A National Study of Assisted Living for the Frail Elderly: Final Summary Report. Staff in High Privacy or High Service ALFs


The project investigated facility staff’s knowledge of the appropriate response in a variety of situations involving relatively common health problems among frail older persons. In many instances, the vast majority of staff were aware of the proper response to specific situations, including most medication management issues. On the other hand, a significant number of staff members were poorly informed about antipsychotic drugs and some issues related to the care of individuals with dementia. More troubling, the majority of staff members were almost completely unaware of what constitutes normal aging. Given the goal of enabling residents to age in place and the advanced age of current residents, these results are particularly disquieting. Poor training and knowledge in these areas may in the future become more and more troublesome and risky, both for providers and residents, since many of the conditions staff identified as a “normal part of aging” were potentially treatable and reversible.

Staff in ALFs Offering High Services or High Privacy

  • Were knowledgeable about many care issues
  • Were less knowledgeable about dementia care and very uninformed about normal aging
  • Staff appeared satisfied with most aspects of work, except salary and advancement opportunities
  • Median staffing level was 14 residents for each caregiver

Most staff in the high privacy or high service ALFs reported relatively high levels of satisfaction or positive attitudes toward their working conditions. Two areas, however, were a concern for most staff. The first was their pay level, which usually ranged from between $5 and $9 per hour for personal care attendants. They also expressed dissatisfaction with what they viewed as limited possibilities for advancement.

The median ratio of direct care staff to residents was 1:14 in high service or high privacy ALFs; however, these staff, particularly the personal care assistants typically were responsible for tasks such as laundry, housekeeping, and meal service, in addition to direct resident care.

Personal care staff did not report their workload as overly heavy, and the median number of residents for whom they cared was fourteen.13 In a nursing home this level of staffing would cause concern for some experts. However, as discussed above, the ALF residents were not as impaired as nursing home residents. At the same time, the survey demonstrated that most direct care staff in ALFs also had responsibility for a variety of tasks in addition to direct resident care, including housekeeping, laundry, and meal service. This complicates any attempt to evaluate the adequacy of staffing levels or compare them to those in other settings.

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