What should the ratio of staff to residents be in AL? Do ALs accommodate hospice?

At my dad's AL it works similarly to as AlvaDeer describes. His facility has a mix of Independent Living, which just your own independent apartment where you are responsible for your own cleaning, meals, etc but you do have access to all the facilities, social/recreational activities and transportation. For an extra per meal charge you can get meals in the dining room. Then there is Assisted Living where they additionally provide all meals, laundry, and cleaning, and depending on your needs and for additional fees you get medication management, assistance showering/bathing, additional supervision and cue-ing for activities/meals, etc. They have about 5 levels of care available. Then they just opened up a Memory Care wing where there is much more supervision, separate recreation rooms and patios all behind a locked door to keep people from wandering. Hospice is available for all residents when needed. They do not, however, provide Skilled Nursing Care such as you'd find in a nursing home, nor do they have the equipment and level of nursing staff that you'd find at a nursing home. Some residents do hire additional private nurses and therapists when that level of care is needed.

My dad, at 98 1/2, is in assisted living at the least level of assistance which is medication management. The nurse checks twice a day and provides him his medication, takes his blood pressure, temp, etc. If he needs additional medical assistance the nurse will contact the facility doctor. The doctor is paid for through his medicare/insurance just like all doctors, and you are free to use your own doctor if you wish. If he needed additional assistance I could increase his level of care to include more supervision of daily activities or bathing etc. I have also asked for occasional additional cleaning when I'm not around to tidy up during the week by paying a one time charge instead of having to up his level of care.

My brother had hospice in his last weeks, at his assisted living. They had two they highly recommended. Yes, hospice does go to assisted living. As to staff ratios it is more the "care ratios" that matter. For instance, let us just pull a figure out of the hat and sat you pay 3,000 a month for the room or rooms. Then you pay a level of care fee. 400.00 a month means you are basically self care; you manage your own drugs, do your shopping on the care center bus; you come to eat with the cottage dining hall and don't require help dressing, bathing, changing. There is usually the three meals and cleaning services, often laundering once a week. If you need medications managed you need the med nurse and this bumps up the fee. When you are wheelchair bound, need help with bathing, perhaps with changing, then you are way up and your fee is likely 1,000 a month on top of the room fee. These fees decide the staffing. Say there are five cottages and each has a different level of care, or there are five and the residents require more caregivers. It is in the hands of the company and this is what management is about. Hospice is always available whether you live in your own home, a nursing home, or an assisted living.