could safely
address the resident’s needs. The assisted living manager shall document in the resident’s record this discussion and
all individuals who participated in the discussion.
(3) If there are alternatives that could safely address the resident’s needs, the assisted living manager shall
notify the resident and, if appropriate, the resident’s legal representative, the delegating nurse, and resident’s
physician of the change to the order. The assisted living manager shall document in the resident’s record this change
and the date of notification.
(4) If a manager fails to implement a nursing or clinical order without identifying and providing alternatives to
the care or service order, the delegating nurse shall notify the resident’s physician, the OHCQ, and the resident or, if
appropriate, the legal representative of the resident.
(5) Failure to implement a nursing or clinical order, without demonstrating why the order should not be
followed or without identifying alternatives to care, may result in sanctions against the assisted living program.

F. On-site nursing personnel shall work in partnership with the delegating nurse and assisted living program staff
to ensure:
(1) Adequate assessment of residents;
(2) Planning of medical services; and
(3) Oversight of nursing activities.

Pro Tip:
• Calculate the hours it takes to perform each service you are providing to residents (ex: 15 min to
toilet resident 3x daily = 45 min of toileting for 1 resident per day). Use this number to develop a
staffing ratio for how many staff hours are needed to perform resident services

FEATURED COMMUNITY PARTNERS

If your organization has a collaborative relationship with the assisted living facilities and would like to be included on our website, ALF BOSS is happy to help you.