Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Staffing Requirements


All respondents felt there was a need to increase staffing levels in ALFs.

  • Nursing homes have minimum staffing requirements and are paying higher wages with better benefits. ALFs are vying for the same pool of staff and have no way of competing.

  • We need to increase the staffing levels; ALFs cannot have high quality without better staffing.

Two respondents mentioned abuse of residents by staff, but stated that it was atypical.

  • Staff abusing residents is the exception to the norm. We try to do criminal background checks. Given that Florida has over 2,200 ALFs, 600 nursing homes, and numerous home health agencies, the number of horrific incidences is not high. Florida is pretty safe.

  • Periodically, there are horror stories of violence occurring with no prior indicators--but they don't always involve staff--sometimes other residents and sometimes family. The same things that happen in the home and community can happen in a residential care setting. Just like you can't expect the police to have 24 hours oversight of your neighborhood, you can not expect that level of vigilance to prevent incidents in an ALF.

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