State

NURSING HOME STAFFING STANDARDS

IN STATE STATUTES AND REGULATIONS

Charlene Harrington. Ph.D.

Department of Social and Behavioral Sciences

University of California San Francisco

3333 California Street Suite 455

San Francisco, CA 94118

[email protected]

January 2008

We 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 REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

FEDERAL STAFFING: 1 RN 8 consecutive hrs/7days/wk & 1 RN/LVN for 2

remaining shifts. Must have 1 RN who is Full Time DON (5days/wk); if fewer than 60

residents, DON may also be Charge Nurse. (For 100 residents, LN .30 hours per

resident day (hprd) would be required.)

SC= State Code

SAL = State Administrative Law (Rules and Regulations)

SDP = State Departmental Written Policy

SUFFICIENT STAFF: No requirement

LICENSED STAFF (RN, LPN/LVN)

For 1-60 occupied beds:

1 RN Day 7days/wk and 1 RN Eve 5 d/wk and 1

LPN all shifts when RN not present

For 60+ occupied beds:

2 RNs Day 7d/wk and 1 RN Eve & Night 7

days/week

DIRECT CARE STAFF

No minimum requirement

LN .32

SAL: SAL: AK

Administrative Code

Title 7 Health and

Social Services, Pt. 1,

Ch. 12, Art. 5 Nursing

Facilities, Sec. 275, 7

AAC 12.275. Eff.

11/19/83. Am. 5/28/92.

http://www.legis.state.a

k.us/cgi-

bin/folioisa.dll/aac/query

=%5Bjump!3A!277+aac

+12!2E275!27%5D/doc/

%7B@31471%7D?

SUFFICIENT STAFF: Sufficient numbers of licensed

nurses and other nursing personnel on a 24-hour basis

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time included in

1 RN 8 consecutive hrs/7ds/wk

For 1-60 residents: DON may be charge nurse

DIRECT CARE STAFF

No minimum requirement

LN .08

SAL: SAL: AL

Administrative Code

420-5-10-.10 "Nursing

Services" Eff. 8-23-96

http://www.alabamaadm

inistrativecode.state.al.u

s/docs/hlth/index.html

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time normally work on day shift; if

DON has other institutional responsibilities in

addition to written job description, then add 1 more

RN as Assistant DON to equal one FTE of DON on

duty.

1 RN or LPN Charge Nurse for each shift.

1-70 residents DON may be Charge Nurse

In multi-story homes, each floor should be staffed as

a individual unit

DIRECT CARE STAFF

Effective 10/1/2003-- Day Shift: 1 licensed nurse

per 40 residents; 1 direct-care staff (licensed or

certified nursing staff) per 6 residents

Evening Shift: 1 licensed nurse per 40 residents; 1

direct-care staff (licensed or certified nursing staff)

per 9 residents

Night Shift: 1 licensed nurse per 80 residents; 1

direct care staff (licensed or certified nursing staff)

per 14 residents

LN .58

DC 2.8

Total 3.8

SDP: Rules and

Regulations for Nursing

Homes, Office of Long

Term Care, State of

Arkansas, Sect. 510-

511.2, 511.4, 512.1,

512.4, 513.2; Sect. 520

SDP: Rules and

Regulations for Nursing

Homes, Office of Long

Term Care, State of

Arkansas, Sect.

520.1.1, 520.3.1.1-

520.3.1.3

http://www.sos.arkansa

s.gov/elections/election

s_pdfs/register/nov_05/

016.06.05-095F-

8007.pdf

New Legislation: Act 192 (HB 1363) requires the

Office of Long-Term Care to create staffing

standards for nursing facilities designated or

certified as Eden Alternative nursing facilities or

Green House Project nursing facilities. The act

permits the Department of Health and Human

Services to development a reimbursement

methodology for payments for staff services and

care.

(http://www.arkleg.state.ar.us/data/summary/2007/2007

%20FinalSummary_for%20print.pdf )

Legislative Updates: http://www.arkleg.state.ar.us/

SUFFICIENT STAFF: Nursing services to meet the

needs of a resident

LICENSED STAFF (RN, LPN/LVN)

1 DoN RN full time;

For 1-59 average daily occupancy: DON may

provide direct care on regular basis

DIRECT CARE STAFF

1 nurse must be present and responsible for

providing direct care to not more than 64 residents

LN .185

SAL: AZ Administrative

Code Title 9, Ch. 10,

Sec. 901-905. Eff. 2-

17-95. (Supp. 95-1).

section repealed; new

Section made by final

rulemaking at 9 A.A.R.

338, eff.3-16-2003

(Supp.03-1).

http://www.azsos.gov/P

UBLIC_SERVICES/Title

_09/9-10.htm

AZ Administrative Code, Chapter 28 is known as

AHCCCS, the Arizona Health Care Cost

Containment System--Ariz. Long Term Care

System. Expressly incorporates Medicaid by

reference in 42 CFR 442 and 42 CFR 483.

OnLine Updates:

http://www.azsos.gov/aar/contents.htm

Arizona Administrative Register.

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Each facility [SNF] shall employ

sufficient nursing staff to provide a minimum daily

average of 3.2 nursing hours per patient day.

LICENSED STAFF (RN, LPN/LVN)

For 1-59 licensed beds:

1 RN/LVN 24 hours/day

For 60-99 licensed beds:

1 DON RN Day Full Time (may not be charge nurse)

and 1 RN/LVN 24 hours/day

For 100+ beds:

1 DON RN (may not be charge nurse) and

1 RN 24 hours/day

DIRECT CARE STAFF

3.2 hprd Do not double hours of RNs/LPNs and

exclude hours of DON

Regulations in process:

Day: 1LN:20 patients 1 CNA:9 patients

Evening: 1 LN:25 1 CNA:10

Night: 1 LN:30 1 CNA:15

RN .30

DC 3.20

Total 3.5

OnLine Updates:

Legislation/Bills:

http://www.leginfo.ca.go

v/bilinfo.html

Health & Safety Code:

http://www.leginfo.ca.go

v/calaw.html

Access this website for

California Code of

Regulations and insert

sections of interest

(e.g., 73319; 77329)

http://ccr.oal.ca.gov/link

edslice/default.asp?SP

=CCR-

1000&Action=Welcome

SC: CA Health and Safety Code, Sec. 1276.5 (as

amended by AB 1107, 1999) Eff. 7-22-99.

SC: CA Welfare and Institutions Code Sec.

14110.7. Am. 1999.

http://www.leginfo.ca.gov/cgi-

bin/waisgate?WAISdocID=13257014885+0+0+0&

WAISaction=retrieve

SAL: CA Code of Regulations Title 22 Ch. 4 Sec.

73319 and Sec. 72329.

http://weblinks.westlaw.com/toc/default.aspx?Abbr

=ca%2Dadc&Action=ExpandTree&AP=CAT22D2&

ItemKey=CAT22D2&RP=%2Ftoc%2Fdefault%2Ew

l&Service=TOC&RS=WEBL7.09&VR=2.0&SPa=C

CR-1000&fragment#CAT22D2

10-16-07 Title 22, Sections 72077 and 72329

DHP-03-010E Emergency Regulations are under

consideration to establish minimum ratios of

staffing per shift to implement AB 1075 Chapter

684, 2001). The following ratios would be

established.

Day: 1LN:20 patients 1 CNA:9 patients

Evening: 1 LN:25 1 CNA:10

Night: 1 LN:30 1 CNA:15

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient staff to provide prompt

assistance

LICENSED STAFF (RN, LPN/LVN)

1 DoN RN Full Time 40 hrs/wk included in

1 RN 24 hours/7days/week and

1 LN each care unit at all times

DIRECT CARE STAFF

For 1-60 residents: 2.0 hprd

For 60+ residents: 2.0 excluding the DON, staff

development coordinator, and other supervisory

personnel.

LN .48

DC 2.0

Total 2.48

SAL: Code of CO

Regulations,

Department of Public

Health and Environment

Regulations, Health

Facilities Division –

1011, Ch. V, Long Term

Care Facilities, Pt. 7,

Nursing Services, Sec.

7.2 & 7.3. Eff. 7-1-

1988.

http://www.cdphe.state.co.

us/regulations/healthfacilit

ies/10110105longtermfaci

lities.pdf

Also in Dept. of Health

care Financing Staff

Manual:

http://www.chcpf.state.co.

us/HCPF/Pdf_Bin/402-

416ltc.pdf

Current Regulations: Intermediate Care

Facilities

require 1 RN/LPN Day Shift 7days/week. If DoN

is LPN, then 1 RN consultant 4 hrs/wk.

