Effective staffing in the ALF | VA

Effective staffing in the ALF

Appropriately staffing an ALF is a tall task. There are so many variables related to the number of staff you can have working at any given time. First, you must ensure you have enough direct care staff to effectively meet the clinical needs of your residents. This could include bathing and grooming residents, incontinence assistance, medication administration, and many other tasks that come up during the shift. Depending on the size of your facility your care staff may also be required to provide housekeeping services and even help during mealtime. The Virginia Department of Social Services has issued the following regulation in regards to proper staffing levels as well the work schedule of ALF employees:

22VAC40-73-280. Staffing.

  1. The assisted living facility shall have staff adequate in knowledge, skills, and abilities and sufficient in numbers to provide services to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments and individualized service plans, and to ensure compliance with this chapter.
  2. The assisted living facility shall maintain a written plan that specifies the number and type of direct care staff required to meet the day-to-day, routine direct care needs and any identified special needs for the residents in care. This plan shall be directly related to actual resident acuity levels and individualized care needs.
  3. An adequate number of staff persons shall be on the premises at all times to implement the approved fire and emergency evacuation plan.
  4. At least one direct care staff member shall be awake and on duty at all times in each building when at least one resident is present.

EXCEPTION: For a facility licensed for residential living care only, in buildings that house 19 or fewer residents, the staff member on duty does not have to be awake during the night if (i) none of the residents have care needs that require a staff member awake at night and (ii) the facility ensures compliance with the requirements of 22VAC40-73-930 C.

  1. No employee shall be permitted to work in a position that involves direct contact with a resident until a background check has been received as required in the Regulation for Background Checks for Assisted Living Facilities and Adult Day Care Centers unless such person works under the direct supervision of another employee for whom a background check has been completed in accordance with the requirements of the background check regulation (22VAC40-90).

22VAC40-73-290. Work schedule and posting.

  1. The facility shall maintain a written work schedule that includes the names and job classifications of all staff working each shift, with an indication of whomever is in charge at any given time.
  2. Any absences, substitutions, or other changes shall be noted on the schedule.
  3. The facility shall maintain a copy of the schedule for two years.
  4. The facility shall develop and implement a procedure for posting the name of the current on-site person in charge, as provided for in this chapter, in a place in the facility that is conspicuous to the residents and the public.

22VAC40-73-300. Communication among staff.

  1. Procedures shall be established and reviewed with staff for communication among administrators, designated assistant administrators, managers, and designated staff persons in charge, as applicable to a facility, to ensure stable operations and sound transitions.
  2. A method of written communication shall be utilized as a means of keeping direct care staff on all shifts informed of significant happenings or problems experienced by residents, including complaints and incidents or injuries related to physical or mental conditions.
  3. A record shall be kept of the written communication for at least the past two years.
  4. The information shall be included in the records of the involved residents.

Top Takeaways:

  • The assisted living facility shall maintain a written plan that specifies the number and type of direct care staff required to meet the day-to-day, routine direct care needs and any identified special needs for the residents in care. This plan shall be directly related to actual resident acuity levels and individualized care needs.

Although the required staffing ratio of staff to residents is not specifically stated, it is imperative to understand how the resident’s ISP is related to the need for appropriate numbers of staff. If you have multiple residents requiring a high level of care you MUST provide more staff due to the increased needs of the facility at all times of the day.

  • 22VAC40-73-300. Communication among staff.
  1. A method of written communication shall be utilized as a means of keeping direct care staff on all shifts informed of significant happenings or problems experienced by residents, including complaints and incidents or injuries related to physical or mental conditions.

An effective communication tool for direct care staff to discuss the day-to-day changes and general significant information is key to providing quality care to residents. If the first and second shifts is not on the same page there may be duplication of unnecessary services or worse checks that aren’t completed because they didn’t know it was needed.