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Care assistant-to-resident ratio

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Care assistant-to-resident ratio

This requirement refers to the minimum amount of care assistants that must be employed per residential care facility. In some countries, the ratio of care assistants to residents is not specified (e.g. Cyprus, Czech Republic, France, Ireland, Italy, Latvia, Norway and the UK). In some countries (e.g. Ireland, UK-England), each facility is required to provide sufficient numbers of suitably trained and capable staff to meet the needs of their residents. It is argued that each resident has different needs and that needs change over time. This is what should dictate staff ratios and each residential care facility should respond to this.

However, in some other countries references to ratios are made. For example:

  • Belgium (Flanders): five care assistants to 30 residents.
  • Croatia: five care assistants to 20 residents (this ratio is for units providing care to people with dementia).
  • Hungary: 24 care assistants to 100 residents.

In some cases, ratios are not defined specifically for care assistants but refer to all staff providing direct care to residents (e.g. including nurses, AHP etc.). Examples of this approach are found in:        

  • Belgium (Wallonia): one member of staff to five residents.
  • Finland: 0.5 care staff to one resident.
  • Slovakia: one member of staff to two residents.
  • Poland: 0.4 staff members to one resident, and 0.5 in the case of residents with (physical) disabilities.

Finally, another approach is found in some countries where the required ratio is calculated taking into account the level of dependency of residents, for example:

  • Cyprus: for independent residents, one care assistant to 10 residents; for dependent residents, one care assistant to five residents.
  • Germany: for residents who require care level 1 the ratio is of one care assistant to 13.40 residents; for care level 2, one to 4.60; care level 3, one to 2.80; care level 4, one to 1.99 and care level 5, one to 1.77.
  • Greece (private facilities): during the day, for independent residents one nurse and one care assistant to 25 residents; one nurse and one care assistant to 15 dependent residents. Over 25 residents, one more care assistant should be provided per 11 residents.
  • Lithuania: three to five care assistants to 10 residents with severe disability and 0.8 to three care assistants to 10 residents with mild to moderate disability.
  • Luxembourg: in integrated centres for older people: one care assistant to 20, 10, 5 or 2.5 residents, respectively from residents who are more independent to those who have more care needs. In nursing homes, only the last two ratios (i.e. 1 to 5, 1 to 2.5 residents) apply.
  • Malta: the ratios of care staff are determined according to the assessed needs of residents and in accordance with the Barthel 20 index.
  • Portugal: one care assistant to eight residents; one care assistant to five highly dependent residents.
  • Romania: the ratio of staff (this includes care assistants but also other professionals providing care) to residents in facilities providing care to older people is calculated according to the needs of residents and in accordance with the minimum quality standards. For independent residents, who can carry out activities of daily living, the ratio is one to 10. For dependent residents the ratio is one to two and for people with disabilities, one to one.
  • Slovenia: ratio of care staff (this includes care assistants but also other professionals providing care such as AHP) 0.25 for independent residents and 0.35 for dependent residents.
  • Turkey: one care assistant to 15 residents, in special units for older people one to 10.

Table 12 shows relevant differences in terms of the ratio of care assistants to residents in the different countries. Germany, Lithuania, Luxembourg and Poland (also Finland and Slovakia but in these cases all care staff are included) seem to require the highest ratios of care assistants to residents. However, due to the complexity and diversity of long-term care systems in Europe, any conclusions should be taken with great caution as these figures may be due to differences in the type of residential care facility, type of care and services provided and residents who are most likely to live in these facilities. Also, these figures need to be considered along with the composition of the team providing care, ratios for other health and social professionals present in the facility and required training and skills.


Table 12: Ratio of staff to one resident according to dependency of the residents (own calculations, based on provided data).[50]

 Country

Less dependent

More dependent

Cyprus

0.10

0.20

Germany

0.07 to 0.21 (level 1 to 2)

0.35 to 0.56 (level 3 to 5)

Greece(private facilities)

0.08[51]

0.1352

 

Lithuania

0.08 to 0.30

0.30 to 0.50

Luxembourg

0.20

0.40

Portugal

0.12

0.20

Romania

0.1

0.5 to 1[52]

Slovenia

0.25[53]

0.35[53]

Turkey

0.06

0.10

51 This figure includes care assistant and nurse.

52 This ratio includes all staff providing care.

53 This ratio includes all staff providing care.

 

 

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Last Updated: Friday 31 January 2020

 

 
  • Acknowledgements

    This Dementia in Europe Yearbook received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
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