Current Medicaid Regulations: CO Department

of Health Care Policy and Financing, Staff Manual,

Vol. 8 - Medical Assistance, Secs. 8.408(3) and

8.409.24. SNF requires 2.0 hppd; ICF 1 RN or

LPN DoN full time 7days/wk. If LPN as DoN, 4 hrs

weekly consulting by 1 RN.

http://www.cdphe.state.co.us/regulations/healthfaci

lities/10110105longtermfacilities.pdf

OnLine Updates: Dept. of Health Care Policy and

Financing homepage: http://www.chcpf.state.co.us/

and Dept. of Public Health and Environment

homepage: http://www.cdphe.state.co.us/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient nurses and nurse's

aides to provide appropriate care 24 hours 7 days/week.

LICENSED STAFF (RN, LPN/LVN)

1 DoN RN full-time; if more than 120 beds, 1 Asst.

DoN

1 RN 24 hours/7 days/week and

1 RN/LPN (each floor) 24 hrs/7days included in

Day [7 am - 9 pm] .47 hprd

Night [9 pm - 7 am] .17 hprd.

For 61-120 beds: exclude DON; for 121+ beds,

exclude Asst. DON

NURSE ASSISTANT STAFF (NA/CNA)

Total nursing & NA: 7am-9pm: 1.40 hprd; 9pm-7am

.50 hprd

LN .70

NA 1.90

Total 2.60

SAL: CT Public Health

Code 2000 Sec. 19-13-

D8t (m)(1)-(8). Eff.

05/2001

http://www.dph.state.ct.

us/php/docs/39_Long-

term_Hospitals.doc

Enabled by CT General

Statutes Code of Public

Health Sec, 19a-36

(1997).

http://www.cga.ct.gov/2

007/pub/Title19a.htm

Current Regulations: SNF/NF called chronic

care & and convalescent home. Rest Home with

Nursing Supervision (ICF): 1 NA 24 hours/7

days/week included in Licensed Staff: Day [7 am

to 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 floor

24 hours/7 days and Day -- .70 hprd; Night -- .17

hprd. For 61-120 beds, exclude DON; for 121+

beds, exclude Asst. DON.

OnLine Updates:

Public Health Code

http://www.dph.state.ct.us/phc/phc.asp

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: 24-hour licensed nursing

services 7days a week sufficient to meet the nursing

needs of all patients

LICENSED STAFF (RN, LPN/LVN)

1DON RN Fulltime and

1 Nursing Supervisor (RN) at the facility 24hrs/7d/wk

DON may serve as supervisor while on regular duty

if less that 30 beds

1 RN/LPN Charge Nurse on each unit 24hrs/d

If charge nurse is LPN, then must have access to an

RN for consultation

RN/LPN (planning, coordination, supervision at unit level)

Day 1:35 (0.23 hprd)

Evening 1:45 (0.18 hprd)

Night 1:50 (0.16)

DIRECT CARE STAFF

Minimum of 2 nursing employees per nursing unit

per shift

30+ licensed beds: exclude DON RN or other

nursing supervisory employee not providing direct

care

Beginning no later than Jan 1, 2005, each facility shall

employ sufficient nursing staff to provide a minimum

daily average of 3.5 hprd. Hours shall be adjusted

upward for higher nursing care needs/more acute

conditions.

Direct care (RN, LPN, or CNA)

Day 1:5 (1.6hprd)

Evening 1:10 (0.8hprd)

Night 1:15 (0.53hprd)

LN .80

DC: 2.93

Total 3.50

SAL: DC Municipal

Regulations Title 22

Public Health and

Medicine Ch. 32 Skilled

Care Facilities, Sec.

3208 (Nursing

Services), 3209

(Nursing Services

Supervision), 3210

(Licensed Nursing

Coverage), 3211

(Nursing Personnel),

(10/12/01)

http://www.hpm.umn.ed

u/NHRegsPlus/state_re

gulation_attachments/D

C_regulation_attachme

nts/DISTRICT%20OF%

20COLUMBIA-

nursing%20facilities.pdf

OnLine Updates: DC Register:

http://www.abfa.com/dcdocs/dccontents.htm

To view DC Municipal Regulations directly from

DC website (for a fee):

http://os.dc.gov/os/cwp/view.asp?a=1206&q=5223

contact Office of Documents & Administrative

Issuances for titles not available online (e.g., Title

22)

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient number of nursing

service personnel to provide care.

LICENSED STAFF (RN, LPN/LVN) *

1 Supervisory Nurse (DoN) RN Full Time 8hrs/7d/wk

1 RN on duty each shift, 7 days a week

Designate adequate relief personnel, including a RN

in charge of each shift, when she is not in the facility

so that a responsible person is available at all times

in the event of an emergency.

Each institution shall have at least 2 or more nursing

service personnel monitoring the patients 24 hours a

day.

DIRECT CARE STAFF

Must provide 3.67 hours of direct nursing care per 24-

hour period. By May 2003:

RN/LPN

Day 1:15

Evening 1:20

Night 1:30

CNA

Day 1:7

Evening 1:10

Night 1:15

LN 1.2

CNA 2.47

Total 3.67

Title 16 Health & Safety

Regulatory Provisions

Concerning Public

Health, Ch. 11 Nursing

Facilities & Similar

Facilities, Subchapter

VII. Minimum Staffing

Levels for Residential

Health Facilities (note

this is the “16 Del C

Sect. 1162” from the

National Health Law &

Policy Resource Center

table). Eff. 8/28/07

http://delcode.delaware.

gov/title16/c011/sc07/in

dex.shtml

OnLine Updates:

http://www.legis.delawa

re.gov/LIS/LIS144.nsf/v

wLegislation/SB+175?O

pendocument

New Legislation: General Assembly 144, SB 175-

-An Act to amend Title 16 of the Delaware Code

relating to nursing facilities and other facilities. This

proposed legislation, most recently under

consideration in the Senate Finance Committee

(7/11/2007) would require the following minimum

staffing levels:

RN LPN AIDE Total

Level

I .29 .84 2.15 3.28

II .29 .84 2.25 3.38

III .39 .84 2.31 3.54

IV .72 .84 2.56 4.12

V .89 .84 2.56 4.29

VI .56 .09 1.82 3.28

VII .89 1.04 2.72 4.65

VIII 1.22 1.04 3.21 5.47

BY APRIL 1, 2008 the facility must also

meet the following minimum shift ratios:

RN/LPN CNA and all other

direct caregivers

Day 1:15 1:7

Evening 1:23 1:9

Night 1:40 1:15

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: sufficient staff to maintain the

highest practicable physical, mental, and

psychological well-being of each resident

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time. If DON is delegated

institutional responsibilities, a full time qualified RN

shall be designated as ADON.

For 121+ residents, add 1 ADON RN

1 RN/LPN each shift included in:

RN/LPN : 1.0 hprd (24 hour average)(Jan 2002)

Never below 1 licensed nurse for 40 residents

DIRECT CARE/NURSE ASSISTANT STAFF

CNA: 2.7 hprd (24 hour average) starting

01/01/2007 OR 1 CNA/ 20 residents AND 1

LPN/LVN per 40 residents. Beginning 01/01/2007,

min. weekly ave 2.9 hprd per day CNA direct care

LN 1.0

DC 2.9

Total 3.9

SAL: FL Administrative

Code Ch. 59A-4

"Minimum Standards for

Nursing Homes" Sec.

59A-4.108(4). Eff. 4-1-

82. Am. 4-18-94.

https://www.flrules.org/g

ateway/ruleNo.asp?id=

59A-4.108

**Also see 2007 Florida

Statutes Chapter 400

Nursing Homes &

Related Health Care

Facilities 400.23 (3)(a)1

http://www.flsenate.gov/st

atutes/index.cfm?App_mo

de=Display_Statute&URL

=Ch0400/ch0400.htm

Current Statute on Direct Care Minimum

Staffing Standards: starting Jan. 1, 2007 2.7 hprd

or 1 CNA per 20 residents and no less than 1

CNA per 40 residents

http://www.flsenate.gov/statutes/index.cfm?App_mode

=Display_Statute&URL=Ch0400/ch0400.htm

OnLine Updates:

Http://www.leg.state.fl.us/session/index.cfm?/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient nursing staff on duty at

all times

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time Day; DON may be director of

nursing services in other nearby nursing homes if

those nursing homes have 1 RN as full time Asst.

DON

1 RN/LPN in each 8-hr shift 24h/7d included in:

RN/LPN to total nursing personnel ratio: 1:7

DIRECT CARE STAFF

2.0 hprd

MEDICAID LEVEL I AND LEVEL II

2.5 hprd

LN .30

DC 2.0

Total 2.3

SAL: GA Rules &

Regulations, Rules of

the Dept. of Human

Resources, Ch. 290

(Public Health), Ch.

290-5-8-.04 Nursing

Service

http://rules.sos.state.ga.

us/docs/290/5/8/04.pdf

and Ch. 290-5-9

Intermediate Care

Homes (ICF).

http://rules.sos.state.ga.

us/docs/290/5/9/04.pdf

Note: A Level I nursing facility is an Intermediate

Care Facility. A Level II nursing facility is a Skilled

Nursing Facility.

