Best Staffing Ratios | Elite Care

Best Staffing Ratios

Staffing ratios in Assisted Living, Residential Care, and Memory Care are prone to exaggeration and misinformation. Should staffing ratios be used as one of the metrics in judging if adequate care is being planned for and given?

The following is about figuring out both staffing ratios and how they affect the quality of life of our elders.  In Assisted Living and aging in general, isolation and loneliness are powerful forces in the decline of our elders.

Isolation leads to Loneliness.  Loneliness is defined as a feeling of emptiness, deprivation, or sadness. As our population ages, more and more senior citizens suffer from loneliness. We can be surrounded by people and still be very lonely.  The cure to loneliness is relationships.

For frail and declining elders in Assisted Living, Residential Care, and Memory Care, staffing is the most prevalent and obvious source of relationships.  The second source of active relationships is friends and family.  When an elder is living at an Assisted Living, Residential Care, or Memory Care facility, family visits most often occur on a weekly basis, making staff relationships all the more important. Almost as important as the staffing ratio is the facility’s belief in what the caregivers’ responsibilities are. At Elite Care Oatfield Estates (Milwaukie, OR) and Fanno Creek (Tigard, OR) we believe staff are responsible for creating meaningful relationships with the residents and serve as one of their primary socialization outlets.

Our founder, Bill Reed, recalls how it was for his mother when she lived at a facility in Naples, Florida. The facility moved the staff around every month so they could not establish relationships. As a result, Bill’s mother missed an important outlet for relationships while the facility maintained a very cold and professional appearance.

There are many ways to measure staffing ratios and many different opinions on what is the most important ratio.  Is it care staff to residents, RNs to residents, activity coordinators to residents?  We figure since it is largely about relationships, maybe the best and least ambiguous ratio is full-time employees (FTEs) in a facility to residents.

Median FTEs per Resident by Department
Data from State of Seniors Housing 2009

National Average Elite Care
Administration 0.03 0.05
Community Manager N/A 0.08
Dietary 0.1 0.08
Housekeeping 0.03 0.03
Maintenance 0.02 0.02
Marketing 0.02 0.03
Assisted Living/Care Givers 0.26 0.58
Nursing 0.07 0.05
Gardening N/A 0.02
Activities Coordinator N/A 0.08
Total 0.53 1.02


This is a very telling number and allows for comparisons without fully understanding the nuances of how different organizations calculate their staffing. The average employee (including administration, RNs and care staff) costs about $16 per hour or around $20 hour including benefits and taxes.  This means that a ratio of 1 FTE per Staff will cost the facility a little over $41,000 a year or over $3,400 per month just for personal costs.

Face Time: The Real Story Behind Staffing Ratios

The real story behind the numbers is face time or the amount of time the employees are expected to spend with the resident.

At Elite Care, we expect all care staff to spend a majority of their time in the presence of a resident. It’s listed as a requirement in their job descriptions.

Elite Care Time with Resident

  • Chef 85%
  • RN 85%
  • Community Manager 75%
  • PA (Personal Assistant) 90%

All of our staff are expected and graded on the amount of time they spend with residents.  We expect that this time is also spent in forming and maintaining strong, loving relationships. It is estimated that the average amount of time our staff are in the presence of a resident is 85% for a face time of .85 FTE per resident

In a typical facility there are .5 FTEs per resident, but of these almost  half are behind the scenes: housekeeping, cooking, medication administration, maintenance, grounds keeping, office staff and administrator.  Of the other half, since the directive is one of production not relationship, we estimate that their staff spend .25 FTE in relationship with resident.

The old adage, “Out of sight, out of mind,” holds especially true for our elders.  When design and culture promote efficiency over individual attention, the elders suffer, fall through the cracks, and become important only when crisis happens.

Elite Care breaks these patterns with over twice as much quality face time with each resident.

Seeing is believing. Come take a tour today!