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NURSING HOME STAFFING STANDARDSIN STATE STATUTES AND REGULATIONSByCharlene Harrington. Ph.D.Department of Social and Behavioral SciencesUniversity of California San Francisco3333 California Street Suite 455San Francisco, CA 94118Charlene.Harrington@ucsf.eduJanuary 2008We want to acknowledge the assistance of Theodore Tsoukalas, Ph.D. and Caroline Stephens, M.S., R.N.in collecting and preparing the data for this report which updates a report prepared in May 2001.
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSSTATE STANDARDEstimatedStaffing StandardCommentsvariance fromCitation and URLfederal standardfor facility with100 bedsFEDERAL STAFFING: 1 RN 8 consecutive hrs/7days/wk & 1 RN/LVN for 2SC State Coderemaining shifts. Must have 1 RN who is Full Time DON (5days/wk); if fewer than 60 SAL State Administrative Law (Rules and Regulations)residents, DON may also be Charge Nurse. (For 100 residents, LN .30 hours perSDP State Departmental Written Policyresident day (hprd) would be required.)AKSUFFICIENT STAFF: No requirementSAL: SAL: AKLN .32Administrative CodeLICENSED STAFF (RN, LPN/LVN)Title 7 Health andFor 1-60 occupied beds:Social Services, Pt. 1,1 RN Day 7days/wk and 1 RN Eve 5 d/wk and 1Ch. 12, Art. 5 NursingLPN all shifts when RN not presentFacilities, Sec. 275, 7For 60 occupied beds:AAC 12.275. Eff.2 RNs Day 7d/wk and 1 RN Eve & Night 711/19/83. Am. in/folioisa.dll/aac/queryDIRECT CARE STAFFNo minimum requirement %5Bjump!3A!277 aac 12!2E275!27%5D/doc/%7B@31471%7D?StateALMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: Sufficient numbers of licensednurses and other nursing personnel on a 24-hour basisLICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time included in1 RN 8 consecutive hrs/7ds/wkFor 1-60 residents: DON may be charge nurseLN .08SAL: SAL: ALAdministrative Code420-5-10-.10 "NursingServices" Eff. al.us/docs/hlth/index.htmlDIRECT CARE STAFFNo minimum requirementUCSF Survey of Nursing Home Staffing Standards, 20076
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateARMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: No requirement.LICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time normally work on day shift; ifDON has other institutional responsibilities inaddition to written job description, then add 1 moreRN as Assistant DON to equal one FTE of DON onduty.1 RN or LPN Charge Nurse for each shift.1-70 residents DON may be Charge NurseIn multi-story homes, each floor should be staffed asa individual unitAZDIRECT CARE STAFFEffective 10/1/2003-- Day Shift: 1 licensed nurseper 40 residents; 1 direct-care staff (licensed orcertified nursing staff) per 6 residentsEvening Shift: 1 licensed nurse per 40 residents; 1direct-care staff (licensed or certified nursing staff)per 9 residentsNight Shift: 1 licensed nurse per 80 residents; 1direct care staff (licensed or certified nursing staff)per 14 residentsSUFFICIENT STAFF: Nursing services to meet theneeds of a residentLICENSED STAFF (RN, LPN/LVN)1 DoN RN full time;For 1-59 average daily occupancy: DON mayprovide direct care on regular basisDIRECT CARE STAFF1 nurse must be present and responsible forproviding direct care to not more than 64 residentsUCSF Survey of Nursing Home Staffing Standards, 2007STATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSDP: Rules andLN .58Regulations for NursingHomes, Office of LongDC 2.8Term Care, State ofArkansas, Sect. 510Total 3.8511.2, 511.4, 512.1,512.4, 513.2; Sect. 520CommentsNew Legislation: Act 192 (HB 1363) requires theOffice of Long-Term Care to create staffingstandards for nursing facilities designated orcertified as Eden Alternative nursing facilities orGreen House Project nursing facilities. The actpermits the Department of Health and HumanServices to development a reimbursementmethodology