OnLine Updates:

http://www.legis.ga.gov/cgi-bin/htsearch

SUFFICIENT STAFF: Sufficient in number and

qualifications to meet the needs of the patients

LICENSED STAFF (RN, LPN/ LVN)

1 RN Full Time 24 hours/7 days/week

DIRECT CARE STAFF

No minimum requirement

RN. 24

SAL: HI Administrative

Rules Title II,

Department of Health,

Ch. 94, Skilled Nursing,

Int. Care Facilities, Sec.

23 Eff. 5-3-85.

http://www.hawaii.gov/h

ealth/about/rules/admrul

es.html

HI regulations currently

being updated.

http://www.hawaii.gov

Current Regulation: Intermediate Care Facility:

1 RN Full Time Day and 1 RN/LPN whenever

medications are administered.

OnLine Updates: http://www.hawaii.gov.

Administrative Rules:

http://www.hawaii.gov/health/about/rules/admrules.

html

For pending bills:

http://www.capitol.hawaii.gov/site1/docs/docs.asp#

hrs.

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/LVN)

1 RN/LPN Health Service Supervisor and

For 1-74 beds: if supervisor is LPN, RN must be

hired For 4 hrs/wk when LPN is on duty.

For 75+ beds: supervisor must be RN and add 1

RN/LPN 24 hrs/7 days/week

DIRECT CARE STAFF

2.0 hprd (computed on 7-day week)

20% must be from "qualified nurses" RN/LPNs

including time of Health Service Supervisor

At least 2 people "capable of rendering nursing

service" on duty at all times.

LN .30

DC 2.0

Total 2.30

SAL: IA Administrative

Code, Inspections and

Appeals [481], Chapter

58 Nursing Facilities

Sec. 58.11(2) Nursing

Supervision and

Staffing. Eff. 9-27-

1976.

https://dia-

hfd.iowa.gov/DIA_HFD_

WEB/cmsDocDir/481%

20IAC%2058.pdf

OnLine Updates: For pending rules and regs

changes, see IA Administrative

Code:http://www.legis.state.ia.us/IAC.html

To track legislation, see the Track Legislation

page of the Iowa Legislature, General Assembly

at: http://www.legis.state.ia.us/Legislation.html.

Daily updates.

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/LVN)

1 DON RN FT (5d/wk) Day

If DON occupied with Administration, then 1 RN

Assist. DON

For 60+ residents: DON only for nursing admin

duties

1 Supervising Nurse, RN/LPN and

For 1-59 residents: DON may be Supervisory Nurse

1 Charge Nurse, RN/LPN as follows:

For 1-59 residents:

1 RN one shift (8 hrs each day shift) & 1 LPN other

2 shifts 7days/wk

For 60-89 residents:

1 RN two shifts (Day & Eve) &1 LPN Nights 7

days/wk

For 90+ residents:

1 RN 24hrs/7d/wk

DIRECT CARE STAFF

2.4 hprd. For 1-59 residents: exclude DON but

include supervisory nurse on each shift. For 60+

residents: exclude DON and supervisory nurse.

RN .36

DC 2.4

Total 2.76

SAL: ID Administrative

Code, 16.03.02.200.02

Eff. 1-1-88; 11-20-89,

12-31-91, and 7-1-93.

http://adm.idaho.gov/ad

minrules/rules/idapa16/

0302.pdf

Current Regulation: Intermediate Care Facility

(licensed exclusively as ICF) : 1 DON RN Full

Time (5d/wk) Day And 1 RN/LPN on duty as

Charge Nurse 24hrs /7d/wk. If DON is LPN, RN

must be on call. Direct care 1.8 hprd including the

DON, supervisory nurse and charge nurse.

Nursing hours per resident per day may be

averaged over the week if the facility has received

prior approval from the Licensing Agency to

calculate nursing hours in this manner.

OnLine Updates: For notices of pending rules

and regs, and for proposed reg. tracking, see ID

Administrative Bulletin and Master Cumulative

Index of All Rule Making:

http://adm.idaho.gov/adminrules/bulletin/mstrtoc.ht

For Idaho State Statutes, search statutes:

http://www3.state.id.us/legislat/legtrack.html

and for current legislation and bill tracking:

http://www3.state.id.us/legislat/legtrack.html.

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Staffing shall be based on the

needs 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; at

least 16 hrs on duty between 7am and 7pm

For 1-49 beds, DON may provide direct care and

included in staff-to-resident ratio calculations

For 100+ 1 Asst. DON RN full-time.

1 licensed nurse (RN/LPN) charge nurse on

remaining non-DON or Asst DON shifts. If RN and

LPN present on same shift, RN is charge nurse

1 RN on shift (8 consec. hrs) 7days/wk included in

1 RN/LPN 24 hrs/7d/wk on each floor

DIRECT CARE STAFF

2.5 hprd with Day-40%, Eve-25%, and Night-15%.

Including 20% LPN time; exclude DON

and 1 person on duty 24h/7d in each unit

Each resident requiring intermediate care shall be

provided at least 1.7 hours of nursing/personal care

each day, of which at least 20% must be license

nurse time.

LN .35

DC 2.5

Total 2.85

SAL: IL Administrative

Code Title 77 Public

Health, Ch. 1, Dept. of

Public Health, Subch.

C, Long-Term Care

Facilities, Sec. 300-

1230, Pt. 300, and 1240

Skilled Nursing and

Intermediate Care

Facilities Code

Eff. 3-24-89; Am at 16

III. Reg. 17089,

Eff. 11-3-92.

Online information:

http://www.ilga.gov/com

mission/jcar/admincode/

077/07700300sections.

html

Current Regulation: Intermediate Care Facility:

1 licensed nurse (RN/LPN) 24 hours/7days/week

and direct care 1.7 hprd* 20% LPN time. If 150+

occupied beds, 1 licensed nurse (RN/LPN) as

Asst. DON. If DON or Assist. DON absent, 1

licensed nurse (RN/LPN) as charge nurse.

Online Updates:

IL Dept. Public Health Administrative Rules

Updates:

http://www.idph.state.il.us/rulesregs/rules-

index.htm

IL Legislative Updates:

IL General Assembly:

http://www.ilga.gov/legislation/default.asp

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: to maintain highest

practicable...well-being of each resident

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time included in

1 RN 8 consecutive hours/7days/wk and

1 LPN Charge Nurse each shift

For 1-60 resident: DON may be Charge Nurse

included in: RN/LPN RATIO

0.5 hprd LPN to resident ratio (averaged over 1

week, excluding DON)

DIRECT CARE STAFF

No minimum requirement

LN .56

SAL: IN Administrative

Code Title 410, Art.

16.2, Sec. 3.1-17

Filed 5-2-84 , most

recent revision eff. 4-1-

97. Readopted filed 7-

11-2001. Readopted

filed May 22, 2007.

http://www.in.gov/legisla

tive/iac/iac_title?iact=41

Current Regulation: SNF/NFs are called Health

Facility.

OnLine Updates: See General Assembly and

State agencies at IN Homepage:

http://www.in.gov/apps/lsa/session/billwatch/billinfo

Also IN Administrative Code:

http://www.in.gov/legislative/iac/

SUFFICIENT STAFF: Sufficient staff...to attain or

maintain the highest practicable physical, mental

and psychosocial well-being

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time

1 RN at least 8 consecutive hours/day 7d/wk (DON

may be included in this requirement) and

1 RN/LPN per nursing unit on Day Shift included in

1 RN/LPN 24 hours/7days/wk

If 1 LPN on duty Day shift, 1 RN must be on call

DIRECT CARE STAFF

2.0 hprd weekly average

[with a 1.85 hprd minimum 24-hour average]

For 60+ beds: exclude DON

Minimum ratio per unit nursing personnel to

residents of 1:30 and at least 2 nursing personnel

on duty at all times

LN .48

2.0

Total 2.48

SAL: KS Administrative

Regulations, Nursing

Facility Regulations

28-39-154 Nursing

Services (7) (A). Eff.

11-1-93. Am. 2-21-97.

Available online :

http://www.kslegislature

.org/legsrv-

kars/search.do;jsessioni

d=5ED9B30DE17F68F

1378912F440AD3FF4

OnLine Updates: Pending legislation, bill

tracking, and legislative texts:

http://www.kslegislature.org/legsrv-

legisportal/index.do.

The Kansas Register and KS Administrative

Regulations are available online:

http://www.kslegislature.org/legsrv-kars/search.do

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: To provide nursing and related

services to attain or maintain the highest practicable

physical, mental & psychosocial well-being of each

resident. Shall have adequate personnel to meet the

needs of the patients on a 24 hour basis.

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time Day; may serve as charge

nurse with average daily occupancy <60 residents;

If DON is facility administrator, add 1 Asst. DON RN

Full Time Day)

1 Supervising Nurse RN FT (DON or Asst. DON

may be Supervising Nurse)

1 RN at least 8 hours/day, 7 days/wk

1 RN/LPN Charge Nurse 24 hrs/7days/wk; if LPN

Charge Nurse, RN must be on call.

