OSHA and staffing ratios in an Alzheimer care unit

August 14, 2006

Ms. Carol Meeker

[Recipient address omitted]

Dear Ms. Meeker:

Thank you for your January 8, 2006 letter to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA). Your letter was submitted to OSHA's Directorate of Enforcement Programs for an answer to your specific question regarding the staff to resident ratio in your nursing home. This letter constitutes OSHA's interpretation only of the requirements herein, and may not be applicable to any question(s)/scenario not delineated within your original correspondence. We apologize for the delay in responding to your request.

Scenario: In the nursing home where I work, the Alzheimer's Unit is a locked and controlled unit with 21 residents. These residents are considered physically violent or are considered a fall risk. Management has indicated that only one staff member is required at night. I feel that this is going to generate an unsafe environment, both for the worker and for the residents.

Question: Does OSHA have a "...staff-to-Alzheimer resident ratio" requirement?

Reply: No. OSHA does not have any requirements that specifically address a "staff-to-Alzheimer resident ratio." However, OSHA has provided general guidance on the issue of violence inflicted by patients or clients against staff employee its publication #3148-11R, Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers (copy enclosed). These guidelines are not a new standard or regulation. They are advisory in nature, informational in content and intended to help employers to establish an effective workplace violence prevention programs adapted to their specific worksites. These guidelines do not address issues related to patient care. They are performance-oriented, and how employers implement them will vary based on the hazards identified.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at www.osha.gov. if you have any further questions, please feel free to contact the Office of General Industry Enforcement at (202) 693-1850.

Sincerely,

Richard E. Fairfax, Director

Directorate of Enforcement Programs