for payments for staff services andSDP: Rules andcare.Regulations for Nursing 007Homes, Office of Long %20FinalSummary for%20print.pdf )Term Care, State ofArkansas, Sect.Legislative Updates: http://www.arkleg.state.ar.us/520.1.1, tions/elections pdfs/register/nov 05/016.06.05-095F8007.pdfLN .185SAL: AZ AdministrativeCode Title 9, Ch. 10,Sec. 901-905. Eff. 217-95. (Supp. 95-1).section repealed; newSection made by finalrulemaking at 9 A.A.R.338, IC SERVICES/Title09/9-10.htmAZ Administrative Code, Chapter 28 is known asAHCCCS, the Arizona Health Care CostContainment System--Ariz. Long Term CareSystem. Expressly incorporates Medicaid byreference in 42 CFR 442 and 42 CFR 483.OnLine na Administrative Register.7
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateCAMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: Each facility [SNF] shall employsufficient nursing staff to provide a minimum dailyaverage of 3.2 nursing hours per patient day.LICENSED STAFF (RN, LPN/LVN)For 1-59 licensed beds:1 RN/LVN 24 hours/dayFor 60-99 licensed beds:1 DON RN Day Full Time (may not be charge nurse)and 1 RN/LVN 24 hours/dayFor 100 beds:1 DON RN (may not be charge nurse) and1 RN 24 hours/dayDIRECT CARE STAFF3.2 hprd Do not double hours of RNs/LPNs andexclude hours of DONRegulations in process:Day: 1LN:20 patients 1 CNA:9 patientsEvening: 1 LN:25 1 CNA:10Night: 1 LN:30 1 CNA:15UCSF Survey of Nursing Home Staffing Standards, 2007STATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsOnLine Updates:RN .30Legislation/Bills:http://www.leginfo.ca.goDC 3.20v/bilinfo.htmlTotal 3.5CommentsSC: CA Health and Safety Code, Sec. 1276.5 (asamended by AB 1107, 1999) Eff. 7-22-99.SC: CA Welfare and Institutions Code Sec.14110.7. Am. 1999.http://www.leginfo.ca.gov/cgiHealth & Safety Code: bin/waisgate?WAISdocID 13257014885 0 0 0&http://www.leginfo.ca.go WAISaction retrievev/calaw.htmlSAL: CA Code of Regulations Title 22 Ch. 4 Sec.Access this website for 73319 and Sec. 72329.California Code rRegulations and insert ca%2Dadc&Action ExpandTree&AP CAT22D2§ions of interestItemKey CAT22D2&RP %2Ftoc%2Fdefault%2Ew(e.g., 73319; 77329)l&Service TOC&RS WEBL7.09&VR 2.0&SPa Chttp://ccr.oal.ca.gov/link CR-1000&fragment#CAT22D2edslice/default.asp?SP CCR10-16-07 Title 22, Sections 72077 and 723291000&Action Welcome DHP-03-010E Emergency Regulations are underconsideration to establish minimum ratios ofstaffing per shift to implement AB 1075 Chapter684, 2001). The following ratios would beestablished.Day: 1LN:20 patients 1 CNA:9 patientsEvening: 1 LN:25 1 CNA:10Night: 1 LN:30 1 CNA:158
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateCOMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: Sufficient staff to provide promptassistanceLICENSED STAFF (RN, LPN/LVN)1 DoN RN Full Time 40 hrs/wk included in1 RN 24 hours/7days/week and1 LN each care unit at all timesDIRECT CARE STAFFFor 1-60 residents: 2.0 hprdFor 60 residents: 2.0 excluding the DON, staffdevelopment coordinator, and other supervisorypersonnel.UCSF Survey of Nursing Home Staffing Standards, 2007STATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSAL: Code of COLN .48Regulations,Department of PublicDC 2.0Health and EnvironmentRegulations, HealthTotal 2.48Facilities Division –1011, Ch. V, Long TermCare Facilities, Pt. 7,Nursing Services, Sec.7.2 & 7.3. Eff. ealthfacilities/10110105longtermfacilities.pdfAlso in Dept. of Healthcare Financing StaffManual:http://www.chcpf.state.co.us/HCPF/Pdf Bin/402416ltc.pdfCommentsCurrent Regulations: Intermediate CareFacilitiesrequire 1 RN/LPN Day Shift 7days/week. If DoNis LPN, then 1 RN consultant 4 hrs/wk.Current Medicaid Regulations: CO Departmentof Health Care Policy and Financing, Staff Manual,Vol. 8 - Medical Assistance, Secs. 8.408(3) and8.409.24. SNF requires 2.0 hppd; ICF 1 RN orLPN DoN full time 7days/wk. If LPN as DoN, 4 hrsweekly consulting by 1 facilities/10110105longtermfacilities.pdfOnLine Updates: Dept. of Health Care Policy andFinancing homepage: http://www.chcpf.state.co.us/and Dept. of Public Health and Environmenthomepage: http://www.cdphe.state.co.us/9