May submit licensed nurse &/or RN waiver

DIRECT CARE STAFF

No minimum requirement

LN .30

SAL: KY Revised

Statutes 216B.042 and

216B.105 authorize

regulation by Cabinet

for Health and Family

Services. KY Cabinet

for Health and Family

Services, Long-Term

Care Regulations and

Statutes:

902.020.026 sec

3(9)(d) 1-5. Eff. 7-2-96.

Online resources:

http://www.lrc.state.ky.u

s/kar/902/020/300.htm

http://www.lrc.ky.gov/ka

r/902/020/026.htm

Current Kentucky Administrative Regulations:

Online: http://www.lrc.ky.gov/kar/titles.htm

OnLine Updates: KY Law,

http://www.lrc.ky.gov/Law.htm

Pending legislation, legislative search, etc., at

http://www.lrc.ky.gov/record/08RS/prefiled.htm.

SUFFICIENT STAFF: Consisting of RNs, LPNs, and

NAs to provide nursing care to all

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time Day and (If DON has regular

administrative responsibility add 1 Asst. DON RN

Full Time)

For 1-60 average daily occupancy: DON may be

charge nurse

1 RN/LPN Charge Nurse 24hrs/7days

DIRECT CARE STAFF

1.5 hprd

MEDICAID

2.6 hprd

LN .30

DC 1.5

Total 1.8

SDP: LA Department of

Health and Hospitals,

Bureau of Health

Service Financing,

Louisiana Minimum

Licensure Standards

Secs. 9811 and 9813.

Promulgated: January

1998.

http://www.dhh.louisian

a.gov/offices/publication

s/pubs-

112/NH_Minimum_licen

sure_01201998.pdf

Current Medicaid Regulation: ICF: 2.35

hprd.[[[[[[NOTE: Cannot find anything on it]]]]]]]]]]

OnLine Updates: State law portal, search

codified laws by text or number:

http://www.state.la.us/

For the LA Administrative Code

http://doa.louisiana.gov/osr/lac/lacsublist.htm and

the LA Register

http://doa.louisiana.gov/osr/reg/register.htm

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Appropriate, adequate and

sufficient nursing services and 24 hour nursing service

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time (40 hours) Day and

In multi unit facilities: 1 RN FT Day Supervisor for up

to two (2) units in the same facility. DON may be

supervisory in single unit facilities,

1 RN/LPN Charge Nurse 24 hrs/7da/wk for each

unit

Supervisory nurse and Charge nurse may be

counted in calculation of licensed personnel.

DIRECT CARE STAFF

2.6 hprd with 0.6 licensed nursing personnel - Level

2.0 hprd with 0.6 licensed nurses -- Level II

LN .60

DC 2.6

Total 3.20

SAL: Code of MA

Regulations Dept.

Public Health 150.007

"Nursing Services"

Eff. 4-1-1994.

Licensing of Long-Term

Care Facilities (Updated

12/6/2005):

http://www.mass.gov/Ee

ohhs2/docs/dph/regs/10

5cmr150.pdf

Current Regulation: SNF and NF are equivalent

to MA Levels I and II and ICF to Level III. For

Level III, multi unit facilities must have 1 RN FT

Day Supervisor and 1 RN/LPN Charge Nurse on

Day & Eve 7d/wk and 1 Nurse's Aide on Night

Shift. For Level III, direct care of 1.4 hprd with 0.4

licensed nurses.

Current Proposed Legislation:

Senate No. 398--Resolve--Creating a Special

Commission on Institutional Long-Term Care

Services: to recommend a plan for the provision of

a seamless transition to a continuum of long term

care services for elders and persons with

disabilities as part of a reduction of MassHealth

licensed nursing home beds using criteria of

quality measures such as staffing levels, turnover

rate and training options for direct care staff.

http://www.mass.gov/legis/bills/senate/185/st00pdf/

st00398.pdf

OnLine Updates: MA General Court

(Legislature):

http://www.mass.gov/legis/

MA Dept. of Public Health:

http://www.mass.gov/dph/msearch.htm

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Supervisory personnel and

sufficient number of supportive personnel to provide

a 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 Time

100-199: 2 RNs Full Time

200-299: 3 RNs Full Time

300-399: 4 RNs Full Time

DIRECT CARE STAFF

2.0 hprd 7 days/week (including RN, LPN and

supportive personnel and ward clerk's time at 50%

and only the documented bedside hours of DON)

Minimum 1 nursing service personnel per 25

patients at all times

LN .18

DC 2.0

Total 2.18

SAL: Code of MD

Regulations

10.07.02.12

Eff. 9-97.

http://www.dsd.state.md

.us/comar/10/10.07.02.

12.htm

Current Regulations: NFs are called

comprehensive care facilities. Extended care

facilities require 1 RN 24hrs/7d/wk & additional

LNs & supportive staff" to meet the needs. Distinct

Part extended care facilities: in multi-level facilities,

requires 1 DON RN and 1 RN in charge at all times

& additional LNs & supportive staff to meet the

needs of residents.

Proposed Statutes – Not Passed: HJ 8 calling

for "a staffing goal of one nurse for every eight

nursing home residents," (Died in Committee Feb

18, 2004)

http://mlis.md.us/2004rs/billfile/hj0008.htm

OnLine Updates: For pending regulatory

changes, the bi-weekly MD Register

http://www.dsd.state.md.us/MDRegister/

Also Code of Maryland regulations:

http://www.dsd.state.md.us/comar/subtitle_chapter

s/10_Chapters.htm

For pending and recently considered legislation, by

bill http://mlis.state.md.us/#bill AND by subject:

http://mlis.state.md.us/#indx

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/LVN)

1 RN on duty or on call at all times

Day:

1 DON RN Full Time included in

1 RN 8 consecutive hrs, 7 d/wk and

1 RN/LPN Charge Nurse Day 7 d/wk

For 20+ beds: DON may not be Charge Nurse

For 100, 150, 200 etc. beds: add 1 LN for each

increment of 50

For 100+: for each multiple of 100, the additional LN

shall be an RN and

1 RN/LPN Eve, on duty 8 hrs every eve. and

1 RN/LPN for multiples of 70 beds

For 100+: one of additional LNs shall be an RN and

1 RN/LPN Night & 1 RN/LPN for multiples of 100

For 100+: an RN shall be on duty at night

DIRECT CARE STAFF

Day 1:5 direct care provider to resident

Evening 1:10

Night 1:15

Includes RNs, LPNs, CNAs who provide direct care.

LN .56

DC 2.93

Total 3.49

SAL: Code of ME

Rules

10-144 CMR 110 Ch. 9

Sec. 9.A.3 and 9.A.4.

ME Sec of State, Rules

By Department:

http://www.maine.gov/s

os/cec/rules/10/ch110.h

SC: Public Law 1999

Ch. 731 Sec. BBBB -11

Passed & Signed 4-25-

00. Eff. 10-1-00.

http://janus.state.me.u

s/legis/ros/lom/lom119

th/5pub701-

750/5Pub701-750-

110.htm

Previous Regulation: Direct care ratios were: Day

1:5 Eve 1:10 and Night 1:18.

New Statute: LD 981--Supervision of Nursing

Support Staff-A Certified Nurse Practitioner

delegating certain activities pertaining to advance

practice registered nursing to employees or

support staff is liable for the activities of those

persons.

(http://www.mainelegislature.org/legis/bills/billtexts/

ld098101.asp)

OnLine Updates: Dept. of Health & Human

Services (DHHS) Homepage:

http://www.maine.gov/dhhs/

And DHHS Rule Updates:

http://www.maine.gov/dhhs/dlrs/rulemaking/index.s

html

ME legislative updates & search:

http://www.mainelegislature.org/legis/bills/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: 24 hour nursing care and

services sufficient to meet the needs

LICENSED STAFF (RN, LPN/LVN)

1 DON RN (with training in gerontology) included in

1 RN/LPN 24 hrs/7d/wk

DIRECT CARE STAFF

2.25 hprd or ratio of

Day: 1:8

Eve 1:12

Night 1:15 For 30+ beds, exclude time of DON.

LN .24

DC 2.25

Total 2.31

SC: MI Compiled Laws,

Public Health Code

"Act 368 of 1978"

Sec. 333.21720a(2)

Eff. 3-30-79, 1-1-80.

http://www.legislature.m

i.gov/(S(r30sqz452jdpb

gzpy3yk0x45))/mileg.as

px?page=getObject&obj

ectName=mcl-333-

21720a

OnLine Updates: For pending legislation, text

and status, see MI Legislature homepage:

http://www.legislature.mi.gov/(S(zhnvpk55hzqitk45

54icfiaz))/mileg.aspx?page=home

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient numbers & adequate

to meet the needs

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time (at least 35 hrs) included in

1 RN/LPN 8 hrs/7 days/week

Must designate a nurse to be responsible for the

duties of the DON services related to the provision

of resident services in the director’s absence.

