Assisted Living Title 22 Ratio ???

[NickiLaughs, ADN, BSN, RN]

Hi.

I'm fairly new in the Assisted Living world. It seems to be a lot like a SNF to me in some ways. I have staff wondering how many patients per staff is allowed in the ratio. One of my buildings has only 5 residents in it. So they assign 1 staff a shift, to do all the cooking cleaning, etc. in an alzheimers unit. She (the staff) believes that when we get 7 people. the ratio requirement is 1:6 so she gets a second person to help her. Is this so? and if so where is it? I've looked through the whole title 22 book. Thanks. I know it's a complicated question.

[JKDON]

You know I would think that it would be in your title 22 book if there were a ratio. Many states do not decide this but leave it to the management of the facililty. We have a SNF ALZ and I haven't staffed over 1 person per shift for even up to 9 residents. But it all depends on the needs of the residents and what risk factors you are dealing with. If you have an eloper and a faller, you may need 2 staff for 4 residents. make a list of your risks and determine where help is available from if needed for short term (another unit close by, on call etc, how attentive family members are etc) and then determine. Are the needs being met safely with the staff you have. I wouldn't increase until I've weighed all of this out first, or see a great safety risk. If you have a great safety risk should look at alternate placement anyway. ALF can be tricky as you are still responsible for them. Good Luck

[Antikigirl, ASN, RN]

Ahhhhhhh the grey area of Assisted Living! Worked in one as a nurse for 3+ years till I recently switched to agency nursing...

The CNA's I worked for had 12 or more pts per section...this included all ADL's, med pass, small wound tx, some housekeeping, garbage detail, and feeding/bussing/serving. It was like "what don't they do!!!". I still am wondering why oh why they do this day after day, or where they get the energy!

I have even asked my BON on the ratios and it is a total grey area to be sure, they didn't even have an answer for me! The nurses...well we had CBG's, treatments, scheduling appts, orders, MAR's, staffing, delegation/assignment, and that for over 140 patients and that doesn't include staff! So everyone was running around like crazy trying to get it all done 24/7 (nursing was 24/7 too...we were lucky).

It seems that until they become a little more popular (which they are...believe me) some BON's are testing the waters so to speak and having come up with reasonable ratios to implement. The dynamics of these places differ so much...nursing staff on call or on facility, how often nurses are there, the availablity of CNA or unlicensed care givers, the availablity of other nursing type homes, rural or urban location...you name it...and that effects what can be done and how many people are reasonably available to get it done...

I don't know...I once said that assisted living is a cement block with lovely frosting to make it look like a cake, but once you bite in....well...many probelms come up!