Best practices for nurse staffing in senior living communities

The evolving landscape of care in both Skilled Nursing Facilities (SNFs) and Assisted Living (AL) communities highlights a pressing need: As a growing number of residents transition into ALs with higher acuity care requirements, staffing models must evolve accordingly. Simply meeting state or federal staffing mandates is no longer sufficient.

What is acuity-based staffing?

Acuity-based staffing means adjusting the number and skill level of nursing staff based on the complexity and intensity of residents' care needs. This approach ensures:

• Residents receive appropriate, timely care.
• Quality of life is enhanced.
• Risk of adverse outcomes is reduced.¹

• Regularly assess residents' acuity levels using standardized tools to determine the appropriate staffing levels.
• Evaluate physical, cognitive, and emotional health.²
• Leverage technology such as electronic health records (EHRs) and telehealth to enhance care coordination and monitoring.³

The risks of inadequate staffing

Failing to staff adequately based on residents' acuity levels can lead to several risks:

• Increased adverse events: Insufficient staffing can result in higher rates of falls, medication errors, and infections.⁴
• Resident deterioration: Without adequate care, residents' health can deteriorate rapidly, leading to hospitalizations and increased healthcare costs.⁵
• Staff burnout: Overworked staff are more likely to experience burnout, leading to high turnover rates and further staffing challenges.⁵
• Legal and financial consequences: Inadequate staffing can lead to lawsuits and financial penalties, as seen in several high-profile cases.⁵
• Reputation damage: Poor staffing practices can harm the community's reputation, making it difficult to attract new residents and staff.⁵

The 24/7 staffing imperative

While home health and hospice staff provide valuable services, they are not present in the building 24/7. This reliance can create gaps in care, especially during emergencies or when residents require immediate attention. Assisted Living Communities must make certain they have adequate and qualified staff available around the clock to meet residents' needs.

Key actions for safer staffing

To ensure the safety and well-being of residents, the community must take responsibility for always providing adequate and qualified staff. This involves several key actions:

• Invest in ongoing training and professional development to stay current with best practices and emerging care techniques.¹
• Ensure staff are trained to manage emergencies and ensure continuity of care, regardless of external support from home health or hospice agencies.³
• Maintain a balanced mix of Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs) to provide comprehensive care. Higher acuity residents may require more RNs for complex medical needs.⁶
• Implement flexible staffing models that can adapt to changing acuity levels. This may involve increasing staff during peak times or when residents' needs are higher.³
• Utilize technology such as EHRs and telehealth to enhance care coordination and monitoring.³

By maintaining a robust staffing model, communities can promote the safety and well-being of their residents at all times.

To safeguard the well-being of residents in Assisted Living and Skilled Nursing Communities, it is essential to adopt acuity-based staffing practices that go beyond state and federal requirements. By doing so, communities can provide high-quality care, reduce risks, and maintain a positive reputation.

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