RN on call during all hours when an RN is not on

duty.

DIRECT CARE STAFF

1 "responsible person" on duty at all times

2.0 hprd. For 60+ licensed beds: exclude DON

hours. Includes all nurses and NAs for any 24 hour

period

For nursing homes not certified to participate in the

medical assistance program, a minimum of two hours of

nursing personnel per resident per 24 hours.

LN .08

DC 2.0

Total 2.06

SC & SAL: MN

Statutes Sec. 144A.04

Subdiv. 7(a). Eff. 1988,

1996, 2000.

http://www.revisor.leg.st

ate.mn.us/stats/144A/0

4.html

MN Rules

Pt. 4655.5100 et seq.

http://www.revisor.leg.st

ate.mn.us/arule/4655/5

100.html

MN Rules Pt.

4658.0510 Nursing

Personnel

http://www.revisor.leg.st

ate.mn.us/arule/4658/0

510.html

MN Rules Pt.

4658.0500 Director of

Nursing Services

http://www.revisor.leg.st

ate.mn.us/arule/4658/0

500.html

Online Updates: MN Legislature:

http://www.leg.state.mn.us/leg/legis.asp

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient numbers to enable

each resident to attain or maintain the highest

practicable level of physical, mental and psychosocial

well-being

LICENSED STAFF (RN, LPN/LVN)

1 DON RN included in

1 RN Day and 1 RN/LPN Eve & Night and

1 RN on call if only LPN on duty

DIRECT CARE STAFF

No minimum requirement

LN .24

SAL: MO Code of

State Regulation 19

CSR 30-85 (34)-(38)

Eff. 1-30-04.

http://www.sos.mo.gov/

adrules/csr/current/19cs

r/19c30-85.pdf

Current Regulation: Intermediate Care Facility:

1 DON RN/LPN. If LPN is DON, RN must be a

consultant 4 hrs/wk included in 1 RN/LPN Day on

duty and 1 RN/LPN on call 24hrs/7days.

Online Updates:

Missouri Code of State Regulations:

http://www.sos.mo.gov/adrules/csr/csr.asp

Legislative Updates:

Missouri General Assembly:

http://www.moga.mo.gov/statutesearch/

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/ LVN)

1 DON RN Full Time Day (40hrs/wk)

For 1-60 beds: DON may be Charge Nurse

For 180+ beds: add 1 Asst DON RN included in

1 RN Day 7 days/week on day shift and

1 RN/LPN Charge Nurse Day & Eve and

1 RN/LPN Medication Nurse Day & Eve on each

station and

1 RN/LPN Charge Nurse & medication/treatment

nurse Night on each station

For 60+ beds: Charge Nurse may not be DON or

Medication/Treatment Nurse

DIRECT CARE STAFF

2.8 hprd for licensed and unlicensed staff

LN .54

DC 2.8

Total 2.8

SAL: MS

Administrative Code,

Title 15, Part 3, Subpart

01, Ch. 45, Part 2, Sect.

103 Nursing Facility,

Subsct. 103.01

http://www.msdh.state.

ms.us/msdhsite/_static/r

esources/119.pdf

(Adopted Aug 8, 2007 &

became effective

September 7, 2007)

OnLine Updates:

http://www.mississippi.gov/frameset.jsp?URL=http:

//www.ls.state.ms.us/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/LVN)

1 RN 8 hours 7days/wk

For 41+ beds: 1 RN Full Time DoN included in

For 41-70 beds: Add 1 LPN day

For 51-75 beds: 1 RN eve

For 76-80 beds : 1 RN and 2 LPNs day, 1 RN and

1LPN eve,

For 81-90 beds: 1 RN and 2 LPNs day, 1 RN and 1

LPN eve and night

For 91-100 beds: 2 RNs and 2 LPNs day, 1 RN and

1 LPN eve and 1 RN and 1 LPN night

For 101+ beds: staffing is negotiable

NURSE ASSISTANT STAFF (NA/CNA)

4 NA hours for every 5 residents per day on Days

for 9+ beds up to 90 beds (for up to 56 NA hours).

52 NA hours for 91-95 beds

56 NA hours for 96-100 beds

4 NA hours for 16+ beds on Eve increasing in

increments of 4 NA hours for each additional 5

beds up to 40 NA hours for 100 beds

4 NA hours for 21+ beds on Night increasing in

increments of 4 NA hours for every additional

5 beds up to 24 NA hours for 100 beds

LN .64

NA 1.2

Total 1.84

SAL: Administrative

Rules of MT Title 37,

Sec. 106.605 et seq.

Eff. 3-31-02. Minimum

Standards for a Skilled

Nursing Care Facility for

each 24 Hour Period--

Staffing

http://arm.sos.mt.gov/37

/37-26085.htm

Current Regulation: Licensed requirements:

For 41+ beds: add 1 LN on days

For 4-50 beds: add 1 LPN on eve.

For 51-100 beds: add-1 RN on eve.

For 4-70 beds: add 1 LPN on nights

For 71-100 beds: add 1 RN on nights

OnLine Updates: ARM (Admin Rules of

Montana)

http://arm.sos.mt.gov

Legislative Updates:

http://laws.leg.mt.gov/pls/laws07/law0203w$.startu

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: To accomplish the purposes of

needs assessment, care planning and supervision

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time included in

For 1-59 occupancy: DON may be charge nurse

1 RN 8 consecutive hrs 7d/wk included in

1 RN/LPN 24 hours/7d/wk

DIRECT CARE STAFF

2.1 hprd including licensed staff but exclude DON if

over 60 beds and exclude administrators, clerks,

and nurse educators. For multi-storied facilities, 1

direct care staff on duty every floor 24 hrs/7days/wk.

LN .24

SAL: NC

Administrative Code

Title 10 Health and

Human Services, Ch.

03H Facility Services-

Rules for the Licensing

of Nursing Homes,

2300, Nurse Staffing

Requirements (d)

Eff. 1-1-96.

http://reports.oah.state.nc.

us/ncac/title%2010a%20-

%20health%20and%20hu

man%20services/chapter

%2013%20-

%20nc%20medical%20ca

re%20commission/subcha

pter%20d/subchapter%20

d%20rules.html

Online Updates: NC Register:

http://www.oah.state.nc.us/rules/register

Legislative Updates:

http://www.ncga.state.nc.us/Legislation/Legislation.

html

SUFFICIENT STAFF: On duty at all times to meet the

nursing needs

LICENSED STAFF (RN, LPN/LVN)

1 DON RN included in

1 RN 8 consecutive hrs/7d/wk and

1 RN/LPN Charge Nurse 24hrs/7days/wk

DIRECT CARE STAFF

No minimum requirement

LN .32

SAL: ND

Administrative Code

http://www.legis.nd.gov/

information/rules/admin

code.html

ND Administrative Code

State Department of

Health Regulation 33-

07-03.2-14.

Eff. 7-96.

Online Updates: ND legislative branch

homepage:

http://www.legis.nd.gov/information/bills/

Information about agency rule-making

(administrative law):

http://www.legis.nd.gov/information/rules/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: sufficient number of staff to meet

the resident population's requirements for

assistance or provision of personal care, activities of

daily living, supervision, supportive services and

medical care.

LICENSED STAFF (RN, LPN/LVN)

1 DON RN full-time included in (cannot be waived)

1 RN 8 consecutive hrs/7days/wk and

1 RN/LPN Charge Nurse on each tour of duty 24

hrs/7days/week

For 1-59 occupancy: DON may be Charge Nurse

DIRECT CARE STAFF

No minimum requirement

LN .32

SAL:

NE Agency Rules for

Health and Human

Services, Regulation

and Licensure, Eff.

2/27/2007, SNF-NF-ICF

175 NAC 12

http://www.sos.state.ne.

us/rules-and-

regs/regsearch/Rules/H

ealth_and_Human_Ser

vices_System/Title-

175/Chapter-12.pdf

OnLine Updates:

Agency Rules and Regulations:

http://www.sos.state.ne.us/rules-and-

regs/regsearch

Legislative Updates:

http://www.unicam.state.ne.us/web/public/research

SUFFICIENT STAFF: Adequate to attain the highest

practicable physical, mental and psychosocial well-

being of each resident

LICENSED STAFF (RN.,LPN/ LVN)

1 RN DON included in

1 RN 8 hours/7 days/week included in

1 RN/LPN 24 hours/7 days/week

DIRECT CARE STAFF

No minimum requirement

LN .24

SAL: NH Code of

Administrative Rules;

Ch. He-P 803.03

Personnel and Staffing

http://www.gencourt.stat

e.nh.us/rules/he-

p800.html

OnLine Updates: Legislative Updates:

http://www.gencourt.state.nh.us/index/

Division of Administrative Rules:

http://www.gencourt.state.nh.us/Rules/listagencies.

html

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: No requirement.

