Why Staffing Ratios Matter More Than Star Ratings

You know what matters more than a shiny 5-star rating?

Having enough staff to actually take care of people.

A facility can have perfect inspection scores and still provide terrible care if they don't have enough people working.

Here's why staffing is the most important thing to check.

---

What Are Staffing Ratios?

It's simple: How many residents does each staff member take care of?

The ratio is usually expressed as:

1 CNA to 8 residents (1:8)

1 CNA to 15 residents (1:15)

Lower numbers = better care.

---

Why It Matters

When CNAs (certified nursing assistants) are responsible for too many people:

What suffers:

Call lights go unanswered for 30+ minutes

Residents sit in soiled diapers too long

People don't get bathed regularly

Meals are rushed or skipped

Residents are left in bed all day (easier than getting them up)

Falls happen because no one's watching

Medications are given late or missed

Bottom line: Not enough staff = neglect. Even if it's unintentional.

---

What's a Good Ratio?

During the day (7am - 3pm):

1 CNA to 8-10 residents = good

1 CNA to 12-14 residents = acceptable but tight

1 CNA to 15+ residents = red flag

Evenings and nights:

Ratios are usually higher (fewer staff). That's normal, but:

1 CNA to 12-15 residents = acceptable

1 CNA to 20+ residents = problem

RN (Registered Nurse) coverage:

There should be at least one RN on duty 24/7. Some states require this by law.

---

How to Find Out the Ratio

Ask during your tour:

"What's your CNA-to-resident ratio during the day? What about nights and weekends?"

If they dodge the question or say "it depends," that's a bad sign.

Check Medicare Care Compare:

The website shows staffing hours per resident per day. Look for facilities with:

Total nursing hours: 4+ hours per resident per day

RN hours: At least 0.5 hours per resident per day

---

Observe During Your Visit

Numbers lie. Trust your eyes.

Good signs:

Staff seem calm and organized

Call lights are answered quickly

Residents are dressed and groomed

Staff are interacting with residents (not just rushing)

Bad signs:

Multiple call lights going off with no response

Staff look frazzled and overwhelmed

Residents yelling for help

Staff complaining about being short-staffed

---

Weekends and Nights Are Worse

Facilities cut staff on weekends and overnight shifts. That's when problems happen.

What to do:

Visit on a Saturday or Sunday

Ask specifically about weekend staffing

Come back at different times of day

---

High Turnover = Big Problem

Even if ratios look okay, high staff turnover destroys continuity of care.

Why turnover matters:

New staff don't know residents' needs

Residents feel insecure with constantly changing faces

Training takes time (less experienced staff = more mistakes)

High turnover usually means bad management or poor working conditions

Ask: "How long have your CNAs worked here? What's your turnover rate?"

If most staff have been there less than a year, that's a red flag.

---

Why Facilities Understaff

It's about money.

Staff salaries are the biggest expense for nursing homes. Cutting staff increases profits.

So facilities:

Run skeleton crews

Rely on overtime (burned-out staff)

Don't replace people who quit

Use temp agencies (expensive and inexperienced)

The result: Residents suffer.

---

Star Ratings Don't Tell the Whole Story

Medicare star ratings look at:

Health inspections

Staffing (self-reported by the facility)

Quality measures

But:

Facilities can manipulate staffing data

Inspections are announced (facilities staff up for inspection day)

Star ratings don't capture daily reality

A 5-star facility can still be understaffed.

---

What You Can Do

Before choosing a facility:

Ask about staffing ratios (day, night, weekend)

Visit at different times (including weekends)

Observe how staff interact with residents

Ask current families about staffing (they'll tell you the truth)

Check Medicare ratings, but don't rely on them alone

After your loved one moves in:

Visit regularly at different times

Track how long call lights go unanswered

Check if your loved one is clean and groomed

Talk to staff—are they stressed and overworked?

Speak up if care is suffering

---

The Bottom Line

You can have the cleanest, most expensive facility with perfect inspection scores.

But if there aren't enough people to actually take care of residents, none of that matters.

Ask about staffing. Observe staffing. Check staffing ratios.

It's the single most important thing you can do.