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateCTSTATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSUFFICIENT STAFF: Sufficient nurses and nurse'sSAL: CT Public Healthaides to provide appropriate care 24 hours 7 days/week.LN .70Code 2000 Sec. 19-13D8t (m)(1)-(8). Eff.LICENSED STAFF (RN, LPN/LVN)NA 1.9005/20011 DoN RN full-time; if more than 120 beds, 1 Asst.http://www.dph.state.ct.DoNTotal 2.60us/php/docs/39 Long1 RN 24 hours/7 days/week andterm Hospitals.doc1 RN/LPN (each floor) 24 hrs/7days included inDay [7 am - 9 pm] .47 hprdEnabled by CT GeneralNight [9 pm - 7 am] .17 hprd.Statutes Code of PublicFor 61-120 beds: exclude DON; for 121 beds,Health Sec, 19a-36exclude Asst. htmNURSE ASSISTANT STAFF (NA/CNA)Total nursing & NA: 7am-9pm: 1.40 hprd; 9pm-7am.50 hprdMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESUCSF Survey of Nursing Home Staffing Standards, 2007CommentsCurrent Regulations:SNF/NF called chroniccare & and convalescent home. Rest Home withNursing Supervision (ICF): 1 NA 24 hours/7days/week included in Licensed Staff: Day [7 amto 9 pm] .23 hprd; Night [9 pm to 7 am] .08 hprd.For 61-120 beds, exclude DON; for 121 beds,exclude Asst. DON. 1 Nurse Assistant each floor24 hours/7 days and Day -- .70 hprd; Night -- .17hprd. For 61-120 beds, exclude DON; for 121 beds, exclude Asst. DON.OnLine Updates:Public Health Codehttp://www.dph.state.ct.us/phc/phc.asp10
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateDCSTATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSUFFICIENT STAFF: 24-hour licensed nursingSAL: DC Municipalservices 7days a week sufficient to meet the nursingLN .80Regulations Title 22needs of all patientsPublic Health andDC: 2.93Medicine Ch. 32 SkilledLICENSED STAFF (RN, LPN/LVN)Care Facilities, Sec.1DON RN Fulltime andTotal 3.503208 (Nursing1 Nursing Supervisor (RN) at the facility 24hrs/7d/wkServices), 3209DON may serve as supervisor while on regular duty(Nursing Servicesif less that 30 bedsSupervision), 32101 RN/LPN Charge Nurse on each unit 24hrs/d(Licensed NursingIf charge nurse is LPN, then must have access to anCoverage), 3211RN for consultation(Nursing Personnel),(10/12/01)RN/LPN (planning, coordination, supervision at unit level)Day 1:35 (0.23 hprd)http://www.hpm.umn.edEvening 1:45 (0.18 hprd)u/NHRegsPlus/state reNight 1:50 (0.16)gulation attachments/DC regulation attachments/DISTRICT%20OF%DIRECT CARE STAFFMinimum of 2 nursing employees per nursing unit20COLUMBIAper shiftnursing%20facilities.pdf30 licensed beds: exclude DON RN or othernursing supervisory employee not providing directcareBeginning no later than Jan 1, 2005, each facility shallemploy sufficient nursing staff to provide a minimumdaily average of 3.5 hprd. Hours shall be adjustedupward for higher nursing care needs/more acuteconditions.Direct care (RN, LPN, or CNA)Day 1:5 (1.6hprd)Evening 1:10 (0.8hprd)Night 1:15 (0.53hprd)MINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESUCSF Survey of Nursing Home Staffing Standards, 2007CommentsOnLine Updates: DC To view DC Municipal Regulations directly fromDC website (for a fee):http://os.dc.gov/os/cwp/view.asp?a 1206&q 522371contact Office of Documents & AdministrativeIssuances for titles not available online (e.g., Title22)11