LICENSED STAFF: (RN, LPN/LVN)

1 DON RN Full Time included in

1 RN alternate DoN when regular DoN absent (in

writing)

For 150+ licensed beds: add 1 Asst. DON RN

1 RN on duty during all Day shifts and

1 RN on duty or on call all Eve. & Night shifts

For 150+ beds: 1 RN 24hrs/7d/wk

DIRECT CARE STAFF

2.5 hprd* exclude DON, but include DON's direct

care hours in facilities with more that FT DON;

20% of 2.5 hprd provided by RN/LPN

*Plus additional hprds for specified resident

conditions or treatments.

LN .24

DC 2.5

Total 2.58

SAL: NJ Administrative

Code, Title 8, Ch. 39,

Sch. 25.1-25.4 [8:39-

25.1-25.4]. Eff. 11-21-

1994; Expired 11-21-

1999. Republished

without substantial

change 1-2001;

New Effect.: 2/15/2007;

Expir.: 2/15/2012

http://www.state.nj.us/h

ealth/healthfacilities/doc

uments/ltc/regnjac839.p

OnLine Updates:

For NJ Legislative Updates:

http://www.njleg.state.nj.us/bills/BillsByKeyword.as

For NJ Administrative Code updates:

http://www.state.nj.us/health/healthfacilities/rules.s

html

SUFFICIENT STAFF: To care for specific needs

LICENSED STAFF: (RN, LPN/LVN)

1 DON RN Full Time Day included in (DON may be

Charge Nurse)

1 RN/LPN Charge Nurse 24 hrs/7d/wk

DIRECT CARE STAFF

2.5 hprd [7 day average]

For example: D 1:7; E 1:10; N 1:12. include only

direct care hrs of DON, Asst. DON, Nursing

Department Director. At least 1 nursing staff person

on duty at all times.

LN .24

DC 2.5

Total 2.56

SAL: NM

Administrative Code

7.9.2 Requirements for

Long Term Care

Facilities. Eff: 8-31-

2000

http://www.nmcpr.state.

nm.us/nmac/parts/title0

7/07.009.0002.htm

OnLine Updates: Statutes, Administrative Code,

and pending legislation:

http://legis.state.nm.us/lcs/fileExists/BillFinderSubj

ect/SubjectIndex07.pdf

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: To provide nursing care and to

attain and maintain the highest practicable physical,

mental and psychosocial well-being of each patient in

the facility

LICENSED STAFF (RN, LPN/LVN)

1 DON RN included in

1 RN 8 consecutive hrs/ 7d/wk

For 1-60 occupancy, DON may be Charge Nurse

and

1 LPN Charge Nurse each shift

DIRECT CARE STAFF

No minimum requirement

LN .32

SAL: NV

Administrative Code,

Regulations of State

Board of Health, Ch.

449, Sec. 59 and Secs.

74517 and 74519

Eff: 9-27-1999.

http://www.leg.state.nv.us

/NAC/NAC-449.html

THEN GO TO:

http://www.leg.state.nv.us

/NAC/NAC-

449.html#NAC449Sec745

OnLine Updates:

Administrative Code:

http://www.leg.state.nv.us/NAC/CHAPTERS.HTMl

Legislative Updates:

http://www.leg.state.nv.us/23rdSpecial/Reports/

SUFFICIENT STAFF: To provide nursing and related

services, to attain well-being for 24 hours/day

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time included in

1 RN 8 consecutive hours/7d/wk

For 1-60 occupancy: DON may serve as charge

Nurse and

1 RN/LPN Charge Nurse 24 hours/7d/wk or

1 Charge Nurse for each unit for each tour of duty

DIRECT CARE STAFF

No minimum requirement

LN .56

SAL: NY Code Revised

Regulations, Title 10

Health, Sec. 415.13

Nursing Services

Eff: 1-13-93, Reissued

7-95, Revised 3-31-97.

http://w3.health.state.ny

.us/dbspace/NYCRR10.

nsf/56cf2e25d626f9f785

256538006c3ed7/8525

652c00680c3e8525652

c004980f8?OpenDocu

ment

OnLine Updates:

NY State Dept. of Health Laws and Regulations

Changes:

http://www.health.state.ny.us/regulations/

NY State Assembly Legislation Updates:

http://assembly.state.ny.us/leg/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient staff on each shift to

meet the needs of the residents

LICENSED STAFF (RN, LPN/LVN)

1 DON RN FT (between 6am&6pm) 5D/wk); Acting

DoN must be RN;

1-59 beds, DoN may be counted in

NURSE ASSISTANT STAFF (NA/CNA)

2.0 hprd minimum

DIRECT CARE STAFF

2.75 hprd minimum (2.0 hrpd NA; 0.2 hprd RN)

1:15 ratio of 1 NAs to 15 residents 24 hrs/7day/wk

RN .20

NA 2.0

Total 2.75

SAL: OH

Administrative Code

3701-17-08

Eff. 1-1-74; 12-21-92;

10-20-01

Nursing Home

Regulations

http://codes.ohio.gov/oa

c/3701-17

Also: OH Revised

Code, Title 37--XXXVII-

-Health-Safety-Morals,

Chapter 3721 Nursing

Homes; Residential

care Facilities: 3721.01-

-Nursing home and

residential care facility

definitions and

classifications

http://codes.ohio.gov/or

c/3721

OnLine Updates:

OH Code changes:

http://codes.ohio.gov/oac/3701-17

Also, OH Revised Code (ORC):

http://codes.ohio.gov/orc/3721

OH General Assembly: Legislative Updates/Bills:

http://www.legislature.state.oh.us/search.cfm

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient, adequately trained

staff shall be on duty, 24 hours a day, to meet the

needs of all residents residing in the facility without

regard to the direct staff ratios

LICENSED STAFF (RN, LPN/LVN)

1 DON RN/LPN, day shift and available by phone

1 RN/LPN 8 hours 7 days/week and (if DON is LPN,

1 RN 8h/wk consultant)

1 RN/LPN on duty at all times

DIRECT CARE STAFF

At least 1 certified medication aide on duty when

any shift is not covered by a licensed nurse

At least 2 direct care staff persons shall be on duty

and awake at all times regardless of the number of

residents

On or after Sept.1, 2003: Minimum direct-care-staff-

to-resident-ratios: 7am-3pm 1:6; 3pm-11pm 1:8;

11pm-7am 1:15. Facilities can vary the start times

for the 8 hr shifts by 1 hr before or 1 hr after the

above designated times without overlapping shifts.

If implement flexible staff scheduling, must maintain

2.86 hrs of direct-care-service per resident per day

and cannot fall below 1:16 and at least 2 direct care

staff on duty & awake at all times. Lists progressive

increases in staffing (based on reimbursements)

from 2.86 to 3.2 to 3.8 to 4.1 hrs/day/occupied bed.

LN .32

DC 2.86

Total 3.18

SAL:

OK Administrative

Code, Title 310--

Chapter 675,

Subchpt.13--Oklahoma

Dept. of Health, Nursing

and Specialized

Facilities, Staff

Requirements:

http://www.oar.state.ok.

us/oar/codedoc02.nsf/fr

mMain?OpenFrameSet

&Frame=Main&Src=_75

tnm2shfcdnm8pb4dthj0

chedppmcbq8dtmmak3

1ctijujrgcln50ob7ckj42tb

kdt374obdcli00_

For 63:1-1925.2 of the

Nursing Home Care Act

Title 63 of the

Oklahoma Statutes

(updated 11/1/05):

http://www.health.state.

ok.us/PROGRAM/condi

v/675act.pdf

OnLine Updates:

Oklahoma Administrative Code and Register:

http://www.oar.state.ok.us/oar/codedoc02.nsf/frmM

ain?OpenFrameSet&Frame=Main&Src=_75tnm2s

hfcdnm8pb4dthj0chedppmcbq8dtmmak31ctijujrgcl

n50ob7ckj42tbkdt374obdcli00_

Oklahoma Legislative Changes/Bills:

http://webserver1.lsb.state.ok.us/WebBillStatus/ma

in.html

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient in quantity, quality to

provide care to achieve highest degree of function

LICENSED STAFF (RN, LPN/LVN)

RN hour per resident per week. For 41+ beds:

exclude hrs of RN administrator

1 DON RN and 1 RN/LPN Charge Nurse 24

hr/7d/wk including 1 RN Charge Nurse Day 8

consec hrs (7am -11pm)

For 1-60 residents: DON may serve as Charge

Nurse

NURSE ASSISTANT STAFF (NA/CNA)

1:10 7am-3pm Day

1:15 3pm-11pm Eve

1:25 11pm-7am Night

DIRECT CARE STAFF

2 Nursing care staff on duty at all times

LN .32

NA 1.65

Total 1.97

SAL: OR Administrative

Rules, 411-086-0100

Eff. 08/01/2004.

http://www.dhs.state.or.us

/policy/spd/rules/411_086.

pdf

OnLine Updates: Pending legislation and

legislature homepage (Oregon Revised Statutes

and Oregon Laws):

http://www.leg.state.or.us/bills_laws/

For OR Administrative Rules and Oregon Bulletin,

notices of proposed rulemaking:

http://www.dhs.state.or.us/policy/spd/alpha.htm

SUFFICIENT STAFF: Sufficient numbers on 24-hour

basis to meet the needs

LICENSED STAFF (RN, LPN/LVN)

1 DON RN FT (1 per facility) and

1 RN Charge Nurse 24hrs/7d/wk

For 1-59 residents: 1RN D & E; 1 RN/LPN N

If LPN is Charge Nurse, RN must be on call

For 60-150 residents: 1 RN 24hr/7d/wk;

For 151-250 residents: 1 RN & 1 LPN 24 hr/7d;

For 251-500 residents: 2 RNs 24hr/7d

For 501-1,000 residents: 4 RN D; 3 RN E&N

For 1001+ residents: 8 RN D; 6 RN E&N.

