Care home staffing ratio in Hong Kong: what the Code sets

Where the requirement comes from, and the grades it counts

Minimum staffing in a Hong Kong residential care home for the elderly is not a target and not a guideline. Section 11(1) of the Residential Care Homes (Elderly Persons) Regulation requires the operator of a care home, other than a nursing home, to employ a home manager and to comply with the minimum staffing requirements for the type of home, which are set out in Schedule 1 to the Regulation. Chapter 9 of the Code of Practice for Residential Care Homes (Elderly Persons), the June 2024 revised edition updated in June 2026, reproduces those tables for day to day use, and it is the version most staff will ever read.

The legal frame is the Residential Care Homes (Elderly Persons) Ordinance (Cap. 459) and its subsidiary Regulation, administered by the Director of Social Welfare through the licensing system. The Residential Care Homes Legislation (Miscellaneous Amendments) Ordinance 2023 was gazetted on 16 June 2023, and most of it took effect on 16 June 2024, but the requirements on staffing and on the area of floor space per resident are being implemented in phases, as the department states on its licensing pages. Chapter 9 of the Code uses 16 June 2024 as its material date. Operating a care home without a valid licence is an offence carrying a maximum fine of HK$1,000,000 and two years of imprisonment, with a further HK$10,000 for each day the offence continues.

The tables count grades, not people, and the Regulation defines each grade. Getting a definition wrong is the most common way a roster looks compliant on paper and is not. The table below sets out the grades the tables count, what each grade is, where the Code requires it and the minimum it carries.

Care and attention home: the daytime requirement

A care and attention home carries the heaviest of the three tables, because it serves residents who need personal care. During, or at, the times the home has designated, there must be at least the number of staff members in the table, and where the number of residents is not a multiple of the number in the table, the home must round the resident number up to the next multiple before working out the headcount.

• Nurse and health worker, for 13 hours within the specified period: 1 health worker on site and on duty for every 30 residents, and 1 nurse on site and on duty counts as equivalent to 2 health workers.
• Care worker, for 10 hours within the specified period: 1 care worker on duty for every 20 residents.
• Care worker, at any time outside those 10 hours: 1 care worker on duty for every 40 residents.
• Ancillary worker, for 11 hours within the specified period: 1 ancillary worker on duty for every 40 residents.
• Any staff member, from 6 p.m. on a day to 7 a.m. on the next day: 2 staff members on duty.
• Any staff member, at any time when a resident is in the home: 1 staff member on site and on duty.

The two footnotes that make the table workable

The night requirement and the always present requirement both say that the staff counted may be persons engaged to satisfy another row of the table, which is what makes the arithmetic workable for a small home. A care worker on duty at 7 p.m. can be counted towards the care worker ratio and towards the 2 staff night requirement at the same time.

The other footnote is already dated in law. From the fourth anniversary of the material date, that is from 16 June 2028, a care and attention home with more than 60 residents must have at least 1 nurse and 1 health worker on site and on duty for 8 hours within the specified period, in addition to the nurse and health worker row above. A home of that size planning its roster for the years ahead should be building towards that requirement now rather than discovering it in 2028.

Aged home and self-care hostel: the lighter tables

An aged home serves residents who can largely manage their own personal care, and a self-care hostel works with residents who can look after themselves, so the requirements fall away accordingly. The two tables are short, and they are where a manager who has only ever run a care and attention home is most likely to mis-read the requirement.

• Aged home, nurse and health worker, for 6 hours within the specified period: either 1 nurse on site and on duty, or 1 health worker on site and on duty for every 60 residents.
• Aged home, care worker or ancillary worker, for 11 hours within the specified period: 1 on duty for every 30 residents.
• Aged home, any staff member, from 6 p.m. to 7 a.m.: 2 staff members on duty.
• Aged home, any staff member, at any time when a resident is in the home: 1 staff member on site and on duty.
• Self-care hostel, care worker or ancillary worker, for 11 hours within the specified period: 1 on duty for every 60 residents.
• Self-care hostel, any staff member, at any time between 7 a.m. and 6 p.m. when a resident is in the hostel: 1 staff member on site and on duty.
• Self-care hostel, any staff member, from 6 p.m. to 7 a.m.: 1 staff member on site, whether or not on duty, and 1 staff member on call, whether or not on site.

