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I have recently inquired into a couple local Memory Care Facilities and on day and evening shifts the staff to pt ratios were 1:6 and 1:8. On nights the staff to pt ratio was 1:18 and 1:15. That night shift ratio sounds like a lot of ALZ/Dementia pts for one staff person to care for. Am I way off base or is this the average? I would appreciate your opinions. Thanks

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I understand your concerns but as long as there are people like you to take advantage of there will always be abuse. You need a job where those in charge care for the residents and the employees. Don't be a doormat or someone will always give you a floor to lay on.
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I work in a critical care facility in a locked Alzheimer's and dementia ward. On the men's unit there are 11 residents and our woman's has ten. The men's unit there are 4 "fall risks" and 9 with violent behaviors. Woman's all but one are basically one on one and violent. I have tried and tried to get our head nurse to have more than one aid but she refuses. She always puts any extra help we have on the front units. Mind you our front units out of the 30+ people only 9 need any assistance. Our problem lies in the locked units. State where I live said it was to be 2 aids for ever 10 residents. I have been physically attacked by our residents on numerous occasions and management does nothing. I've called state 3 times in 3 months and they get out of it. They overwork staff which causes a severe lack of care to the residents due to staff calling in or staff is falling asleep. I have reported abuse to both my management as well as state even went so far as to report it to family members. Still some how some way they keep getting away with it. I work 16 hour shifts without a single break and they continue to take money from my check for a break I didn't take. I won't quit because I care about these people and know if I leave they will not be cared for. I need help! I don't know who to contact to get the residents and staff the help they need. If anyone has any ideas I'm all ears.
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But, they are not getting the care they deserve, not by caregivers,we have to skip showers because we don't have eyes on all of them. I think osha should be called, for safty. I work 6-2pm, we dress them, shower them, serve 2 meals, put laundry away.
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Joni, each state develops its own staffig standards. This is from the Florida laws:

STAFFING STANDARDS

The following chart outlines the minimum ALF staff hours per week as required by Chapter 58A-5, F.A.C.:

Number of Residents Staff
Hours/Week

0 - 5 168
6 - 15 212
16 - 25 253
26 - 35 294
36 - 45 335
46 - 55 375
56 - 65 416
66 - 75 457
76 - 85 498
86 - 95* 539
*For every 20 residents over 95 add 42 staff hours per week.

In addition to the minimum staff hours per week, ALFs are required to maintain the following staffing standards:

At least one staff member who has access to facility and resident records in case of an emergency must be in the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be left solely in charge of other residents while the facility administrator, manager or other staff are absent from the facility.

In facilities with 17 or more residents, there must be one staff member awake at all hours of the day and night.

At least one staff member who is trained in First Aid and CPR, as provided under Rule 58A-5.0191, F.A.C., must be in the facility at all times when residents are in the facility.

