staffing ratios

Evaluating the Staffing Ratios of Nurse to Patients in ALFs

The long-term care industry has faced staffing shortages for decades. Staffing is one of the most critical risk factors in care delivery in assisted living facilities (ALFs), nursing homes, and memory care centers. Inadequate staffing has long plagued the senior healthcare industry, resulting in significant declines in quality of care. While nursing home insurance serves as a foundational element of risk management, ALF owners and managers must also consider staffing ratios to protect the facility and its residents against healthcare-related risks.

The State of ALF Nursing Shortages

Across the senior healthcare sector, staffing has been an issue of concern for many years. As nurses and paraprofessionals in ALFs reach retirement age, they are not being replaced by younger individuals. The problem of understaffing is only growing; according to a report published by the U.S. Public Interest Research Group at the end of 2020, nearly 23% of senior care facilities reported serious staffing shortages. That figure has risen from just under 20% since May 2020, pointing to a growing staffing crisis in ALFs and nursing homes. Staffing shortages include nurses, nurse aides, certified nursing assistants (CNAs), and medication aides.

What are the factors leading to staffing shortages in ALFs? In addition to the attrition rate as staff retire, other factors include:

  • Lower average wages than in other healthcare sectors.
  • Inadequate recruitment of young medical professionals and paraprofessionals.
  • High workloads that represent health and safety risks to staff.
  • Growing patient demands for specialized care, shrinking the recruitment pool for qualified caregivers.

Nursing home insurance protects facilities and their assets from a wide range of risks. Understaffing risks, however, can strain even the most robust nursing home insurance policy. When a facility is understaffed, patient injury and avoidable death rates tend to rise. Medication errors become more common. Finally, ALFs are at a greater risk of negligence and neglect lawsuits by patients and their families.

The Nurse-to-Patient Ratio

As ALFs and other long-term care facilities become more crowded, and patients require more intensive healthcare, the lack of adequate staff becomes a significant risk management issue. For ALFs facing staffing concerns, what is the appropriate ratio of nurses to patients? The answer is unclear. According to a study published by King University Online in 2019, most U.S. states are allowed to set their own staffing levels. In other words, there is no federal mandate requiring a certain staff-to-patient ratio. Fourteen states have passed safe staffing laws in recent years, but even these laws are limited in their scope and regulatory authority. In fact, of the 14 states with safe staffing laws on the books, only California stands out with a mandated 1:5 ratio of nurses to patients.

Why is a nurse-to-patient ratio so important? Studies have shown important benefits in balancing the number of staff to patients, including:

  • Better healthcare outcomes for patients.
  • Improved levels of job satisfaction among staff members.
  • Reduced burnout levels among staff.
  • Improved recruitment, hiring, and retention levels resulting from better working conditions.
  • Fewer patient-related injury claims.
  • Fewer claims of neglect or negligence.

For facility owners, quality of care is an important aspect of business success. By achieving appropriate nurse to patient ratios, care delivery improves, thereby improving patient satisfaction. Satisfaction among patients further improves the facility’s ability to stand out in a competitive marketplace. In one sense, overcoming staffing shortages is more than a risk management step designed to supplement the protections of nursing home insurance. Achieving a nurse-to-patient balance also provides facilities with the opportunity to increase consumer confidence, helping to drive revenue. Investments in staff recruiting and hiring of quality caregivers ultimately protects the facility, fellow staff members, and patients.

About Caitlin Morgan

Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at (877) 226-1027.