Staffing is a key variable in determining whether a facility has enough resources to meet the needs of its residents. In the late 1990s, the National Survey of Assisted Living found that 29 percent of facilities had no licensed nurse on staff and 65 percent did not have an RN on staff at least 40 hours a week (Hawes et al., 2003). A 2002 study of six states that use Medicaid to pay for services in RCFs found that virtually all stakeholders had concerns about insufficient numbers of staff, untrained staff, and the potential negative impact of these staffing patterns on the quality of care (O'Keeffe, O'Keeffe, & Bernard, 2003). Other researchers have argued that because RCFs often lack professional staff, they may not adequately address the functional and health care needs of persons with dementia (Pruchno & Rose, 2000).Few states establish staffing ratios for RCFs, preferring to give facilities the flexibility to vary staffing patterns based on residents' care needs. No consensus exists about the appropriate type and level of staffing needed in RCFs, particularly nurse staffing. A major problem in reaching such a consensus is that the type and amount of care provided varies significantly across settings, as do the needs of the residents (O'Keeffe & Wiener, 2005).