NURSE ASSISTANT STAFF (NA/CNA)

1:20 nursing staff employees to residents

DIRECT CARE STAFF

2.7 hprd

RN .30

DC 2.7

Total 3.10

SAL: PA Administrative

Code Sec. 211.12

Nursing Services

Eff: 9-1-1975; Am. 7-1-

87; Am (e) and (f) 7-1-

1988; Am. 7-24-99

http://www.pacode.com/

secure/data/028/chapte

r211/s211.12.html

OnLine Updates: http://www.pabulletin.com/

Also:

http://www.pacode.com/

PA Legislation/Bills:

http://www.legis.state.pa.us/cfdocs/legis/home/ses

sion.cfm

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: To meet the needs at all times

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time and (1 relief Rn when DoN

absent)

1 RN on duty 24 hrs/7d/wk

For 1-29 beds: DON may act as Charge Nurse

DIRECT CARE STAFF

1 individual certified in basic life support

24hrs/7d/wk

RN .30

SAL: RI Department of

Health, Rules and

Regulations for

Licensing of Nursing

Facilities (R23-17-NF)

Part III, Sec. 24.0 Eff.

11-07-2006.

http://www2.sec.state.ri.

us/dar/regdocs/released

/pdf/DOH/4215.pdf

OnLine Updates: For pending regulations:

http://www.sec.state.ri.us/rules/

For pending legislation:

http://www.rilin.state.ri.us/Genmenu/

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time and

For 1-22 beds: include DON in licensed staff

1 Licensed Nurse per station, per shift

For 45+ residents per station: 2 LNs per shift

1 RN per facility 24hrs/7days OR on call

NURSE ASSISTANT STAFF (NA/CNA)

Shift 1 (7am-3pm)*1:9

Shift 2 (3pm-11pm)1:13

Shift 3 (11pm-7am)*1:22

LN .54

NA 1.87

Total 2.41

SAL & SC: SC Dept.

Health & Environmental

Control, Regulation No.

61-17 "Standards for

Licensing Nursing

Homes" Pub. 3-28-92

as amended by SC

Code of Regulations

Sec 44-7-262.

Amended by S238

(1977). Eff. 1-1-99.

http://www.scdhec.gov/

administration/regs/doc

s/61-17.pdf

OnLine Updates: Legislative Information:

http://www.scstatehouse.net/cgi-

bin/web_subject.exe

SC Dept. Health & Environmental Control updates:

http://www.scdhec.gov/administration/regs/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Adequate to meet total needs of

patients at all times

LICENSED STAFF (RN, LPN/LVN)

1 DON RN FT and

1 RN/LPN Charge Nurse 24 hours/7days/wk

For 1-59 residents: DON may be Charge Nurse and

ratio of LNs to NAs* sufficient to assure professional

guidance.

DIRECT CARE STAFF

No minimum requirement

LN .30

SC: SD Rules

44:04:06:09. Eff: 11-7-

04.

http://legis.state.sd.us/r

ules/DisplayRule.aspx?

Rule=44:04:06

OnLine Updates: Administrative Rules Updates:

http://legis.state.sd.us/rules/RulesList.aspx

Legislative Bills/Updates:

http://legis.state.sd.us/sessions/2007/keyword.htm

SUFFICIENT STAFF: Adequate numbers to provide

care as needed

LICENSED STAFF (RN, LPN/LVN)

1 DON RN and

1 RN/LPN 24 hours/7days/week included in

0.4 hprd licensed nursing personnel time

DIRECT CARE STAFF

2.0 hprd including

0.4 hprd of licensed personnel time and at least 2

nursing personnel on duty each shift

LN .40

DC 2.0

Total 2.0

SAL: Rules of

Tennessee Department

of Health, Div. of Health

Care Facilities, Ch.

1200-8-6 "Standards for

Nursing Homes" -.06-

(4)(a)(b)(d) revised July

2007

http://state.tn.us/sos/rules/

1200/1200-08/1200-08-

06.pdf

OnLine Updates: Current and pending

regulations:

http://state.tn.us/sos/rules/index.htm;

Legislative Updates:

http://www.legislature.state.tn.us/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: On a 24-hour basis to provide

care to all

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time 40 hrs/wk included in

For 1-59 occupancy: DON may be Charge Nurse

1 RN 8 consecutive hrs/7d/wk and

1 RN/LPN Charge Nurse 24hrs/7days/wk in

0.4 hprd licensed care hours or 1:20 Licensed

Nurse* to resident every 24 hrs

Exclude administrative time of licensed staff and

DON of a multi level facility-

DIRECT CARE STAFF

No minimum requirement

LN .40

SAL: TX Administrative

CodeTitle 40, Part I,

Subch. K, Rules

19.1001 and 19.1002

"Nursing Services." Eff:

5-1-95; amended to be

Eff: 3-1-98

http://info.sos.state.tx.u

s/pls/pub/readtac$ext.T

acPage?sl=R&app=9&p

_dir=&p_rloc=&p_tloc=

&p_ploc=&pg=1&p_tac

=&ti=40&pt=1&ch=19&rl

=1001

Enabled by TX Health

and Safety Code Title

40 Health Facilities, Ch.

242.037. Eff. 9-1-89;

Amendments through 9-

1-99.

Both Licensure and

Medicaid Certification

are governed by TX

Administrative Code,

Title 40, Part I, Subch.

OnLine Updates: Texas Register:

http://www.sos.state.tx.us/texreg/

Legislative Updates:

http://www.capitol.state.tx.us/MnuLegislation.aspx

Administrative Code Updates:

http://www.tea.state.tx.us/rules/tacupdates/index.ht

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: No requirement.

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time

1 RN 8 consecutive hours/7days/wk included in

1 RN/LPN Charge Nurse each shift

DON may not serve as Charge Nurse

DIRECT CARE STAFF

No minimum requirement

From UAC R432-200-15 for “Small Healthcare

Facility (4-16 beds) : any facility that provides

nursing care shall provide at least two hours (120

minutes) of nursing-staff coverage (RN + LPN +

Aides) per resident per 24 hours of which 20 percent

or 24 minutes per resident shall be provided by

licensed staff (RN + LPN).

LN .30

SAL: UT Administrative

Code R432-150-5

Scope of Services. Eff:

12/1/99.

http://www.rules.utah.gov

/publicat/code/r432/r432-

150.htm

R432-200-15. [re: Small

Health Care Facility (4-

16 beds)] 3/3/95.

http://www.rules.utah.go

v/publicat/code/r432/r43

2-200.htm#T15

OnLine Updates:

Administrative Code Updates:

http://www.rules.utah.gov/main/index.php?module

=Pagesetter&func=viewpub&tid=1&pid=24

Legislative Updtates/Bills:

http://le.utah.gov/asp/billsintro/index.asp

SUFFICIENT STAFF: In sufficient numbers to meet the

assessed needs

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time 5d/wk and

For 1-59 beds: DON may be Nursing Supervisor

1 [RN/LPN] Nursing Supervisor

DIRECT CARE STAFF

Qualified RNs/LPNs and CNAs on all shifts 7d/wk

No minimum requirement

LN .14

SAL:VA Administrative

Code 12 VAC5-371-

200, 210, 220. Eff. 7-1-

97; Rev. 1/11/2006

Nursing Facility

Regulations:

http://www.vdh.state.va.

us/OLC/Laws/document

s/nursingHomes/nursin

g%20facility%20regs.pd

OnLine Updates:

VA Dept. Health Regs:

http://www.vdh.state.va.us/OLC/Laws/documents/n

ursingHomes/nursing%20facility%20regs.pdf

Code of Virginia Updates:

http://leg1.state.va.us/000/src.htm

VA Administrative Code:

http://leg1.state.va.us/cgi-

bin/legp504.exe?000+men+SRR

Legislation/Bills: http://leg1.state.va.us/cgi-

bin/legp504.exe?071+men+BIL

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: To provide services to attain

well-being

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time included in

For 1-59 occupancy: DON may be Charge Nurse

1 RN 8 consec. Hours/7d/wk and

1 RN/LPN Charge Nurse 24 hrs/7d/wk

NURSE ASSISTANT STAFF (NA/CNA)

24-hour other nursing personnel services

2.0 hprd LNA (CNA)

DIRECT CARE STAFF

3.0 hprd of which 2.0 hprd by LNA (CNA)

LN .32

NA 2.0

Total 3.0

SAL: VT Administrative

Code 7.13 Nursing

Services. Eff: 1994.

