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Staff and Administration
Assisted Living Administration and Staff

Older adults who live in a residential care or assisted living facility need basic help with living skills, like bathing, showering, dressing, medications, personal hygiene, and eating, they do not need constant 24/7 medical monitoring.

The major difference between an assisted living facility and a nursing home is that the residents living in a nursing home facility, do require round-the-clock monitoring for major chronic illnesses and/or disabilities. Assisted living is ideal for those who have some problems with mobility and personal care skills but are not able to live alone in their homes.

Assisted living helps older adults be active and more social. Studies show that adults who are immobile; unable to drive or have trouble walking, become depressed due to isolation. Assisted living is a remedy for the problem.

The Typical Assisted Living Staff

Staff and Administration
Staff and Administration

Assisted living facilities have a wide range of staffing philosophies. The makeup and size of the facility determine the staff selection. If the assisted living community or shares a campus with a skilled nursing facility, then the staff resources integrate between the two.

Some facilities are large and contain several hundred residents and many types of employees such as an administrator, admissions coordinator, various directors, nurses, housekeepers, aides and volunteers. While other facilities are very small and may employ only a few people who perform a multitude of tasks. Smaller doesn't necessarily mean of poorer quality, as a smaller facility may contract the necessary healthcare services if they do not provide them directly. When researching your facility options, become informed about the credentials of the staff.

Level of Care Should Determine Staff Needs

Each resident has different needs and will require different levels of care. For those seniors in good health that do not require much, if any, medical assistance, there is no need for a skilled nurse. For others, having accessible physical therapy might be a requirement. Since assisted living homes come in all shapes and sizes, the patient's level of care should help determine the required staffing. Many facilities may not directly employ various specialized staff such as skilled nurses or physical therapists, but may make arrangements for such care visits.

As mentioned, listing the specific types of staff is almost impossible due to the wide range of sizes of licensed assisted living facilities. However, some general titles of staff that you might find at the larger assisted living facilities include:

  • Administrator - the director of the facility
  • Medical Director - in charge of the overall healthcare strategy
  • Director of Nursing - responsible for overseeing all nursing activities
  • Admissions Coordinator - responsible for resident admissions
  • Housekeeping Coordinator - responsible for all housekeeping activities
  • Dining Coordinator - responsible for all dining activities
  • Nursing Staff - may include registered nurses, licensed practical nurses, clinical nursing assistants and personal care technicians
  • Housekeeping Staff
  • Custodial Staff
  • Dining Staff
  • Administrative Staff
  • Volunteers

It is important to get an idea for how the facility hires, recruits and trains its staff. Does the facility seek out experienced staff only? What are the requirements to become a volunteer? What is the typical turnover of the support staff? A tour of a facility is invaluable as you can see how residents and staff interact and can get a good sense of how many staff members are around while you visit the property.

Let's take a look at the most common staff below:

Registered Nurses in Assisted Living Facilities

It's the larger assisted living facilities that hire full-time nurses. Registered nurses supervise certified nurse assistants, aides and personal care assistants. On-site nurses provide monitoring and oversight of residents needing specialized care.

The smaller assisted living facilities hire visiting nurses or part-time registered nurses to supervise nurse assistants and to monitor a resident's specialized care. Assisted living facilities that care for residents with memory loss or physical disabilities hire a nurse on staff.

The Center for Disease Control surveyed Residential Care Facilities nationwide. The survey revealed that registered nurses did not put in many hours at most of the facilities the last 7 days. However, some facilities reported that RNs worked 40 hours the same 7 days.

During the last 7 days or last work week, how many total hours were worked by Registered Nurses (RNs)?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Licensed Practical Nurses in Assisted Living Facilities

In the same CDC survey, residential care facilities reported the same number of hours worked by LPN (licensed practical nurse) and LVNs (licensed vocational nurse) the past 7 days.

During the last 7 days or last work week, how many total hours were worked by Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs)?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Certified Nurse Assistants, Aides, Medical Attendants, and Personal Care Assistants

Aides Provided Most of the Daily Care
Aides Provided Most of the Daily Care

In assisted living, it's the certified nursing assistants, or CNAs, orderlies and medical attendants who provide the day-to-day personal care to the residents. CNAs help with care duties like bathing, toileting, dressing and mobility.

The nursing assistants monitor health changes and report concerns and issues when they occur. For example, when an assisted living resident stops eating or refuses to get out of bed, the CNA alerts the nursing supervisor, who then can arrange for medical tests or transport to the hospital.

