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What Staff Will Residents be in Contact with?
What Healthcare Staff Works Directly with Residents?

Residential or Assisted Living Facilities uphold safety standards set by state laws. From a licensing standpoint, there are differences from state to state for facilities described as assisted living and the types of personal care and supervision given.

Senior housing employs a range of healthcare staff. The residents stay in contact with the Executive Director (at a high level), the Activities Director, depending on how active you are, and the medical staff.

The total hands-on care depends on the type and severity of the medical condition(s) and whether the facility meets the state licensing standards for restrictive health conditions. Some medical conditions are not allowed in an assisted living facility, for example, tube feeding or treatment of open bedsores.

Restriction on Care Given

Residential Care Services
Residential Care Services

It's up to you to know the limitations. Check the state license. It's up to you to know if the facility can serve individuals having specialized requirements. Since assisted living facilities do not receive a "medical" license, services like tube feeding, treatment of open bedsores or 24-hour nursing care are not permitted.

There is no staff to resident ratio requirements for assisted living facilities. Guidelines express that personnel be available in sufficient numbers and competency to deliver the services. Facilities with 15 or fewer residents - one "qualified" person are on call and at the premises. Those with 16-100 residents - one person be awake and on premises, and another on call and capable of responding within 10 minutes.

Residents were moderately satisfied with the attention received by the facility staff but doubtful about the affection they showed and their willingness to listen. Their greatest concerns point to staffing levels and personnel retention.

A registered nurse oversees the licensed practical nurse and nurse assistant staff at the assisted living facility. They handle a large number of residents, depending on the size. Their day includes tasks like medication records management, writing out care plans and monitoring staff to make sure the residents are healthy. RNs oversee residents during admissions, doctor visits, and new orders. Due to the RNs loaded schedule, they have little time for one on one visits with residents.

In a national survey (2010 by Center for Disease Control) of residential care facilities, 61% of residents had no contact with registered nurses. And 21% had less than 7.5 minutes of direct care with a registered nurse.

RN direct care hours per patient per day
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Licensed Practical Nurse

Licensed practical nurses perform nursing care such as medication administration, data collection, vital sign checks, wound care and dressing changes. Other tasks include specimen collection, urinary catheter insertion and attention, tracheostomy, ostomy site care and maintenance, CPR, and blood sugar testing.

A licensed practical nurse has fewer hours per resident each day (as compared to an RN), averaging 15 minutes a day to 14% of the residents. Source: 2010 Study of Residential Care Facilities by the Center for Disease Control.

LPN/LVN direct care hours per patient per day
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Nurse Aide

Nurse aides (NAs) receive supervision by nurses or physicians at the assisted living facility. They're trained to handle fundamental elements of a resident's care. Nurses Aides feed, dress, bathe and groom patients, spending the most time with the residents. NAs are given medical duties like taking and recording temperature, blood pressure, and other vital signs. Nurses' aides assist with the administrative duties like record-keeping.

NAs have the biggest impact on the day-to-day experience of residents. NAs also called personal care aides spend 3+ hours with 34% of patients/residents per day. 19% of the residents have less than 3 hours/day contact with a nurse aide and 27% has 1 to 2 hours a day contact with them. Source: 2010 Study of Residential Care Facilities by the Center for Disease Control.

Personal care aide direct care hours per patient per day
Responses of don't know (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

The following graphs explain all tasks that facilities ask the nurse or personal care aides to perform. These illustrate why residents closely associate with nurse aides on a daily basis.

Also to helping with activities of daily living, such as dressing and assistance with medications, 82% of the personal care/nurses' aides help with routine housekeeping in the assisted living facility.

In addition to helping with activities of daily living, such as dressing and assistance with medications, do personal care aides routinely perform housekeeping?
Responses of legitimate skip (6%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Other Services Performed

Even though a nurse aide's trained to provide health-related services to residents in a residential care home, in some cases, they're asked to perform janitorial services too. 64% of facilities indicate they ask personal care aides to help with janitorial services.

What other services are performed by personal care aides?
The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

69% of the facilities ask personal care aides to perform other non-technical services like food preparation. Source: 2010 Study of Residential Care Facilities by the Center for Disease Control. In the same survey, 87% of facilities ask personal care aides to provide routine assistance with recreational activities. 89% ask personal care aides to wash the resident's laundry. 52% ask personal care aides to drive or escort residents. 97% ask nurse aides to perform any other task(s) the resident needs.

In addition to helping with activities of daily living, do personal care aides routinely perform any other tasks?
Responses of legitimate skip (6%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Residents have a right to ask the facility to describe how it will meet one's care needs. If a resident is struggling with incontinence, mental health, supervision or dementia, you need to know the type of care to expect. If a facility does not provide a staff person to assist with needs, ask if you can contract with an outside home care or home health care company. 16% contract out to other agencies. Source: 2010 Study of Residential Care Facilities by the Center for Disease Control.

Does this facility use contract workers to provide direct care to residents?

Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
During the past 7 days or last work week, did your facility use any volunteers to help your residents or this facility's staff in any way?

Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Assisted living facilities are a great place to volunteer. When someone has a special interest in older people and appreciates the wisdom and generosity of an older person, volunteer services is a fun way to start working with residents. More often than not, the volunteer position turns into a rewarding career. Here are some ways volunteers help out: Visit residents, Provide entertainment, Assist with social activities, and Organize a group of volunteers to visit.

33% of residence care facilities use volunteers to help residents.

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.