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateDEMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: Sufficient number of nursingservice personnel to provide care.LICENSED STAFF (RN, LPN/LVN) *1 Supervisory Nurse (DoN) RN Full Time 8hrs/7d/wk1 RN on duty each shift, 7 days a weekDesignate adequate relief personnel, including a RNin charge of each shift, when she is not in the facilityso that a responsible person is available at all timesin the event of an emergency.Each institution shall have at least 2 or more nursingservice personnel monitoring the patients 24 hours aday.DIRECT CARE STAFFMust provide 3.67 hours of direct nursing care per 24hour period. By May 2003:RN/LPNDay 1:15Evening 1:20Night 1:30CNADay 1:7Evening 1:10Night 1:15UCSF Survey of Nursing Home Staffing Standards, 2007STATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsLN 1.2Title 16 Health & SafetyRegulatory ProvisionsCNA 2.47Concerning PublicHealth, Ch. 11 NursingTotal 3.67Facilities & SimilarFacilities, SubchapterVII. Minimum StaffingLevels for ResidentialHealth Facilities (notethis is the “16 Del CSect. 1162” from theNational Health Law &Policy Resource Centertable). Eff. 07/index.shtmlCommentsNew Legislation: General Assembly 144, SB 175-An Act to amend Title 16 of the Delaware Coderelating to nursing facilities and other facilities. Thisproposed legislation, most recently underconsideration in the Senate Finance Committee(7/11/2007) would require the following minimumstaffing levels:LevelIIIIIIIVVVIVIIVIIIRN LPN 2.312.562.561.822.723.21BY APRIL 1, 2008 the facility must alsoOnLine Updates:http://www.legis.delawa meet the following minimum shift ratios:re.gov/LIS/LIS144.nsf/vRN/LPN CNA and all otherwLegislation/SB 175?Odirect 71:91:1512
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateFLMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: sufficient staff to maintain thehighest practicable physical, mental, andpsychological well-being of each residentLICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time. If DON is delegatedinstitutional responsibilities, a full time qualified RNshall be designated as ADON.For 121 residents, add 1 ADON RN1 RN/LPN each shift included in:RN/LPN : 1.0 hprd (24 hour average)(Jan 2002)Never below 1 licensed nurse for 40 residentsDIRECT CARE/NURSE ASSISTANT STAFFCNA: 2.7 hprd (24 hour average) starting01/01/2007 OR 1 CNA/ 20 residents AND 1LPN/LVN per 40 residents. Beginning 01/01/2007,min. weekly ave 2.9 hprd per day CNA direct careUCSF Survey of Nursing Home Staffing Standards, 2007STATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSAL: FL AdministrativeLN 1.0Code Ch. 59A-4"Minimum Standards forDC 2.9Nursing Homes" Sec.59A-4.108(4). Eff. 4-1Total 3.982. Am. ?id 59A-4.108CommentsCurrent Statute on Direct Care MinimumStaffing Standards: starting Jan. 1, 2007 2.7 hprdor 1 CNA per 20 residents and no less than 1CNA per 40 m?App mode Display Statute&URL Ch0400/ch0400.htmOnLine Updates:**Also see 2007 Florida utes Chapter 400Nursing Homes &Related Health CareFacilities 400.23 App mode Display Statute&URL Ch0400/ch0400.htm13
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateGAMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: Sufficient nursing staff on duty atall timesLICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time Day; DON may be director ofnursing services in other nearby nursing homes ifthose nursing homes have 1 RN as full time Asst.DONSTATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSAL: GA Rules &LN .30Regulations, Rules ofthe Dept. of HumanDC 2.0Resources, Ch. 290(Public Health), Ch.Total 2.3290-5-8-.04 0/5/8/04.pdf1 RN/LPN in each 8-hr shift 24h/7d included in:RN/LPN to total nursing personnel ratio: 1:7CommentsNote: A Level I nursing facility is an IntermediateCare Facility. A Level II nursing facility is a SkilledNursing Facility.OnLine d Ch. 290-5-9Intermediate CareHomes .pdfDIRECT CARE STAFF2.0 hprdMEDICAID LEVEL I AND LEVEL II2.5 hprdHISUFFICIENT STAFF: Sufficient in number andqualifications to meet the needs of the patientsLICENSED STAFF (RN, LPN/ LVN)1 RN Full Time 24 hours/7 days/weekDIRECT CARE STAFFNo minimum requirementUCSF Survey of Nursing Home Staffing Standards, 2007RN. 24SAL: HI AdministrativeRules Title II,Department of Health,Ch. 94, Skilled Nursing,Int. Care Facilities, Sec.23 Eff. 5-3-85.Current Regulation: Intermediate Care Facility:1 RN Full Time Day and 1 RN/LPN whenevermedications are administered.OnLine Updates: http://www.hawaii.gov.Administrative rules.http://www.hawaii.gov/h htmlealth/about/rules/admrules.htmlFor pending s.asp#hrs.HI regulations currentlybeing updated.http://www.hawaii.gov14
