Page Reviewed / Updated – September 06, 2020

Overview / Conclusion

For families facing the daunting task of placing a loved one in an assisted living community, one important consideration is the number of employees on hand dedicated to helping elderly occupants on a daily basis. According to a recent analysis of Google data, a common search adult children make when looking for assisted living for their aging parents is the number of staff compared to residents. This is known as the so-called Staff-to-Resident ratio. Our organization has studied this question in-depth. We found that while the staff-to-resident ratio is an important factor, it can be difficult to obtain this data. In addition, it can be misleading to compare communities on this point. A better and easier method to evaluate an assisted living community’s capacity to provide quality care is to look at whether the residence employs licensed medical professionals, such as Registered Nurses (RNs) and Licensed Professional Nurses (LPNs).

A National Standard for Staff-to-Resident Ratios?

Many states offer an official guide to finding the best assisted living communities. And most guides include the staff-to-resident ratio as an essential element to consider. Yet, most states offer no regulations over assisted living community staffing, much less regarding the proper staff-to-resident ratio for any given residence. According to the US Department of Health & Human Services, when finding an assisted living facility it is important to learn what types of training staff receive and how frequently they receive training. Yet no rules or regulations about general staffing requirements currently exist. The lack of a suggested staff-to-resident ratio is not just a government shortcoming. Organizations specializing in assisted living also fail to provide this type of guidance.   The Assisted Living Federation of America (ALFA) official policy is that “ALFA supports staffing requirements that allow assisted living communities to hire staff in sufficient numbers to adequately meet the needs and preferences of the resident population.”  Essentially ALFA recommends that each facility determine their staffing needs on a case by case basis.

Importance of the Type of Staff

Part of the problem when looking at raw staff-to-resident ratios is how the needs of differing assisted living communities vary. A rural community with walking paths and gardens might employ a staff of 4 landscapers, while an urban community would have none. An older residence might require a larger maintenance staff than a brand new community. In addition, grounds and maintenance staff have little effect on the care that residents receive. But counting them can lower the staff-to-resident ratio. A better ratio to consider would be Staff-to-Personal Care Assistants (PCAs). However, most residences do not publish or offer this statistic. In fact, so few do provide this information that it makes comparing this statistic across residences almost meaningless. This is especially true given most families seriously consider just 2-4 assisted living residences in their search. And they’d be lucky to receive this information on even one of them.

The US Department of Health and Human Services released a study that found that one-quarter of assisted living communities had a ratio of one PCA for each 23 or more residents.

A Better, Easier Way to Compare Assisted Living

It turns out that the type of staff on hand is more important than any statistical ratios and greatly affects residents’ health and quality of life. Government research has looked into the type of staff that is most important to a resident’s wellbeing. It has been concluded that residing in an assisted living community with a full-time Registered Nurse (RN) who provides care to residents reduces a resident’s likelihood of going to a nursing home, or to some other setting, roughly by 50%. Time and time again, relevant research has shown that assisted living communities with full-time RNs and direct care with in-house nursing staff have a direct impact on resident outcomes.

The question families should be asking is not how many staff are on hand for the resident population, but how many registered nurses and other medical professionals are on staff at any given time.

Finding Assisted Living Residences with Staff Nursing

Knowing what to look for in assisted living communities and knowing how to look for communities that offer it are two very different things. Unfortunately, searching the Internet for “assisted living residences with nursing” is not an effective way to find communities that offer this type of care. This is particularly true when considering the other criteria families might have, such as proximity and cost. Our organization recommends contacting a free referral service that is able to help families sort through the many assisted living options available to them. Doing so enables them to conduct their search without having to contact every community in their preferred area. Families can find such help here, free of charge.

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Does On-Staff Nursing Increase the Cost of Assisted Living?

A definitive answer is elusive. Typically, having a registered nurse on site does increase costs for an assisted living residence. And those expenses may be reflected in their fees. However, it depends on the resident’s agreement. The use of a nurse may have no impact on cost for those with all-inclusive pricing. Alternatively, those residents on a fee-for-service contract may pay nothing unless they require the nurse’s services. Another possibility is that nursing services, which are medical services, may be covered by insurance, such as Medicare. Furthermore, assisted living communities with on-staff nurses are shown to have lower nursing home admission rates. Thus, a resident’s overall care costs may be lower if extremely expensive nursing home placement has been avoided by use of an on-staff nurse in an assisted living facility.