In the United States, many states offer an official guide to finding the best assisted living communities. And most guides include the staff-to-resident ratio as an essential element to consider. However, most states offer no regulations over assisted living community staffing, much less regarding the proper staff-to-resident ratio for any given residence.

When finding an assisted living facility, it is very crucial to understand what types of training staff receive and how frequently they receive training, but no rules or regulations about general staffing requirements currently exist. Note that the lack of a suggested staff – to – resident ratio is not just a government shortcoming.

Organizations specializing in assisted living also fail to provide this type of guidance. The Assisted Living Federation of America (ALFA) official policy states that “ALFA supports staffing requirements that allow assisted living communities to hire staff in sufficient numbers to adequately meet the needs and preferences of the resident population.”  Essentially ALFA recommends that each facility determine their staffing needs on a case by case basis.

Truthfully, a huge part of the problem when looking at raw staff – to – resident ratios is how the needs of differing assisted living communities vary. For instance, a rural community with walking paths and gardens might require a staff of 4 landscapers, while an urban community would have none. Also an older residence might need a larger maintenance staff than a brand new community.

Nonetheless, grounds and maintenance staff have little effect on the care that residents receive. But counting them can lower the staff – to – resident ratio. A better ratio to consider would be Staff – to – Personal Care Assistants (PCAs). However, most residences do not publish or offer this statistic.

In the United States, so few provide this information and it tends to make comparing this statistic across residences difficult. This is especially true given that most families seriously consider 2 – 4 assisted living residences in their search. And they would be lucky to receive this information on even one of them.

But in a perfect world, there would be one or more staff members dedicated to each resident. These staff members would provide individually appropriate activities, health care, and companionship. However, this is not always the case. High staff to resident ratios can maximize the amount of personal attention given to each resident. This can reassure family members that their elderly loved ones are safe and healthy.

Types of Staff You Can Find in an Assisted Living Facility

Assisted living facilities have a wide range of staffing philosophies. The makeup and size of the facility determine the staff selection. Adequately staffing your assisted living facility is a necessity if you want to provide proper care and avoid problems that result in injuries to residents. While the size of an assisted living facility’s staff varies based on the facility’s size, most rely on certain key staff members to meet the needs of residents.

  1. Executive Director

The Executive Director of an assisted living residence is known to oversee all aspects of the life of the residents, ranging from ensuring that medical needs are being met to overseeing maintenance and upkeep of the facility.

Also note that the executive director is often the face of the residence, involved in everything from showing the facility to prospective residents to hiring staff. Ideally, the Executive Director has a background in Person – Centered Care to be able to best facilitate an enriching environment for the residents. In small residences, the owner may serve as the Executive Director.

  1. Activities Director

The activities director is tasked with organising a variety of events to both entertain residents and keep them healthy. Note that this can vary from scheduling in – house activities like exercise classes to arranging trips to town for shopping, or trips to the park for nature walks.

In addition, the activities director also encourages spontaneous interactions for the residents throughout the day. A key role is to interact with the residents, along with staff and family members, and to identify activities that are of particular interest to the residents. A skilled and enthusiastic activities director brings their exuberance to the residence, which results in much more engaged, happy and well – adjusted residents.

  1. Personal Care Assistants (PCAs)

The PCAs are usually not certified and can have a varying level of experience. This would be dependent on the years they have spent in the industry before coming to be of service to the assisted living facility. Howbeit, the job description of a PCA involves holding conversations with the patients, providing companionship and walking them.

They can also get involved in chores and activities such as general hygiene and clean – up (bathing, using the toilet, etc.), offering transportation to appointments, helping them go shopping and so much more. Before you hire a PCA – type worker, it would be beneficial to check the provisions concerning their employment in your state. Some states require that PCAs have training while the rules are lax in other states.

  1. Home Health Aides (HHAs)

Unlike the PCAs, HHAs are expected to be trained and certified before they can get into this service. However, it is also advisable to check the state laws regarding home health aides to know what to look out for before hiring. Their job description is one that also requires assisting with parts of daily living such as bathing, dressing up and using the bathroom. Asides that, HHAs are trained to monitor the patient’s vitals and observe their conditions to ensure they are kept in the best of health.

  1. Licensed Nursing Assistants (LNAs or CNAs)

The certification level of a Licensed (or Certified) Nursing Assistant is much higher, and that reflects in the added importance of their job type. Have it in mind that the personal care provided by certified nursing assistants, and personal attendants is imperative to the welfare of residents.

CNAs are known to help with personal care duties that can include bathing, toileting, dressing and mobility. They are tasked with monitoring patient’s vitals and are trained to watch for health changes and to report their concerns when issues arise that could compromise patient safety and welfare.

  1. Skilled Nursing Providers (SNPs)

SNPs are also expected to meet the federal standard for health and safety, and then be licensed by the state they will be practicing in. After years of training and education, they are able to offer care services and direct medical care that cannot be provided by any of the professionals listed above this category.

Also note that training makes them equipped to administer drugs and shots, change wound dressings, care for diabetes patients and provide education for the caregiver and patient, as well as many other medical intensive care tasks. Some of these professionals have added skills to buffer their trade. It is, thus, not surprising to see a SNP with extra skills in occupational, physical and/ or speech therapy.

  1. Food and Nutrition Staff

Assisted living residences take pride in their food and do their best to ensure that healthy, nutritious food is provided to all residents. They also make sure that dietary requirements based on preference, religion and medical needs are accommodated.

Howbeit, the involvement of staff members with the food planning and preparation may vary from a contracted professional chef or food service provider who designs a custom menu, to having a dedicated nutritionist or culinary director on staff. In virtually all cases, residences consult with nutritionists to make sure that their meals are providing optimal nutrition.

  1. Registered Nurses (RNs)

RNs probably don’t need much of an introduction and don’t often find themselves in assisted living facilities, but depending on the scope of the facility, they can be employed in senior care and deserve to be mentioned as well. Note that these professionals hold a diploma or degree that allows them practice in the medical field.

They have passed all of the exams and licensing requirements from the board of nursing in their state or the state where they wish to practice in. In the United States, their job involves providing direct medical care when they can or assisting doctors in more advanced procedures.

They also offer guidance to family members in addition to operating intricate medical equipment and administering regulatory level medications. Smaller assisted living facilities or those that focus on cost – cutting measures often use visiting nurses or part – time RNs to oversee the nursing assistants and check on residents.

  1. Housekeeping and Maintenance

A team of janitorial staff is required to take care of housekeeping services in each resident’s room as well as in public areas and offices and to handle laundry duties. Preparing and serving food as well as cleaning the dining area after meals are served require a handful of staff, including a cook, dishwasher and wait staff.

Keeping an assisted living facility in top shape requires people who handle maintenance and landscaping, including mowing, removing snow in the winter and keeping sidewalks and pathways free and clear of debris.

  1. Dementia Care

Also note that any facility that offers special services for residents with dementia or Alzheimer’s disease will require additional staff. For example, in the state of New York, assisted living facilities that provide Alzheimer’s care must hire a case manager and nursing staff. These staff members must be trained on the behaviour symptoms as well as the emotional and mental changes residents go through as the disease progresses.


The size of an assisted living residence will affect the composition of the staff. Large complexes that also have a skilled nursing facility may share staff with their assisted living unit. However, in the case of smaller assisted living residences, specialized or skilled nursing care is often contracted out to a third party. But the best Assisted Living Facilities are led by people with relevant training and a genuine commitment to human well – being.

Ajaero Tony Martins