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Staffing Is Key to the Selection of a Long-Term Care Community

I have so many fond memories of my dad and his dry but delightful sense of humor. He wasn’t athletic and once managed to pitch a hard ball through a picture window while practicing baseball with my brother. He told my mom, “Well, I never told you that you married Sandy Koufax!” I used to bring him a Long John (no, not the underwear but a long chocolate, creme filled doughnut) everyday when I visited him at the nursing home. He had a terrible sweet tooth and my husband was continually coaxing him to eat. The doughnut was always wrapped in a paper doily. One time he told me, “Andrea, this is the best d__m paper I’ve ever eaten!”

It is also the memories of the poor staffing at the nursing home where he lived that makes me strive harder to place my clients appropriately. Here’s what happened:

Real-Life Story

My father suffered a stroke at the age of 86. He also had Alzheimer’s disease. After the stroke, he required a level of care that prevented my mother from bringing him home. My mother felt an obligation to place him at a nursing home that was owned by the hospital where he had practiced as a physician for many years. That was our first mistake. We assumed that since he practiced at the hospital well into his 80’s that he would have decent care. Much to our family’s dismay, it was quite the opposite.

My story is no different than anyone else’s nursing home nightmare. But at the time, I was not yet in the eldercare industry and didn’t know any better. I didn’t know that checking the ratio of the staff to residents, observing the staff’s attitude, and watching for possible language barriers were critical components in the selection of a community. Instead, we made a decision based on emotion. As a result, I found him in a soiled diaper every night. We often waited 30 minutes for someone to answer the call light. If I tried to speak with an aide about it, I was often rudely told, “I’m on break.” At times, I couldn’t decipher a foreign accent. If I passed the break room, there were often 4-5 aides on break at the same time watching the television. If I knew what I know now, I would never have allowed my mother to place him there.

Illinois doesn’t mandate staff to patient ratios in nursing homes. There are actual mathematical calculations in the Illinois Nursing Home Act that set the parameters for what the ratios should be. The calculations are based upon the number of residents, type of care the residents need, physical characteristics of the building, and doctors’ orders. It basically gives you the minimum number of hours for nurses and aides required to adequately take care of the residents. That’s in a perfect world.

Here are some thoughts and guidelines that you should keep in mind if you ever need to select a long-term care facility:

  1. Nursing home and assisted living care are NEVER 1 to 1 care with regard to ratio of caregiver to resident. Please dispel that thought immediately.
  2. You are dealing with very low paid staff which may be reflected in the type of persons applying for the aide positions. There is high turnover. Since aides may be from another country, there is often a language barrier.
  3. If your loved one is moving to a skilled nursing community, expect a ratio of one nurse to about 25 residents to be common around the Chicago metro area. Most communities will have a Director of Nursing, an Assistant Director of Nursing, a wound care specialist, and others who will float between the floors and assist the nurse on duty. With respect to the Certified Nurses’ Assistants (CNAs), I have seen ratios as high as 1 assistant to 12 residents. Anything above that is unacceptable, as CNAs are involved in the “hands on” care. The more aides that are available, the better. I have seen ratios of 1 to 7 or 8 in some of the homes that are mostly private pay residents.
  4. The special care units for Alzheimer’s residents normally run about 1 to 9.
  5. Assisted living communities will vary depending upon which model they are following. Among social models that provide mostly “standby assistance” and focus on activities I have observed ratios that are 1 to 13 or 15. Some of the communities that are based on a medical model where they are providing some “hands on” assistance can run from 1 to 8 or 10.
  6. If you ask an Admissions Director questions about ratios and he or she answers, “We staff for according to the acuity of the residents,” the response could mean three things. First, the director doesn’t know. Second, he or she doesn’t want to tell you what it is because the facility is understaffed. Third, the director could be telling the truth.

So how does my story end? We transferred Dad to a community that had a ratio of 1 to 10 with a very compassionate staff. But I remember as Dad was being moved into the ambulance to be transferred to his new home, his attending physician and former colleague said, “Goodbye Cornell.” And when the ambulance sped away, I saw there were tears streaming down his face. That memory is enough to motivate me to provide the best staffing and placement for your loved one.

Many people do not understand appropriate staffing levels at long-term care communities.Andrea Donovan has documented the staffing levels at 350 senior communities. Let Andrea help you select the appropriate community and staffing for your loved one.

andrea-donovan100Andrea Donovan Senior Living Advisors
361 Nuttall Road Riverside, IL 60546 708-442-7174 708-415-2934 (cell)