As assisted living communities care for residents who have increasing care needs, additional nursing staff may be necessary — especially during overnight shifts — to ensure that care delivery aligns with resident needs, according to a new study.
Using data from the 2021 Ohio Biennial Survey of Long-Term Care Facilities, researchers from the Scripps Gerontology Center at Miami University in Oxford, OH, compared staffing patterns of direct care nursing staff by shift in assisted living communities, nursing homes and their corresponding memory care units. Their results were published in JAMDA — The Journal of the Post-Acute and Long-Term Care Medical Association.
Ohio assisted living communities and nursing homes had lower resident-to-staff ratios on the day shift, meaning more staff per resident at that time. Nursing homes, however, edged out assisted living communities when it came to having more staffing on all shifts.
Resident-to-staff ratios for memory care units in both settings were similar. The authors noted that many assisted living communities have dedicated memory care units, which cost more to operate than general assisted living units. But the researchers said it is unclear whether memory care units in assisted living communities provide any additional services or improved quality compared with general assisted living, leading to questions about what care is being provided in assisted living communities.
Across all settings, the day shift had the highest staffing levels, although several assisted living communities had no licensed nurses on duty during the overnight shift.
The investigators found that assisted living communities and nursing homes had different staffing patterns based on differences in residents’ needs. But they pointed out that as assisted living cares for more residents needing nursing home levels of care, communities may need additional staffing, particularly on the overnight shift, when some communities have no licensed nurses on duty.
The researchers noted a growing concern over the increasing needs of residents in assisted living communities given the lack of reporting on staffing levels and the fact that few states require minimum staffing levels in the setting. The study authors stated that Ohio and most other states only require assisted living communities to have “sufficient staff” to meet residents’ care needs, and the definition of sufficient varies.
Nursing homes, on the other hand, have been required to publicly report staffing levels for more than two decades. The authors added that several studies have identified an association between staffing levels and resident outcomes.
As assisted living communities care for a greater share of older adults needing long-term services and supports, the researchers said a need exists to better understand the residents in those settings as well as which services they are receiving or not receiving.
The researchers said that their findings can help inform decision-making on future staffing policies to ensure that care delivery aligns with resident needs.
