Washington Post Reports Assisted Living Facilities Using Algorithm to Set Staffing Levels

On April 1, 2024, the Washington Post published an article titled “Algorithms guide senior home staffing. Managers say care is suffering.” The article indicates that a system, called Service Alignment, was developed more than two decades ago when assisted living facility (ALF) executives began timing caregivers performing tasks. That data was fed into a computer and an algorithm was developed and used to set staffing levels. The goal was to reduce staff and, in doing so, reduce costs. Brookdale, a company operating 652 facilities is on of the largest users of Service Alignment. Both Brookdale and a rival, Sunrise Senior Living, are dependents in law suits alleging inadequate care was provided.

The article reports that at least one local supervisor “begged her superiors to send help as she scrambled to care for the rapidly declining health of residents in a Jacksonville facility she managed during the covid pandemic.” When help was not sent, she scheduled additional “training staff” without company permission. She was fired for doing so.

Georgia is one of 13 states with minimum staffing levels. Although Service Alignment is supposed to schedule at least the State minimums, the article reports that at least four facilities fell short of state minimums during at least one shift per day.

Although businesses and management consultants have been timing workers since the late 1800s with the goal of improving efficiency, patient care is different. The article quotes Carri Chan as saying “When you are taking care of patients, all of whom have unique needs, there is going to be a lot of variation.”

Georgia Rule 111-8-63-.09(18) provides: “The community must maintain an average monthly minimum on-site staff to resident ratio of one awake direct care staff person per 15 residents during waking hours and one awake direct care staff person per 20 residents during non-waking hours where the residents have minimal care needs. Average monthly minimum staffing levels shall be calculated and documented by the community using methods and forms specified by the department. However, the assisted living community must staff above these minimum on-site staff ratios to meet the specific residents’ ongoing health, safety and care needs.”

Georgia regulations distinguish assisted living facilities from personal care homes. An “Assisted living community” or “community” means a personal care home serving 25 residents or more that is licensed by the department to provide assisted living care, and “Assisted living care” means the specialized care and services provided by an assisted living community which includes the provision of personal services, the administration of medications by a certified medication aide, the provision of assisted self-preservation, and the provision of limited nursing services. Regulations define a “Personal Care Home”, “home” or “facility” means any dwelling, whether operated for profit or not, which undertakes through its ownership or management to provide or arrange for the provision of housing, food service, and one or more personal services for two or more adults who are not related to the owner or administrator by blood or marriage. Rule 111-8-62-.10 which relates to Personal Care Homes licensed for less than 25 people must also “maintain a minimum on-site staff to resident ratio of one awake direct care staff person per 15 residents during waking hours and one awake direct care staff person per 25 residents during non-waking hours where the residents have minimal care needs.”