Personal Care Aide Staffing in U.S. Residential Care Communities

TL;DR

This study explores how training requirements and facility characteristics affect staffing levels of personal care aides in U.S. residential care communities.

Contribution

The study identifies new associations between training reimbursement, occupancy rates, and Medicaid support with aide staffing levels in residential care communities.

Findings

Higher staffing levels are linked to facilities reimbursing aides for initial training and operating at high occupancy.

RCCs requiring more initial training hours and serving Medicaid residents have lower staffing levels.

Facility size and Medicaid support are significant factors in staffing ratios.

Abstract

Residential care communities (RCCs) employ approximately 660,000 personal care aides—nearly three-quarters of the direct care workforce in these settings—yet these workers receive minimal training and are not licensed healthcare professionals. Despite their essential role, national patterns of aide staffing and their relationship to RCC characteristics remain unknown. This study examines how training requirements and organizational factors are associated with aide hours per resident day (HPRD) using data from the 2022 National Post-acute and Long-term Care Study. A weighted sample of 518 RCCs was analyzed using regression models. Higher aide staffing levels were significantly associated with RCCs that reimbursed aides for initial training (β = 0.84, SE = 0.36) and with facilities operating at greater than 85% occupancy (β = 0.82, SE = 0.34). In contrast, lower staffing levels were observed in RCCs requiring more than 60 hours of initial training (β=-1.36, SE = 0.58), serving 1–25% (β=-1.19, SE = 0.57) or ≥ 25% (β=-2.01, SE = 0.51) Medicaid-supported residents, and those with more than 50 beds (β=-2.14, SE = 0.30). Neither continuing education requirements nor ownership type were significantly associated with staffing. Findings underscore the importance of supporting aide training reimbursement in association with higher staffing ratios. However, more extensive initial training requirements may reflect an expectation of greater responsibility per aide, potentially reducing staffing needs. Further research is needed to explore the trade-offs between training hours and staffing levels and to better understand the influence of Medicaid participation on workforce capacity in RCCs.