Staffing to meet resident needs

Ensuring proper staffing ratios is one of the administrator’s most difficult daily tasks. 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 ADHS 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.

504.3 Required Staffing

To effectuate the intent of these regulations, the assisted living facility shall develop a staffing plan to ensure sufficient personnel/staff/employees are available to meet the needs of the residents. A facility shall meet minimum staffing ratios set forth below at all times and shall utilize sufficient staff to meet each resident’s particular direct care needs as agreed to and specified in the resident’s services plan portion of the occupancy admission agreement.

  1. In facilities with sixteen (16) or fewer residents, the facility administrator may be counted as direct care staff while still acting as, or performing the duties of, administrator. In facilities with more than sixteen (16) residents, the facility administrator may be counted as direct care staff on shifts on which he or she is not performing or required to perform the duties of an administrator. The administrator must meet all licensing or certification requirements for the duties that the administrator is performing.
  2. The facility shall have as many personnel/staff/employees awake and on duty at all times as may be needed to properly safeguard the health, safety, or welfare of the residents. For purposes of these regulations, on duty means that the individual is on the premises of the facility, is awake, and is able to meet residents’ needs. At least one administrator, on-site manager, or a responsible staff person shall be on the premises twenty-four (24) hours per day. Residents shall not be left unsupervised, as that term is defined in subsection 601.3(a)(1). The following are the required minimum staff/resident ratios and other staffing requirements:
  3. Required on-site staff/resident ratios based on the current resident census are for large and small facilities:

# Residents                         Direct Care Staff Required Per Shift

                                                Day       Evening               Night

1-16                                       1              1                            1

17-32                                    2              2                            1

33-49                                    2              2                            2

50-66                                    3              2                            2

67-83                                    4              2                            2

84-above                             5              3                            2

  1. Each staff person on duty may be counted as direct care staff even if they are currently involved in housekeeping, laundry, or dietary activities as long as universal precautions are followed;
  2. Staff requirements are as follows:
  3. For facilities with sixteen (16) or fewer residents, the facility shall have an electronic system, such as pagers or cell phones, to contact relief staff if the on-duty staff person must leave the facility for an emergency or other reason. A staff person who must leave the facility shall utilize the system to obtain staff relief, and shall not leave the facility until the relief person appears at the facility. For facilities with more than sixteen (16) residents, a relief staff person must be available to relieve staff and to cover if a staff person must leave the facility in an emergency or any other reason;
  4. The staffing schedule must be posted in the facility;
  5. The OLTC may, in its sole discretion, grant waivers to staffing standards in situations where the facility demonstrates an ability to adequately meet service requirements with fewer staff.

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.

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