The night shift, and the specific hours it sits in

Night is not a separate regime. It is a row in the same table. For a care and attention home and for an aged home, the requirement from 6 p.m. on a day to 7 a.m. on the next day is 2 staff members on duty, and the tables state that those two may be staff counted towards another row.

The overlap is the part that catches homes out. The specified period runs from 6 a.m. to 10 p.m., and the daytime rows are counted within the specific hours the home has chosen. If a home's approved specific hours place its 10 hour care worker row across the evening, then from 6 p.m. until the end of those hours the home is carrying the care worker ratio and the 2 staff night requirement at the same time. The same two people answer to both.

A self-care hostel is treated differently at night: 1 staff member on site, whether or not on duty, and 1 staff member on call, whether or not on site. Across all three types the Code also requires a minimum of 2 shifts of staff in attendance. None of these rows sets a ceiling. They are floors, and a home may staff above them.

The hours in the tables are not left to the home to interpret freely. A care home that is not a nursing home has to formulate its own specific hours, meaning a specific period, or periods totalling that number of hours, on every day, and have them approved by the Director of Social Welfare. The specific hours must fall within the specified period, which the Regulation defines as 6 a.m. to 10 p.m., and a home may propose different specific hours for weekdays, Saturdays, Sundays and public holidays to match its residents' routines.

The application is made on the form the Code prescribes, before the arrangement takes effect, and it is not a short letter. The Code lists what has to accompany it: the residents' schedule of activities and rest hours, the staff duty roster for the proposed specific hours, job descriptions and duty statements for the staff grades, and the corporate documents the form requires. A change to approved specific hours needs an application at least one month before the change is made.

Then the approved document becomes the standard. The department's Licensing Office of Residential Care Homes for the Elderly inspects against the specific hours a home has filed, so the timetable a home applies with is also the timetable it will be measured against.

Training, relief cover and the records an inspection asks for

Four operational requirements sit alongside the numbers.

• Every member of staff has a medical examination by a registered medical practitioner before employment, certifying that the person can meet the requirements and perform the duties of the job.
• All staff should have basic knowledge of first aid, and at least 1 staff member must have completed a first aid course and hold a valid certificate issued by St John Ambulance, the Auxiliary Medical Services or the Hong Kong Red Cross. A home employing a registered or enrolled nurse is exempt from that particular requirement, because the nurse's qualifications are recognised for first aid.
• The operator and the home manager should arrange continuous on the job training and supervision, covering occupational safety, stress management, infection control, drug management, nursing care, handling suspected abuse, use of restraints and the protection of residents' privacy, with the records kept.
• Minimum staffing has to be met at any time, so relief staff have to be arranged whenever anyone is on casual, vacation, sick, maternity or paternity leave. Where a home uses hire of service contract staff, the contracts and the employment records are kept.

The record trail, and the inspections that read it

The record trail is what an inspection asks for first. A home must maintain a staff list, the duty list for different posts, the monthly duty roster, and an attendance record and an outdoor duty record for all staff including relief and contract staff, and make them available for inspection by the licensing office at any time. The staff list and the duty roster go to the department four times a year, on or before 5 January, 5 April, 5 July and 5 October, and the home manager must inform the department in writing of any change in the list of staff employed at least once every three months.

Inspections are unannounced. Four professional inspectorate teams, for social work, health, building safety and fire safety, conduct surprise inspections at different times during and outside office hours, as set out in a Government reply to a Legislative Council question of 22 June 2022. That is the practical reason the roster has to be current rather than reconstructed after the fact.

What technology changes in the staffing arithmetic

A monitoring system can change what a given number of staff can cover. It can hold a watch on corridors and shared areas between rounds, raise an alert within seconds on an unwitnessed fall, and leave a timestamped record of what happened and when it was answered. None of that is authority to roster below the table, and nothing in the Regulation or the Code provides for a lower minimum because a home has bought technology. The requirement is a headcount on duty by grade, and it applies at any time.

Where technology earns its place is in the work a roster cannot reach: the hours between rounds, the corridor nobody is watching, the resident who has taken off a pendant. That framing also fits the test the gerontechnology fund applies, since a fundable product is one that benefits service users and reduces the burden on care staff and carers, which is what covering an unwatched corridor does. We set out the funding rules in what the gerontechnology fund in Hong Kong will and will not pay for.

The limit is the one the Regulation enforces. If a shift cannot be filled, the answer is relief cover, a redesign of the roster, or both, and it is not a lower number. Technology changes how well the hours in the roster are used. It does not change how many people have to be on duty.