Meeting the Minimum Doesn’t Always Mean You’re Compliant

Rule 59A-36.010, F.A.C. – Staffing Standards

One of the biggest misconceptions I hear from assisted living owners is:

“We’re fine. We meet the minimum staffing requirement.”

Unfortunately, that’s not how AHCA evaluates staffing.

Surveyors aren’t simply counting the number of employees working.

They’re asking a much more important question:

“Does this facility have enough staff to safely meet the needs of its residents?”

Those are two very different questions.

There Is No Caregiver-to-Resident Ratio

Unlike nursing homes, Florida assisted living facilities do not have a required caregiver-to-resident ratio.

Instead, Rule 59A-36.010 requires facilities to maintain sufficient staff to provide the care and services needed by the residents living in the facility.

As your residents’ needs change, your staffing should change as well.

A facility with mostly independent residents will have very different staffing needs than a facility where most residents require assistance with bathing, dressing, transfers, toileting, medications, memory care, or other hands-on services.

Florida’s Minimum Staffing Requirements

Florida does establish minimum weekly staffing hours based on resident census.

Current Minimum Staff Hours Per Week

Resident Census	Minimum Staff Hours
0–5	168
6–15	212
16–25	253
26–35	294
36–45	335
46–55	375
56–65	416
66–75	457
76–85	498
86–95	539
Over 95	Add 42 hours for every additional 20 residents (or portion thereof)

These are minimum staffing requirements.

They are not a guarantee that your facility is adequately staffed.

The Minimum Staffing Hours Can Be Misleading

The minimum staffing hours in Rule 59A-36.010 are exactly that…

The minimum.

One of the biggest mistakes I see is facilities building their schedule around the minimum staffing requirement instead of the needs of their residents.

For example, imagine two facilities with 30 residents.

Facility A has mostly independent residents who require minimal assistance throughout the day.

Facility B also has 30 residents, but most require assistance with:

• Transfers
• Toileting
• Bathing
• Dressing
• Medication assistance
• Dementia care
• Frequent supervision

Should both facilities have the same staffing?

Absolutely not.

Yet I often see owners schedule the minimum required hours simply because that’s what the regulation says.

The reality is that if the majority of your residents require extensive hands-on care, the minimum staffing hours may not be enough to safely meet their needs.

AHCA doesn’t evaluate staffing by comparing your schedule to a chart.

They evaluate staffing by watching your operation.

If residents are waiting too long for assistance…

If call bells are going unanswered…

If medication passes are taking too long…

If staff appear rushed and overwhelmed…

Those are all signs your facility may not be adequately staffed, even if you’re meeting the minimum required hours.

Staff your building based on the residents who live there—not simply the minimum number listed in the regulation.

AHCA Can Require More Staff Than the Minimum

Here’s something many administrators don’t realize.

Meeting the minimum staffing hours does not prevent AHCA from requiring additional staff.

Rule 59A-36.010 gives AHCA the authority to require a facility to increase staffing if surveyors determine the current staffing is insufficient to meet the needs of the residents.

In other words…

You can meet every minimum staffing hour required by the regulation and still receive a deficiency if residents are not receiving timely care and supervision.

AHCA may determine that additional staffing is necessary based on observations such as:

• Residents waiting too long for assistance.
• Delayed response to resident needs.
• Residents left unattended.
• Medication passes taking too long.
• Staff appearing overwhelmed.
• Poor supervision of residents with dementia.
• Inadequate assistance with activities of daily living.

The regulation establishes the minimum staffing hours.

AHCA evaluates whether those hours are enough for your resident population.

Those are not always the same thing.

Don’t Forget Emergency Situations

Here’s another question I ask administrators during mock surveys:

If a fire broke out tonight at 2:00 a.m., would you have enough staff on duty to safely evacuate every resident?

Think about your resident population.

How many residents require assistance with:

• Walking?
• Wheelchairs?
• Transfers?
• Dementia or memory impairment?
• Oxygen equipment?

If the answer is that one or two caregivers would struggle to safely evacuate everyone, it may be time to reevaluate your staffing model.

Meeting the minimum staffing hours doesn’t necessarily mean you have enough staff to respond safely during an emergency.

Resident acuity should drive your staffing decisions—not simply the minimum hours listed in the regulation.

Other Staffing Requirements You Can’t Forget

In addition to staffing hours, Rule 59A-36.010 also requires:

• At least one staff member must be present whenever residents are in the facility.
• Facilities with 17 or more residents must have at least one awake staff member on duty 24 hours a day.
• A staff member with current First Aid and CPR certification must always be available.
• The facility must maintain written staffing schedules.
• Staffing schedules and time sheets must be retained for at least six months.

These are items AHCA routinely reviews during surveys.

Is the Administrator Available?

Another area surveyors evaluate is administrator availability.

The administrator is responsible for overseeing the operation of the facility and ensuring residents receive appropriate care.

Surveyors may ask:

• Is the administrator regularly available?
• Who is responsible when the administrator is away?
• Do employees know who to contact when problems arise?
• Is there adequate supervision of staff?

Strong leadership is often one of the clearest signs of a well-operated facility.

Your Schedule Tells a Story

One of the first documents I review during a mock survey is the staffing schedule.

It often tells me everything I need to know.

Questions I ask include:

• Are there enough caregivers during the busiest parts of the day?
• Are staff consistently working overtime?
• Are call-outs leaving the building short staffed?
• Is one caregiver trying to do the work of two?
• Are medication passes taking longer than they should?

Meeting the minimum staffing hours doesn’t matter if residents are waiting too long for assistance.

Common Staffing Problems I See

During mock surveys, I frequently observe:

• Residents waiting too long for assistance.
• Medication passes taking excessive time.
• Staff appearing rushed and overwhelmed.
• Documentation falling behind.
• High employee turnover.
• Administrators regularly filling caregiver shifts instead of managing the operation.
• Families complaining about slow response times.

Many of these problems aren’t caused by poor employees.

They’re caused by inadequate staffing.

Action Steps

Evaluate Your Resident Acuity

Don’t build your staffing schedule around your census.

Build it around your residents’ actual care needs.

Review Your Schedule

Identify the busiest times of the day and determine whether enough caregivers are available.

Think Beyond the Minimum

Ask yourself:

• If AHCA walked into my facility today, would they see residents receiving timely care?
• Would they see employees who have enough time to properly care for residents?
• Would they believe my staffing reflects the needs of my residents?
• If a fire broke out tonight, would my night staff be able to safely evacuate every resident?

Walk Your Building

Observe your operation during:

• Morning care
• Medication passes
• Meal service
• Bathing assistance
• Evening routines

These periods often reveal staffing shortages.

Listen to Your Team

Your caregivers know where the bottlenecks are.

Ask them where they need help.

Their feedback can improve resident care, employee satisfaction, and retention.

The Bottom Line

The minimum staffing hours are the starting point—not the finish line.

Your staffing should reflect the needs of your residents, not simply the minimum hours required by the regulation.

If AHCA determines your residents are not receiving adequate care or supervision, the Agency has the authority to require additional staffing above the minimum.

Don’t staff to the regulation.

Staff to your residents.