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateIAIDMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: No requirement.LICENSED STAFF (RN, LPN/LVN)1 RN/LPN Health Service Supervisor andFor 1-74 beds: if supervisor is LPN, RN must behired For 4 hrs/wk when LPN is on duty.For 75 beds: supervisor must be RN and add 1RN/LPN 24 hrs/7 days/weekDIRECT CARE STAFF2.0 hprd (computed on 7-day week)20% must be from "qualified nurses" RN/LPNsincluding time of Health Service SupervisorAt least 2 people "capable of rendering nursingservice" on duty at all times.STATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSAL: IA AdministrativeLN .30Code, Inspections andAppeals [481], ChapterDC 2.058 Nursing FacilitiesSec. 58.11(2) NursingTotal 2.30Supervision andStaffing. Eff. 9-271976.RN .36DIRECT CARE STAFF2.4 hprd. For 1-59 residents: exclude DON butinclude supervisory nurse on each shift. For 60 residents: exclude DON and supervisory nurse.UCSF Survey of Nursing Home Staffing Standards, 2007OnLine Updates: For pending rules and regschanges, see IA C.htmlTo track legislation, see the Track Legislationpage of the Iowa Legislature, General Assemblyat: y updates.https://diahfd.iowa.gov/DIA HFDWEB/cmsDocDir/481%20IAC%2058.pdfSUFFICIENT STAFF: No requirement.LICENSED STAFF (RN, LPN/LVN)1 DON RN FT (5d/wk) DayIf DON occupied with Administration, then 1 RNAssist. DONFor 60 residents: DON only for nursing adminduties1 Supervising Nurse, RN/LPN andFor 1-59 residents: DON may be Supervisory Nurse1 Charge Nurse, RN/LPN as follows:For 1-59 residents:1 RN one shift (8 hrs each day shift) & 1 LPN other2 shifts 7days/wkFor 60-89 residents:1 RN two shifts (Day & Eve) &1 LPN Nights 7days/wkFor 90 residents:1 RN 24hrs/7d/wkCommentsDC 2.4Total 2.76Current Regulation: Intermediate Care Facility(licensed exclusively as ICF) : 1 DON RN FullTime (5d/wk) Day And 1 RN/LPN on duty asCharge Nurse 24hrs /7d/wk. If DON is LPN, RNmust be on call. Direct care 1.8 hprd including thehttp://adm.idaho.gov/ad DON, supervisory nurse and charge nurse.minrules/rules/idapa16/ Nursing hours per resident per day may be0302.pdfaveraged over the week if the facility has receivedprior approval from the Licensing Agency tocalculate nursing hours in this manner.SAL: ID AdministrativeCode, 16.03.02.200.02Eff. 1-1-88; 11-20-89,12-31-91, and 7-1-93.OnLine Updates: For notices of pending rulesand regs, and for proposed reg. tracking, see IDAdministrative Bulletin and Master CumulativeIndex of All Rule trtoc.htmFor Idaho State Statutes, search .htmland for current legislation and bill .html.15
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateILMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: Staffing shall be based on theneeds of the residents.LICENSED STAFF (RN, LPN/LVN)DON’s time shall not be included in staffing ratios.1 DON RN full-time or minimum 36 hours/week; atleast 16 hrs on duty between 7am and 7pmFor 1-49 beds, DON may provide direct care andincluded in staff-to-resident ratio calculationsFor 100 1 Asst. DON RN full-time.1 licensed nurse (RN/LPN) charge nurse onremaining non-DON or Asst DON shifts. If RN andLPN present on same shift, RN is charge nurse1 RN on shift (8 consec. hrs) 7days/wk included in1 RN/LPN 24 hrs/7d/wk on each floorDIRECT CARE STAFF2.5 hprd with Day-40%, Eve-25%, and Night-15%.Including 20% LPN time; exclude DONand 1 person on duty 24h/7d in each unitSTATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSAL: IL AdministrativeLN .35Code Title 77 PublicHealth, Ch. 1, Dept. ofDC 2.5Public Health, Subch.C, Long-Term CareTotal 2.85Facilities, Sec. 3001230, Pt. 300, and 1240Skilled Nursing andIntermediate CareFacilities CodeEff. 