Personal care aides, including certified nursing assistants and medication technicians worked the most hours in residential care facilities.

During the last 7 days or last work week, how many total hours were worked by Personal Care Aides, including Certified Nursing Assistants (CNAs) and Medication Technicians?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Activities Director

Activity director plans, coordinates, and encourages residents to participate in activities and planned outings. Off-campus trips to museums, theaters, shopping, a day of golf and sports events are common activities. The activities director also arranges bingo games, yoga, exercise groups, karaoke and movie events and volunteer visits. The activity director works with other staff members in the office.

Activities Director work on average, worked at least 40 hours a week. In the chart below, the residential care facilities reporting 0 hours for that position, illustrates no one is on staff.

During the last 7 days or last work week, how many total hours were worked by activities director or activities staff?
Responses of refusal (< 1%), and don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

The CDC survey found that Administrators, directors, assistant administrators or assistant directors, reported the most direct care hours given to residents.

During the last 7 days or last work week, how many total hours were worked by administrators, directors, assistant administrators or assistant directors - direct care time only?
Responses of refusal (< 1%), and don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Working in an assisted living facility is physically demanding. The staff is actively involved with residents and perform a number of physical tasks, such as lifting, helping and transporting residents.

Since the residents are active during the day, the night shift requires a smaller staff. The CDC survey found that 60% of the residential care facilities have 1 person on staff at night, while 22% has 2 people on staff, and 19% have 3 people on staff. They must remain awake during the night shift.

During a typical night how many staff are on-duty and awake? Do not count security guards.
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

53% of the residential care facilities report that 1 person is a full-time and/or part-time administrator, director, assistance administrator and/or director on staff, while 26% report 2 people are on staff for these positions and 3 or more are on staff for 17% of the surveyed facilities.

As of today, how many full-time and part-time administrators, directors, assistant administrators and assistant directors are currently employed by facility for residential care?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Benefits of Nurse on Staff

Benefits of Nurse on Staff
Benefits of Nurse on Staff

Older adults and family members choose an assisted living facility with a nurse on staff because they want to have instant access to medical care, when needed. Having a nurse on staff and on duty, gives a sense of security to anxious family members already feeling guilty about having to make the move to assisted living.

The registered nurse provides two things to residents:

Trained eyes to make observations and assessments, and recommendations to for medical care

Medication Monitoring

Registered nurses have licenses to give care under the direct supervision of a licensed medical provider, like a physician. Otherwise, the nurse is not permitted to provide actual skilled nursing care, other than (potentially) some emergency care. Nurses can recommend that a resident go to an emergency room or receive follow-up care from a physician.

Registered nurses apply medical judgment. When you're evaluating an assisted living facility ask what medical services do nurses provide; the days and hours the nurse is on site and whether the nurse is part-time and works for more than one facility? Find out what happens if the nurse is out ill, on vacation, or leaves permanently.

In the CDC survey, 63% of the residential care facilities do not hire registered nurses, but 28% hire 1 registered nurse and 5% hire 2 registered nurses.

As of today, how many full-time and part-time RNs are currently employed by this facility for residential care?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

68% of the residential care facilities do not hire licensed vocational nurses, but 15% hire 1 LVN, and 4% hire 2 LVNs.

As of today, how many full-time and part-time LPNs or LVNs are currently employed by facility for residential care?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Certified nurse assistants are important to the health care team. It's the CNA who recognizes that something is wrong with a resident like the skin is starting to break down. The CNA is the one who brings it to the registered nurse's attention.

Residential care facilities hire 15 or more personal care aides, including certified nurses assistants and medication technicians.

As of today, how many full-time and part-time personal care aides, including CNAs and medication technicians are currently employed by facility for residential care?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

The CDC survey also asked about how frequently various staff resigned or terminated. The survey found very few administrators resigned or terminated in the past 12 months. A similar finding for the number of RNs, LPNs, and LVNs were found. The CDC survey found that CNAs, Personal Care Aides, and medication technicians most often resigned or terminated from the facility. However, they also make up the largest number of workers out of these groups.

During the past 12 months, how many full-time and part-time administrators, directors, assistant administrators and assistant directors have resigned or been terminated from residential care?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
During the past 12 months, how many full-time and part-time personal care aides including CNAs and medication technicians have resigned or been terminated from residential care?
Responses of refusal (< 1%), and don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
During the past 12 months, how many full-time and part-time RNs have resigned or been terminated from residential care?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
During the past 12 months, how many full-time and part-time LPNs or LVNs have resigned or been terminated from residential care?
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.