Document Type

Post-Print

Publication Date

2025

Subjects

Older people -- Services for -- Oregon, Congregate housing -- Employees, Congregate housing -- Evaluation

Abstract

Objectives

To examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023.

Design

Longitudinal study of licensed AL/RC communities.

Setting and Participants

A total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023.

Methods

Primary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social workers. Fixed-effects linear regression models were estimated to account for the time-invariant characteristics in the panel data.

Results

The mean care staff hours per resident per day was 3 hours and 30 minutes (range, 3 hours and 11 minutes to 4 hours and 1 minute), depending on the survey setting year. The mean occupancy rate was 77.5% and declined significantly from 80.3% to 72.2% during the pandemic (P < .001). Staffing levels (overall and by staff type) varied significantly across AL/RC settings. There was an increase in staffing levels immediately after the pandemic started. Most (64%) of the variation observed in staffing levels could be attributed to between-AL/RC differences. On average, total care staff levels were 19 minutes higher in 2021 and 28 minutes higher in 2023 compared with 2017.

Conclusions and Implications

The wide range of staffing levels points to significant differences in operational structures, resource allocations, and resident characteristics across different communities, with implications for the quality of care provided to residents. Understanding the significant changes to staffing patterns (levels and mix) after the COVID-19 pandemic is crucial for developing policies to improve adaptability and resilience of AL/RC settings.

Keywords: Direct care workers, nurse staffing, home and community-based services, workforce

Rights

This is the author's accepted manuscript -- post-print version. The final version, © Elsevier, is available from libraries or the publisher: https://doi.org/10.1016/j.jamda.2024.105352

DOI

10.1016/j.jamda.2024.105352

Persistent Identifier

https://archives.pdx.edu/ds/psu/42883

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