Do Services and Staffing in Residential Care Facilities Vary With Residential Needs?. 5.3.1. Staffing Levels by Unit of Analysis: Facilities vs. Facilities in Which Residents Live


Staffing is another measure of the services provided to residents. As noted above, many RCFs are small, but they serve only a small proportion of residents. The large majority of residents live in a smaller number of larger facilities. Data on the facilities in which people live more closely aligns with the experience of residents. Table 3 presents estimates for staffing hours by staff type in two ways: facility-level and for facilities in which residents live (resident-level). If averaged across facilities, the direct care staffing ratio is 4.15 hours per person, but if averaged across residents, calculating staffing ratio in facilities where these residents live, the direct care staffing ratio is 2.32 hours per person.

Table 4 presents resident and facility-level estimates of the total direct care staffing ratios by facility characteristics. The resident-level estimates are for the facilities in which the residents live. The staffing ratio varies from 5.81 hours per day in small facilities (4-10 beds) to 1.65 hours per day in very large facilities (more than 100 beds). The large differences in average staffing between the two ways of examining the data are largely the result of differences in staffing by facility size and the relative number of residents that facilities of different size serve. For example, with facilities as the unit of analysis, facility-level administrator hours for direct care are 1.64 hours per person per day in small facilities (4-10 beds), but 0.12 hours per person per day in extra-large facilities (100 or more beds; results not shown on table). Similarly, personal care aide hours are 3.93 hours per person per day in small facilities, but 1.30 hours per person per day in extra-large facilities (results not shown on table).

For both the facility and resident levels of analysis, chain facilities have significantly lower staffing ratios than independent facilities, and for-profit facilities have higher staffing ratios than non-profit facilities. Facilities that serve a high percentage of residents who receive assistance with bathing, eating, or transferring, and those that do not have a special dementia unit, have higher staffing ratios. RCFs in urban areas have higher staffing levels, on average, than those in non-urban areas. We found no statistically significant differences in staffing ratio between Medicaid and non-Medicaid facilities.

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