Do Services and Staffing in Residential Care Facilities Vary With Residential Needs?. 5.3.2. Staffing Levels in the Facilities in Which Residents Live


All other things being equal, people with higher levels of disability require more staff time than residents with lower levels of disability. Table 5 provides data on the average number of hours of direct staff care per resident per day in the facilities in which residents live, by ADL level and cognitive status. The unit of analysis is the resident, not the facility. Care hours are provided for all staff combined and for four discrete staff categories--RNs, LPNs/LVNs, personal care aides, and administrators. Administrators are included because they provide some hands-on care, especially in the large number of small facilities (4-10 beds). Although the survey directed the respondents to include only the hours of direct care provided by the administrator, these estimates may be unreliable because most respondents were administrators who provided the estimates themselves; however, their main responsibilities are not providing direct care.

Comparisons with nursing home staffing should be done with caution and may be misleading for two reasons. First, care hours provided by administrators are included in our measure of total hours of care for RCFs, but they are not usually included for nursing homes. Second, on average nursing homes serve a more medically complex and disabled population than do RDFs, but with our available data it is not possible to control for those differences in case mix.

On average, RCF residents live in facilities that provide 2.32 hours of direct care per resident per day--including nurses, personal care aides, and administrators. The large majority of care provided is delivered by personal care aides, who provide an average of 1.81 hours per person per day. Administrators, mostly in small facilities, provide about 0.27 hours of direct care per person per day. Including residents who receive no RN and no LPN/LVN care, RCF residents live in facilities that provide an average of 0.08 hours of RN care per person per day and 0.16 hours of LPN/LVN care. This is about 5 minutes of RN care and about 10 minutes of LPN/LVN care. Residents live in facilities that deliver an average of 0.24 hours of total nursing care per person per day--14.4 minutes.

When we stratify residents by ADL status, we find that residents with higher levels of ADL assistance (three or more ADLs) live in facilities with significantly higher care hours than residents with lower levels of ADL assistance. Residents not needing any ADL assistance live in facilities with an average of 1.79 hours of total direct care per day, compared with an average of 2.11 hours for residents with a need for assistance with one or two ADLs and 2.90 hours for residents receiving assistance with three or more ADLs. All differences in staffing hours by ADL assistance are statistically significant. Most of the increase in total hours is the result of an increase in personal care aide hours. Although the RN staffing ratio changes across levels of ADL assistance, the actual increases in minutes with higher frailty levels are small--from 0.06 hours for persons with no ADLs to 0.08 hours for persons with one or two ADLs and 0.09 hours for residents with three or more ADLs. Compared with residents without cognitive deficits, those with cognitive deficits reside in facilities that have significantly higher staffing ratios.

Finally, Table 5 presents the proportion of residents who live in facilities without nursing staff. A total of 45.8 percent of residents live in facilities without any RNs on staff, 38.7 percent live in facilities without LVNs/LPNs on staff, and 19.5 percent live in facilities with no licensed nursing staff.

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