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smj859 Asked August 2020

What staff-to-resident ration is appropriate for a memory care unit?

After living with me for the past 15 months, I put my 89-year-old dad in a memory care facility yesterday. Last night I got a call that he had fallen. There are a lot of unsettling details I could share about his first 6 hours there, but my primary question right now is about the staff-to-resident ratio. Of course I asked about that when we were first considering the facility, but I honestly didn't know what was reasonable, plus that info got lost in the overload of other information. I now know that there is 1 nurse, 2 aides, and a med tech (or some title with the word "tech") for 25 residents. For those of you who have a loved one in a memory care unit, what are your thoughts? Is this typical?

sjplegacy Aug 2020
I think 1-5 ratio is appropriate, but I doubt if you'll ever see that low of a ratio in practice. My wife was in a well staffed facility for MC patients. More important than the staff ratio, I believe, is the training. Most, if not all, caregiving staff are poorly trained. Most are shown a 4 hour video and then be expected to provide appropriate care. Caring for someone with cognitive issues requires more than 4 hrs. I believe paid caregivers should go thru a minimum of 3 days, preferably a week of training. They are not person centered- competency trained.

Your dad's facility is under staffed. But that's not unusual. I would watch to see how the residents are cared for. When I was looking, at one facility I saw a staff member pulling a wheel chair resident backward to the dining table. I immediately thought "that won't be my wife". So something a simple as that eliminated that facility from my list. So more than the staffing, watch how he is being cared for.

AlvaDeer Aug 2020
In memory care that RN is likely stuck on phone, record keeping, et al, and taking care of medical crisis. That leaves 2 aids and one med tech. Often med techs are not allowed to do anything BUT meds and these days that is a full time job for 25 residents. That leave two aids making rounds together or separately, as it often takes two to do changes and etc. IF there is not separate staff who comes in for meal time and feeding this 12 patients each or 25 between the two seems very very difficult.
Each facility is different. Is this their norm? Have you spoken with the office? Are they low because of illness? This I am afraid is a serious problem. I think only Califonia, since Schwartenegger, has staffing limits for hospitals. And that doesn't go down to any other care, even skilled nursing. The day the law was passed and I could be required to care for no more than 6 patients was a wonder and a great gift. The one thing a nurse loathes more than any other is not being able to get to their patients who need them.
I don't have any real answers. But you could see this wasn't working, and I don't see, given confusion, danger of falls, and etc, how it could.
smj859 Aug 2020
Thank you for the response. It's especially meaningful coming from someone in the profession. The scenarios you lay out are the same scenarios I was running through in my head. It doesn't seem to be enough, and my rocky start on the first night is an indication of that. The nurse agreed that she and the tech primarily handle medication, leaving just two aides to meet all the needs of 25 residents. My dad needs to be spoon-fed his meals and needs two-person assist sometimes with other activities. I don't know how that can happen with only 2 aides total.

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