What makes great memory care? Is it a perfectly designed building? Experienced leadership? Evidenced-based programming? Carefully vetted and well-trained staff?
Well, yes — all of these things matter.
But with nearly 38 years of nursing experience under my belt, I firmly believe that it is the staff-to-resident ratio that is the single most important factor in providing great memory care for assisted living residents who suffer from Alzheimer’s disease and other related dementias.
What is a good staff-to-resident ratio? Well, that can be a complicated question. In some assisted living and memory care communities, tasks are very segmented, with several different people responsible for different aspects of an individual’s care. In this scenario, care is largely task-based, so determining a staff-to-resident ratio that will provide adequate care is, in many ways, a math problem. Each task takes a certain amount of time, so there needs to be adequate staff (and therefore time) to perform all needed tasks. This is the reason why many communities charge care levels: more care = more time = more staff.
In some alternative Alzheimer’s and dementia care settings (sometimes called “green houses” or “cottage-style care”) caregivers are assigned to care for pretty much all aspects of a resident’s daily life, including grooming, eating, play, rest and the creation of a clean, safe and welcoming environment. With this more holistic approach, a care ratio of about one staff member to five or six residents (during waking hours) is ideal. This type of dementia care model also promotes caregiving by everyone on staff, so it is a bit more organic.
This “organic” approach may also drive a high staff-to-resident ratios during what are generally considered “sleeping hours.” But many Alzheimer’s and other memory care residents do not have regular “sleeping hours” and may actually experience their best time of the day at 2:00AM! A caregiver ratio of about one-to-eight promotes a response to these common sleep disorders associated with dementia that is more focused on engaging the resident when they are at their best, rather than trying to keep them in bed despite restlessness or a lack of desire or ability to sleep.
When asking an assisted living memory care unit about their staffing ratios, it is important to differentiate between day and night. It is also important to differentiate between “staffing” as scheduled, and as worked. If a one-to-five ratio is planned by management, but staffing problems and absenteeism often drive a 1:12 ratio in spite of this planning, this will make an important difference in the quality of care. You should count nurses and non-caregiver staff in the staffing ratio only if they are in an environment where they respond to resident needs in much the same way as direct caregivers do; if a nurse’s only job is to administer medication and write notes in the chart, then they should not be counted in the caregiver ratio. As funny as it may sound, a good litmus test is the bathroom test: ”Will this person assist my loved one to the bathroom if needed?” If the answer is yes, then count them in the ratio!
Every detail is important when caring for Alzheimer’s and dementia memory care residents, because each and every moment counts! Make sure you ask lots of questions about all aspects of a loved one’s care, but the answer to the question of staff-to-resident ratios will give you great insight into the kind and quality of care your loved one will receive in any memory care home.
