A Description of Board and Care Facilities, Operators, and Residents. 3.3 Facility Staffing Patterns


As the board and care population becomes increasingly impaired, the experience, training, and knowledge of staff who care for them become more critical. An examination of facility staffing factors raises concerns about quality.

3.3.1 Staff Training Required by Facility

Nearly 20 percent of the operators in licensed homes and 33 percent in unlicensed homes reported that they did not require training for staff (Exhibit 3-7). Of those who required training, only 23 percent of licensed homes and 15 percent of unlicensed homes required staff to complete all training before they began providing resident care (i.e., preservice). Another 35 percent of operators in licensed homes and 22 percent in unlicensed homes reported that they required some preservice and some on-the-job training for staff.

There were large differences in the number of hours of training required of board and care staff in licensed homes in extensively vs. limited regulation States. Over half of those in extensively regulated States required 2 or more days of training compared to about one-third in States with limited regulation (Exhibit 3-8).

EXHIBIT 3-7. Facility Policies on Staff Training

EXHIBIT 3-7. Facility Policies on Staff Training


EXHIBIT 3-8. Staff Training Hours Required in Licensed Homes by Regulatory Environment

EXHIBIT 3-8. Staff Training Hours Required in Licensed Homes by Regulatory Environment

On major area of concern relates to staff qualifications and medication usage in board and care homes. As noted in Section 3.6, virtually all homes reported providing medication storage or supervision. In addition, three-quarters of the residents reported receiving assistance with medications, and many were taking psychotropic drugs (see Section 6.3 and Section 6.8). Despite this, only 21 percent of the homes had any licensed nurse on staff (Exhibit 3-9). This included full- or part-time nursing staff and registered nurses (RNs), as well as licensed practical or vocational nurses (LPNs/LVNs). Interviews with operators and staff showed that most staff who reported passing medications, 73 percent, were not licensed nurses even though only one State (Oregon) had a program for training and certifying nonnursing staff to pass medication. Eighteen percent reported being LPNs or LVNs, and only 10 percent were RNs. Of the staff passing medications, 26 percent reported they received no training on medication supervision or management. Of staff who reported giving injections to residents, only 21 percent were RNs, 51 percent were LPNs or LVNs, and 28 percent were not licensed nurses.

The influence of more extensive regulations was seen in the greater experience of operators and the more stringent staff training requirements they reported. Although they clearly indicate compliance with State regulations, these structural measures characterizing the training of staff are not necessarily evidence that more extensive regulation improves the quality of the home. Nonetheless, training of board and care home staff was one of the features our expert panel (TAG) felt could make a difference in the lives of the residents who are so dependent upon their caregivers.

EXHIBIT 3-9. Training of Staff Who Pass Medications and Give Injections
    Total Population   
% SE
Facilities with licensed nurse on staff 21 2.6
Staff passing medications 70 6.2
Training of staff who pass medications
   LPN/LVN 18 4.6
   RN 10 2.6
   Not a licensed nurse 73 5.6
Staff who give injections 17 3.2
Training of staff who pass medications
   LPN/LVN 51 11.8
   RN 21 4.2
   Not a licensed nurse 28 12.8

3.3.2 Resident/Staff Ratio

In almost one-fourth of the homes, the operator was the only paid staff person. We observed no difference in the average number of residents per direct care staff as a function of regulatory extensiveness. However, there was a significant difference between licensed and unlicensed homes of most size categories. Unlicensed medium and large homes had, on average, more residents per direct care staff than did comparably sized licensed homes. The average ratio in large unlicensed homes was almost 12 times that of large licensed homes (see Table A-5).

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