The Three Pillars of Staffing
When you audit a facility's staffing, you need to look at three distinct roles. Each one has a different impact on your loved one's day.
RN (Registered Nurse)
The clinical leaders. They handle complex assessments and emergencies. High RN hours usually mean better outcomes during a crisis.
LPN (Licensed Practical Nurse)
The "Med Medics." These nurses primarily handle medications and treatments. Essential, but often overwhelmed if ratios are bad.
CNA (Certified Nursing Asst)
Critical Care. They handle bathing, dressing, and feeding. **90% of a resident's daily interaction is with a CNA.**
Why "Averages" are Dangerous
CMS reports a facility's "Total Staffing Hours." But keep in mind: **these are self-reported.**
The Night Shift Vacuum
A facility might have great staffing from 9 AM to 5 PM when the State inspectors are likely to visit. But if they drop to 1 CNA for every 30 residents at midnight, that is where falls, neglect, and uncleaned accidents happen. **Always ask for the NIGHT SHIFT ratio.**
What to look for on a tour
Don't look at the lobby or the fountains. Look at the people.
Check the Call Light Panel
Is it constantly beeping? Do you see nurses running, or are they walking with purpose? High-stress "running" usually means they are underwater on their ratios.
The Agency "Frown"
Ask how many staff are "Agency" (temp workers). Agency staff are expensive and often don't know the residents. If the turnover is high, the care is never consistent.
Staffing is Safety.
Our safety scores take staffing levels into account. We cross-reference violation data with hours-per-day to find the facilities that are truly struggling to cover their residents.
The "Staffing Garnish" Warning
Be wary of facilities that count "Administrative RNs" in their clinical staffing ratios. If the Director of Nursing sits in an office all day, they aren't helping your mom out of bed. Always ask for the "Floor Staff" count only.