3-24-89; Am at 16III. Reg. 17089,Eff. 11-3-92.CommentsCurrent Regulation: Intermediate Care Facility:1 licensed nurse (RN/LPN) 24 hours/7days/weekand direct care 1.7 hprd* 20% LPN time. If 150 occupied beds, 1 licensed nurse (RN/LPN) asAsst. DON. If DON or Assist. DON absent, 1licensed nurse (RN/LPN) as charge nurse.Online Updates:IL Dept. Public Health Administrative /rulesindex.htmIL Legislative Updates:Online mincode/ IL General Assembly:077/07700300sections. h resident requiring intermediate care shall beprovided at least 1.7 hours of nursing/personal careeach day, of which at least 20% must be licensenurse time.UCSF Survey of Nursing Home Staffing Standards, 200716
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateINMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: to maintain highestpracticable.well-being of each residentLICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time included in1 RN 8 consecutive hours/7days/wk and1 LPN Charge Nurse each shiftFor 1-60 resident: DON may be Charge Nurseincluded in: RN/LPN RATIO0.5 hprd LPN to resident ratio (averaged over 1week, excluding DON)STATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSAL: IN AdministrativeLN .56Code Title 410, Art.16.2, Sec. 3.1-17Filed 5-2-84 , mostrecent revision eff. 4-197. Readopted filed 711-2001. Readoptedfiled May 22, 2007.CommentsCurrent Regulation: SNF/NFs are called HealthFacility.OnLine Updates: See General Assembly andState agencies at IN tch/billinfoAlso IN Administrative in.gov/legislative/iac/iac title?iact 410DIRECT CARE STAFFNo minimum requirementKSSUFFICIENT STAFF: Sufficient staff.to attain ormaintain the highest practicable physical, mentaland psychosocial well-beingLICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time1 RN at least 8 consecutive hours/day 7d/wk (DONmay be included in this requirement) and1 RN/LPN per nursing unit on Day Shift included in1 RN/LPN 24 hours/7days/wkIf 1 LPN on duty Day shift, 1 RN must be on callDIRECT CARE STAFF2.0 hprd weekly average[with a 1.85 hprd minimum 24-hour average]For 60 beds: exclude DONMinimum ratio per unit nursing personnel toresidents of 1:30 and at least 2 nursing personnelon duty at all timesUCSF Survey of Nursing Home Staffing Standards, 2007LN .48DC2.0SAL: KS AdministrativeRegulations, NursingFacility Regulations28-39-154 NursingServices (7) (A). Eff.11-1-93. Am. 2-21-97.Total 2.48OnLine Updates: Pending legislation, billtracking, and legislative al/index.do.The Kansas Register and KS AdministrativeRegulations are available arch.doAvailable online ;jsessionid 5ED9B30DE17F68F1378912F440AD3FF417
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateKYMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: To provide nursing and relatedservices to attain or maintain the highest practicablephysical, mental & psychosocial well-being of eachresident. Shall have adequate personnel to meet theneeds of the patients on a 24 hour basis.LICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time Day; may serve as chargenurse with average daily occupancy 60 residents;If DON is facility administrator, add 1 Asst. DON RNFull Time Day)1 Supervising Nurse RN FT (DON or Asst. DONmay be Supervising Nurse)1 RN at least 8 hours/day, 7 days/wk1 RN/LPN Charge Nurse 24 hrs/7days/wk; if LPNCharge Nurse, RN must be on call.May submit licensed nurse &/or RN waiverLADIRECT CARE STAFFNo minimum requirementSUFFICIENT STAFF: Consisting of RNs, LPNs, andNAs to provide