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When Placing Your Loved One in a Long-term Care Memory Unit, Ask What Is The Ratio of Caregivers to Residents for Both Day and Night

Assisted living communities that have a memory care unit are supposed to be adequately staffed with assistants and aides who are educated to deal with the behaviors of dementia residents. The habits of these residents can often be repetitive and endanger the resident if they are not closely watched. Many residents “sundown” in the evening, meaning they may often become more confused and agitated at this time. In my opinion, the caregiver ratio in these sorts of units at night should be no less than 1 aide to 8 residents, when residents with dementia, whether ambulatory or not, can become very agitated and even combative. The “powers that be” at some senior living communities will dispute my ratio, contending that they only need to staff according to long-term care regulations. This month’s real life story will outline the consequences of understaffing.

Real-Life Story

I was recently hired by a client who was forced to place her memory-impaired relative in an assisted living community’s memory unit. The relative had been living in another retirement community that was not equipped to care for residents with memory issues. When the staff at the original community witnessed the relative dragging a bag of laundry up the hallway in the wee hours of the morning, the staff arranged to have her taken to the local hospital’s behavioral unit for evaluation. Apparently, this had not been the first incident of questionable behavior. When the evaluation of the relative was complete, my client was informed that the retirement community could not handle the relative’s behaviors. Therefore, my client had to place the relative in an assisted living community that had a bed available in its specialized memory unit.

A nightmare began. In the assisted living community, the relative was allowed to sleep on a small ottoman in the memory unit. However, the senior rolled off and knocked out four front teeth. The senior also had the habit of visiting the bathroom in excessive amounts, particularly at night, and subsequently fell four times after that. My client was told that, in order to prevent the relative from falling, a private caregiver would have to be hired at night. The cost of care including a caregiver would be over $10,000 per month. That cost is just as high as the cost of nursing home. My suspicion was that the community was severely understaffed. (PLEASE NOTE: Placement in a senior living community or nursing home can never fully prevent a loved one from falling. It is not one-to-one care.)

I made a surprise visit to the community on a Sunday night at 9 o’clock. When I entered the memory unit, I found several of the residents sleeping on their backs on small ottomans. Fourteen of the residents were gathered in the dining room, where two Certified Nurse Assistants (CNAs) were watching over them. The residents were not particularly clean. I saw only one other CNA entering and leaving the residents’ rooms. In a unit of 60 residents, I suspected that the community was understaffed.

I immediately called a meeting with the Director of the unit. I expressed the thought that it was not fair for a family to bear the cost of a private caregiver just because a unit was understaffed. When I asked the Director what was the ratio of caregivers to residents, I was told 1 to 13. I cringed! When I told the Director they were understaffed, the response was “We staff in compliance with the regulations.”

My point is this: You need to ask about staffing ratios upfront when touring communities. I have identified other places with much higher staffing ratios that could help accommodate this client. With the severe dementia this client has, I shall have to recommend the move. Unfortunately, another move can escalate dementia behaviors when an individual is again placed in unfamiliar surroundings. In this case, I am counting on the benefits to outweigh this potential adverse effect.

For all of your senior living needs, please call Andrea Donovan at (708) 415-2934. Or contact us at Visit our website and watch our videos at