During periods of temporary absence of the administrator or manager when residents are on the premises, a staff member who is at least 18 years of age, must be designated in writing to be in charge of the facility.
Notwithstanding the minimum staffing requirements specified above, all facilities, including those composed of apartments, must have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents scheduled and unscheduled service needs, resident contracts, and resident care standards as described in Rule 58A-5.0182, F.A.C.
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I work in memory Care facility, we have 21 residents, some are very aggressive and the company thinks 2 people staff is enough, we have 4 residents that need to people assist, while we are getting them up, we have residents that go behind the counter getting hot coffee, going into other residents rooms, because we are not allowed to lock their rooms, which they can get out. But sometimes im by myself with one nurse and she has the whole building, 320 rooms. I don't think that is legal. It's embarrassing when family comes in and i can't locate their family member, because I'm trying to get a resident out of someones room. I have had been attacked, knives pulled out one me, butter knife, still a knife. I think we should have at least 3 workers.
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The SNF I am familiar is 1:10 during the day and 1:35 at night. The ratios you quote are excellent.
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Does Oklahoma have a fixed nurse, caregiver/memory care patient ratio?
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Restraints aren't safe for dementia clients. However there are alternatives to restraints.
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In the Seattle area there are lots of Adult Family Homes. An AFH has only six residents (I think), and it is my experience that the care can be much better than at a large facility. If I were looking for a spot for my Mom, I would want to know about the other residents, meet the aides ( check their CNA certifications- you can look that up- even so, trust your instincts), check the home's history for any disciplinary action, make sure the kitchen is well stocked and the aides know how to cook ( I say this because I'm a lousy cook, and fixed some not so good meals when I worked in a AFH)- some homes will have a separate cook.
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I really appreciate all your comments as this is in future for hubby w alz. I was wondering how do we find out what state people are in? I live in WA state so love to hear of good places ahead of time to check places & prices. Also can people not name places & how do I talk to spec person on agingcare?
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My Mom's place is 1:8 days, and 1:12 nights, plus she is checked every 30 minutes because she forgets to push call button. I think the staffing is OK, but feel an RN should be on staff on week=ends.
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Memory Care units differ from place to place, but most do not have adequate staffing because it is too costly. To provide an "ideal" staff to patient ratio would cut into the profit margin of the facility!I feel the fewer patients an aide has the more time there is for better care and loving relationships! Care givers should be able to have time to be sociable with their patients ! Also the more stressed out a worker is the more tension is felt by the patient. Persons with dementia operate on a very intuitive basis. They really feel the emotions of others! I know there are those who will say that if we give the workers too little to do, they won't work. However, I feel part of their work should be play and enjoyment of their patients creating a warm, loving and relaxed atmosphere for all.
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In Arizona, the ratios in a memory care facility are 1staff to 7 residents. If in a small group home, it is 1:5, so better. I am not sure what it is on nights where my dad is living, but he does get good and safe care. When we show up to visit, staff know where he is, if he is not in his own cottage. His place is PACIFICA and it's ALL memory care. There are 5 cottages behind secure fencing and lots of paths and walkways through the gardens. No doors are locked, so residents who need to wander can walk and pace and go from one cottage to another. Staff must know where all their assigned residents are all the time, and it appears, at least on day and evening shifts that they do know. My Mom visits daily and when I or our daughter is down there to visit, we go at various times to see what is happening. It's not perfect and some staff are much more focused on residents than others. He was in two other facilities and one was a small group home with 10 residents. THAT was really the best, but he was too agitated there and needed to wander but was locked inside the house all the time. You can always get on line and find contact info for your state health dept to look up all the state guidelines for Assisted Living facilities. I learned that memory care or dementia care comes under strictly assisted living.....NOT nursing home licensure. I would urge looking at both types of facilities but for the small group home situation, you must ask if they are set up for Memory Care before going to tour one, as many are not here in Arizona. It's difficult to keep someone home, but if that is the preference, there are also day care centers in AZ that will take memory care type people in for 6 hours during the day. If you get Medicaid coverage for in home care, that payment will amount to about 20 hours/week, at least here in AZ....and you must have private pay for the other hours. If a person does not sleep well at night, and is up wandering, then one would need full night shift coverage in the home, in order for spouse or others in the home to get sleep. Many people cannot handle helpers in their home while they are asleep...due to fear of stealing etc. It is a rough situation for all...and as someone said.....if in a facility, the residents who have any manner of visitors showing up at unknown times, will get the most consistent care and focus. I live 5 hrs away from my parents, but I have the personal phone number for one LPN and I call and talk frequently to the LPN who supervises all staff and the Executive Director...but then I and both our daughters are in health care by profession, and we WANT lots of contact and information about how Dad is doing. Mom is home right now with caregivers, and they drive her to visit, so they also get pumped by us, for what they observe while visiting....mostly, though, because Mom only knows how to complain about every little teeny thing about the place, and we need to know which 'hills to fight on' so to speak! I don't expect perfection....but I do expect full safety, and, especially in AZ in the summer, I expect a focus on offering lots of liquids to keep dehydration and UTI at bay, and I expect my Daddy to be offered seconds at all meals where he cleans his plate, because is always hungry....and I expect him to be included in all activities, plus being kept reasonably clean and dry and having people converse with him and not just 'doing things to him'. All these things are based on us knowing his personality and wanting it preserved as much as we can have it happen.