nursing care to allLICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time Day and (If DON has regularadministrative responsibility add 1 Asst. DON RNFull Time)For 1-60 average daily occupancy: DON may becharge nurse1 RN/LPN Charge Nurse 24hrs/7daysDIRECT CARE STAFF1.5 hprdSTATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSAL: KY RevisedLN .30Statutes 216B.042 and216B.105 authorizeregulation by Cabinetfor Health and FamilyServices. KY Cabinetfor Health and FamilyServices, Long-TermCare Regulations andStatutes:902.020.026 sec3(9)(d) 1-5. Eff. 7-2-96.CommentsCurrent Kentucky Administrative Regulations:Online: http://www.lrc.ky.gov/kar/titles.htmOnLine Updates: KY Law,http://www.lrc.ky.gov/Law.htmPending legislation, legislative search, etc., nline 00.htmhttp://www.lrc.ky.gov/kar/902/020/026.htmLN .30DC 1.5Total 1.8SDP: LA Department ofHealth and Hospitals,Bureau of HealthService Financing,Louisiana MinimumLicensure StandardsSecs. 9811 and 9813.Promulgated: ublications/pubs112/NH Minimum licensure 01201998.pdfCurrent Medicaid Regulation: ICF: 2.35hprd.[[[[[[NOTE: Cannot find anything on it]]]]]]]]]]OnLine Updates: State law portal, searchcodified laws by text or number:http://www.state.la.us/For the LA Administrative m andthe LA htmMEDICAID2.6 hprdUCSF Survey of Nursing Home Staffing Standards, 200718
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateMASTATE STANDARDEstimatedStaffing Standardvariance fromCitation and URLfederal standardfor facility with100 bedsSUFFICIENT STAFF: Appropriate, adequate andSAL: Code of MAsufficient nursing services and 24 hour nursing serviceLN .60Regulations Dept.Public Health 150.007LICENSED STAFF (RN, LPN/LVN)DC 2.6"Nursing Services"1 DON RN Full Time (40 hours) Day andEff. 4-1-1994.In multi unit facilities: 1 RN FT Day Supervisor for upTotal 3.20Licensing of Long-Termto two (2) units in the same facility. DON may beCare Facilities (Updatedsupervisory in single unit facilities,12/6/2005):1 RN/LPN Charge Nurse 24 hrs/7da/wk for 10Supervisory nurse and Charge nurse may be5cmr150.pdfcounted in calculation of licensed personnel.MINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESDIRECT CARE STAFF2.6 hprd with 0.6 licensed nursing personnel - Level12.0 hprd with 0.6 licensed nurses -- Level IICommentsCurrent Regulation: SNF and NF are equivalentto MA Levels I and II and ICF to Level III. ForLevel III, multi unit facilities must have 1 RN FTDay Supervisor and 1 RN/LPN Charge Nurse onDay & Eve 7d/wk and 1 Nurse's Aide on NightShift. For Level III, direct care of 1.4 hprd with 0.4licensed nurses.Current Proposed Legislation:Senate No. 398--Resolve--Creating a SpecialCommission on Institutional Long-Term CareServices: to recommend a plan for the provision ofa seamless transition to a continuum of long termcare services for elders and persons withdisabilities as part of a reduction of MassHealthlicensed nursing home beds using criteria ofquality measures such as staffing levels, turnoverrate and training options for direct care t00pdf/st00398.pdfOnLine Updates: MA General Court(Legislature):http://www.mass.gov/legis/MA Dept. of Public Health:http://www.mass.gov/dph/msearch.htmUCSF Survey of Nursing Home Staffing Standards, 200719
NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONSStateMDMINIMUM STAFFING STANDARD FOR SKILLEDNURSING OR NURSING FACILITIESSUFFICIENT STAFF: Supervisory personnel andsufficient number of supportive personnel to providea min 2 hrs per licensed bed per day, 7 days wk.LICENSED STAFF (RN, LPN/LVN)1 DON RN Full Time included in RNs to residents(only bedside care may be counted):2-99 residents: 1 RN Full Time100
IN STATE STATUTES AND REGULATIONS By Charlene Harrington. Ph.D. Department of Social and Behavioral Sciences University of California San Francisco 3333 California Street Suite 455 San Fran
