Staffing and Service Availability in Assisted Living: The Importance of Nurse Delegation Policies

Objectives: To examine the health services provided in residential care and assisted living (RC/AL), the staff providing these services, and the degree to which the services relate to state-level nurse delegation policies and other correlates of service provision. Design: This cross-sectional study descriptively examined the relationships among RC/AL characteristics, services, staffing, and nurse delegation regulations/policies. Setting: RC/AL settings (N=245) in 8 U.S. states (CA, FL, IL, KS, NC, NH, NJ, OR). Participants: Administrators and healthcare supervisors (individuals overseeing health care and services provided to residents). Measurements: Using a telephone survey, we examined how delegation policies related to staffing and the availability of 26 health services. Results: Significantly more services were available in RC/AL settings that permit delegation (delegation states) than states that do not permit delegation (nondelegation states) (19.7 vs 18.1, p <.001). Delegation states also had more medication technicians administering, assisting with, or observing self-administration of prescribed and as-needed medications (p <.001), whereas nondelegation states had staff with fewer qualifications handling medications (p <.001). In 2-way comparisons of categories of nurse staffing (none, licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) only, registered nurses (RNs) only, LPN/LVNs and RNs), RC/AL communities with no nurse staffing offered significantly fewer services than all other categories. Those with RNs only also offered a significantly fewer services than those with LPN/LVNs only. Conclusion: This study is a first step in identifying how staffing and availability of services in RC/AL are related to statewide nurse delegation practices, forming the basis for further exploration of how these characteristics may relate to quality of care. J Am Geriatr Soc 66:2158–2166, 2018.