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My daughter works for a rehab/nursing chain. It's correct that these nurses and aides have a number of patients. Here where I live, you cannot restrain a resident in any way. The hospital beds at my daughters facility go almost to the floor. This way if a patient falls out of bed, they don't have far to go. When it comes to falling...this can happen in their own homes or even your/mine. It only takes a second. And being elderly, something will break. You just need to do your homework. And I agree, make sure that you visit everyday or as much as possible. I had a friend who would call before she went to visit. I told her not to do that. Just go. If there is something wrong, your more likely to see it. Always question even if you think it's silly. You know your parent and your know their history. I would like my Mom as close as possible but if I can't do that, she may be put where my daughter works. I know she'll get good treatment there because they would come up against my daughter if they didn't.
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My mom had to be moved 3 times. The small bed (6 bed) offered the best care. Two staff members to six residents. The food is much better too. For a shared room it is $3500 a month, which includes ALL services. The big facilities kept raising their rates every year for services and staffing was way too low for residents. I found this wonderful place through "A Granddaughter's Promise." It was founded by a woman whose grandmother died through neglect in a nursing home. The price remains the same until she passes. Not having to put through another traumatic move is a blessing!
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I just moved my mom to a residential care facility. She has advanced stage Alz. They can have a max of 6 residents and there are 2 caregivers during the day and one at night. She is also saving ~2500 per month. We went through an agency that had a list of places that they recommend. So far, so good.
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I went to work at a Memory Care Center as a nurse / supervisor. the premise is good. they will make it like a home where people can wander around safely and do their own thing. the reality was entirely different. people were constantly falling there is not enough staff to make sure residents are safe. on 3 to 11, I would be called to 1 unit or another 2 to 3 night times a night because someone was on the floor.they don't take the nursing seriously unless someone has a visible injury they didn't want me to send them out or use unnecessary supplies. I stayed 3 months and realized I could not keep watching these people get inadequate care and continually hurt themselves. I had 28 people to give meds to but was responsible for overseeing 56 people. the aides generally had 14 people unless we had enough help and then they would have 10. the sad part is there aren't any better alternatives/solutions at this time
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I worked in a Memory Care facility in Washington State. I was responsible for at least ten residents. Two in wheelchairs, several "fall risks", and a few were incontinent. Every day was a grueling race to get tasks accomplished. Aides are expected to give showers, clean rooms, do resident laundry, mop floors, assist in the dining room, etc. I found it impossible to give good care. These families were paying up to 10k per month (this was several years ago). Things that happened as a direct result- residents fell (one cracked her head open on the side of a dresser), residents got UTIs (sitting too long in pee soaked diapers), hearing aids weren't properly used, dentures weren't cleaned, and a myriad of other "minor" stuff that just shouldn't happen. I should add that this is probably the biggest chain of elderly care facilities in th US. I don't do CNA work anymore.
The residents who had family members visit got the best care. I think the best thing you can do is show up a lot, but at unexpected times. Treat the aides with respect, as they are often treated poorly, and most live in poverty. IMO
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In reality nursing homes are not safe. If family doesn't do very frequent checks themselves they will be subject to neglect or abuse. also note just because they checked off that piece of paper doesn't mean the patient was checked on. However, in most cases when a person is impounded in a nursing home, the family did not have a choice. I just pray I don't live that long.
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That is about what they were at my Mom's place. I quickly learned that the centers meet state requirements and no more! I found that most people did sleep quite a bit and the wanderers were mostly all right with secured facilities. You may find that some residents have personal aides making the staff's reach go farther. As a family member we never feel it is enough but it somehow works. Most of the 'physical and routine work' was done during the day at my Mom's place so the smaller staff could concentrate on the residents. Ask about things like checks on the residents. One thing I liked about my Mom's place was they checked EVERY hour and had to physically write down that they had seen each resident. At night, this meant they opened the door to be sure everything was all right. At, my aunt's AL they didn't do this and she was on the floor after a fall for several hours!
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