Do you understand the staffing issues in Assisted Living Facilities? 

Assisted Living Facilities (ALF) have become a popular solution for housing for older adults. The goal of ALF’s is to provide support to their residents, while allowing them to maintain their independence and autonomy. Many residents require assistance with activities of daily living (ADL’s) as well as medication management. In order to assist residents with their ADL’s and medication management, the facility must have trained staff, typically unlicensed assistive personnel (UAP), to manage the resident’s needs and that staffing must meet state requirements.

ALFs are defined, regulated and monitored by the state government with minimal input from the federal government. Approximately 70% of ALFs employ at minimum part time a RN or a licensed practical nurse (LPN) or licensed vocational nurse (LVN). RN’s employed by ALFs are permitted to delegate some nursing functions to UAP and these functions are determined by the states nursing practice act (NPA). Typically in ALFs, the most commonly delegated tasks are ADL’s or activities of daily living as in dressing and bathing.

In some states UAPs are delegated the function of medication administration and it is the RNs responsibility to train the UAP in this function and evaluate the process. In the state of Oregon, UAPs are allowed to administer topical and oral medications, after training followed by some supervision and monitoring. RNs could also delegate the administration of insulin and blood glucose testing. The state of Washington follows similar rules and will allow RNs to delegate medication management and overall health monitoring of ALF residents. RNs working, as an employee of an ALF, are responsible for the care provided by the UAP.

Factors impacting delegation include:

  • RN’s comfort level with delegation,
  • RN’s ability to understand the delegation process and follow state NPA regarding delegation,
  • Follow the 5 rights of delegation: Right Task, Right Circumstance, Right Person, Right Direction & Communication, Right Supervision & Evaluation,
  • UAPs willingness to accept delegation of a task and be able to safely complete the task.

In Oregon’s Secretary of State Archive Division, the Oregon State Board of Nursing (OSBN) under division 47 described in OAR 851-047-0000, states the Standards For Community-Based Care Registered Nurse Delegation. Division 47 provides the rules and regulations the RN and the ALF must follow when delegating nursing functions to UAP’s.

Many times, the director of the ALF and the RN reviewed the training process and materials that needed to be completed in order to maintain employment at the ALF. The hands on training (for the UAP to assist a resident with ADL’s) was completed by a senior UAP as directed by the RN and can include training by both the RN and a senior medication aide. Training can include hands on training for blood glucose testing, administering subcutaneous insulin and subcutaneous Lovenox. The RN then likely administers a medication administration test to the UAP, and subcutaneous injection skills are then reviewed regularly (as in every 3 months), with demonstration of those skills by the UAP.

In order for RNs working in ALF’s to delegate tasks to UAPs, they must follow the regulations outlined in OAR 851-047-0000. Staffing at ALF’s is regulated by state and in Oregon it is the Department of Human Services Aging and People with Disabilities Oregon Administrative Rules Chapter 411 Division 54 Residential Care and Assisted Living facilities that provides the regulations for running an ALF.

When working with cases that involve long-term care, it is vital to determine location and the appropriate governing bodies. Nursing homes has mandated care that are governed by the federal government. On the other hand, an Assisted Living Facility or ALF are governed by the state. Because of the minimal regulations on an Assisted Living Facility, any evaluation of a long term care case requires a complete knowledge of state and federal regulations as well as that state’s Nurse Practice Act; the Nurse Practice Act review to include requirements for any additional training for UAP. In summary, any potential long term care case includes consideration of many factors to determine if that facility failed in the standard of care.

Our nurses have experience in reviewing cases that involve both nursing homes and assisted living facilities. Contact us to see how we can best assist you with your caseload.





Mitty, E., Resnick, B., Allen, J., Bakerjian, D., Hertz, J., Gardner, W.,  Mezey, M. (2010).Nursing delegation and medication administration in assisted living, Nursing Administration Quarterly,34(2), 162-171

Department of Human Services Aging and People With Disabilities Oregon Administrative Rules Chapter 411, Division 54( 2013). Residential Care and Assisted Living Facilities. Retrieved from

Oregon State Board of Nursing, Division 47 (October, 2015) Standards For Community-Based Care Registered Nurse Delegation, Retrieved from