Rev 12/15/2001

http://www.dad.state.vt.

us/Regulations/nhregfin

al.html#QualityOfCare

OnLine Updates:

Dept Aging & Disabilities Rules Update:

http://www.dad.state.vt.us/Regulations/nhregfinal.h

tml#QualityOfCare

VT Legislative/Bills Update:

http://www.leg.state.vt.us/database/database2.cfm

SUFFICIENT STAFF: Sufficient services to attain well-

being

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time and

1 RN/LPN Charge Nurse each tour of duty including

1 RN 16 hrs/7d/wk directly supervising care and

1 RN/LPN 8hrs/7d/wk "directly supervising care"

DIRECT CARE STAFF

No minimum requirement

LN .30

SAL: WA

Administrative Code,

Ch. 388-97-115

Nursing Services.

Eff. 10-16-94; 3-26-00.

http://apps.leg.wa.gov/

WAC/default.aspx?cite=

388-97&full=true#388-

97-115

OnLine Updates: For WA Administrative Code

Updates:

http://apps.leg.wa.gov/WAC/default.aspx?cite=388

-97&full=true#388-97-115

For WA Legislation/Bills:

http://apps.leg.wa.gov/billinfo/

For WA Agency Rules:

http://apps.leg.wa.gov/wac/

Also WA Register:

http://www.leg.wa.gov/codereviser/washington%20

state%20register/

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Shall be adequate nursing

service personnel assigned to care for the specific

needs of each resident on each tour of duty. Those

personnel shall be briefed on the condition &

appropriate care of each resident.

LICENSED STAFF (RN, LPN/LVN)

1 DON RN Full Time Day and

For 1-59 residents: DON RN may be Charge Nurse

or other RN

1 Charge Nurse on duty at all times

For 60-74 residents: DON RN & 1 RN Charge Nurse

Day

For 75-99 residents: add 1 RN Charge Nurse 7 days

on a non-day tour of duty

For 100+ residents: DON and 1 RN 24hrs/7days

If LPN is charge nurse, then RN must be in facility or

on call

For intensive skilled nursing care, 3.25 hprd, of

which 0.65 hr shall be provided by a RN/LPN

For skilled nursing care, 2.5 hprd, of which a

minimum of 0.5 hr shall be provided by a RN/LPN

For intermediate or limited nursing care, 2.0 hprd, of

which a minimum of 0.4 hr shall be provided by a

RN/LPN

DIRECT CARE STAFF

No minimum requirement

LN .50

DC 2.5

Total 2.5

SC & SAL: WI Statutes

Ch. 50.04(lm)2 1, 2, 3

Eff: 6-98.

WI Dept. Health &

Family Services

Regulation 132.62(2) &

(3). Eff: 9-1-07.

http://www.legis.state

.wi.us/statutes/Stat00

50.pdf

http://www.legis.state

.wi.us/rsb/code/hfs/hf

s132.pdf

Current Regulation: Intermediate Care Facility:

1 RN/LPN Charge Nurse every tour of duty who

may be DON.

OnLineUpdates:

WI Statutes:

http://www.legis.state.wi.us/rsb/stats.html

WI Dept. Health & Family Services Rule Updates:

http://www.legis.state.wi.us/rsb/code/hfs/110.html

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

STATE STANDARD

State

MINIMUM STAFFING STANDARD FOR SKILLED

NURSING OR NURSING FACILITIES

Estimated

variance from

federal standard

for facility with

100 beds

Staffing Standard

Citation and URL

Comments

SUFFICIENT STAFF: Sufficient to attain or maintain

the highest practicable physical, mental, and

psychosocial well being of each resident

LICENSED STAFF: (RN, LPN/LVN)

1 DON RN Full Time Day 8hrs/5days/wk and

1 RN/LPN Charge Nurse each unit each shift

1 RN on duty 8 consecutive hrs/7days/wk:

For less than 60 beds, DON can count as RN

If no RN on duty, a RN must be on call

DIRECT CARE STAFF

2.25 hprd (RN/LVN/CNA)

For 60+ beds: exclude DON

LN .54

DC 2.25

Total 2.31

WV Code of State

Rules, 64 CSR 13 –

8.14 (Nursing Services

Staffing) and see below

64 CSR 13 -17 for

Table 64-13A for

“Minimum Ratios of

Resident Care

Personnel to

Residents”.(Eff. 7-01-

07).

http://www.wvsos.com/c

srdocs/worddocs/64-

13.doc

OnLine Updates: Legislation/Bills:

http://www.legis.state.wv.us/Bill_Status/bill_status.

cfm

Code of State Rules (CSR):

http://www.wvsos.com/csr/search.asp

64 CSR 8.14 “Staffing shall not, other than during

short unforeseeable emergencies, be less than an

average of two and twenty five one hundredths

(2.25) hours of nursing personnel time per resident

per day. Minimum hours of resident care personnel

to residents are outlined in table 64-13.A of this

rule. Facilities with fewer than fifty-one (51) beds

are staffed at higher hours as outlined in table 64-

13.A. of this rule.”

SUFFICIENT STAFF: "sufficient number to meet total

needs"

LICENSED STAFF (RN, LPN/LVN)

1 DON RN and

1 RN/LPN Charge Nurse on Days 7days/week for

each nursing station and 1 RN/LPN all other tours

of duty (DON excluded for 60+ beds)

DIRECT CARE STAFF

2.25 hprd per 24 hrs/7days/week

LN .56

DC 2.25

Total 2.61

SAL: WY Rules and

Regulations,

Department of Health,

Ch. 11, Sect 9 Eff.

5/26/78.

http://soswy.state.wy.us

/RULES/4065.pdf

OnLine Updates: Wyoming statutes:

http://legisweb.state.wy.us/titles/statutes.htm

WY Rules and Regs, current rules:

http://legisweb.state.wy.us/CALENDAR/SCHED2.

HTM

ALSO

http://legisweb.state.wy.us/leginfo/exorders/exorde

rs.htm

Source: State statutes and regulations were collected from the Internet . Where data were not available, telephone interviews we held with state Licensing and

Certification officials, who were asked to send copies of their statutes, regulations, and policies on staffing. Where responses were unclear, follow-up telephone calls were

made to officials for clarification.

NURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS

UCSF Survey of Nursing Home Staffing Standards, 2007

Definitions:

DON = Director of Nursing – states may their own requirements but the federal requirement is that a DON must be a licensed RN.

RN = Registered nurse -- has a two-year degree, three-year diploma, four-year degree or more education and is licensed in a state.

LPN/LVN = Licensed practical nurse or licensed vocational nurse – has a one-year degree and is licensed in a state.

LN = A licensed nurse can be either a RN or LVN/LPN.

NA = A nursing assistant or nurse’s aide or orderly. If the NA has 75 hours of training and passes a competency exam, the NA can become a certified NA (CNA).

Hprd = Hours per resident day. D= Day shift. E= Evening shift. N = Night shift.

FT = Works fulltime. PT = Works part time.

SC = State code or statutes. SAL = State administrative law or regulations. SDP = State written policy. Eff. = Effective on. Ch.= Chapter.

Note: We included state staffing requirements for Medicaid if there were specific requirements. Since approximately 95 percent of facilities are certified for Medicare

and/or Medicaid, the Medicaid staffing requirements apply to certified facilities. In calculating the estimated variance from the federal standard, the state requirements

were converted to a number by estimating the hours per resident day for a 100 bed nursing facility, assuming that each 100 bed facility had at least 2 units. For simplicity

purposes, each fulltime staff member was considered to work 8 hours per day (even though actual fulltime hours are generally considered to be 35 hours per week if

vacations and sick days are taken into account). For example, a ratio of 1:10 nurse per resident was converted to 8 hours (for 1 nurse) and divided by the number of

residents (10) to determine that the total was .8 hprd. These ratios were added for all three shifts during a day. Where we estimated the hprd, the numbers are shown in

parenthesis. For one fulltime DON (40 hours per week), we assumed that the total hours were .06 hprd (40 hours divided by 7 days divided by 100 residents). For 24

hour per day licensed nurses (LNs), we assumed the equivalent was .24 hprd for 100 residents.