Are Nursing Homes Required To Have Certain Numbers Of Staff?
"Are nursing homes required to have certain numbers of staff"
-Edward, Highland Park, IL
Illinois does not require a specific staff to patient ratio for Illinois nursing home facilities. The responsibility lies on each facility to determine the staffing needs to meet the needs of its residents. (Section 300.1230 – Staffing) The Administrative Code requires that a sufficient number of staff remain on duty for all hours of the day to provide services that meet the total needs of the residents. (Administrative Code Part 300 – Skilled Nursing and Intermediate Care Facilities Code)
Staffing is based on the needs of the residents and is determined by determining the number of hours of nursing time each resident needs on each shift of the day. This determination must be made separately for both licensed and unlicensed nursing personnel. The number and categories of personnel that should be provided is based on:
- Number of residents
- Amount and kind of care required to meet the needs of all residents at all times
- Size, physical condition, and layout of building including proximity to resident rooms
- Medical orders (Section 300.1230 – Staffing)
The Skilled Nursing and Intermediate Care Facilities Code provides examples for how to compute staffing needs for a 100 bed Skilled Nursing Facility, based on the considerations listed above (see Resources below).
The facility must provide the necessary care and services to attain or maintain the highest level of physical, mental, and psychological well-being of the residents. (Section 300.1210 – General Requirements for Nursing and Personal Care)
Each facility must have a director of nursing services (DON) who is a registered nurse and is a full-time employee on duty a minimum of 36 hours, four days a week, with at least 50% of their hours scheduled between 7 A.M. and 7 P.M. In facilities with 100 or more occupied beds, there must also be an assistant director of nursing (ADON), on duty a minimum of 36 hours, four days a week. For all shifts, there must be a licensed nurse designated as being in charge of nursing services when neither the DON nor the ADON are on duty. The facility must also have a minimum of one staff member awake and ready at all times.
Resources:
Illinois Nursing Home Care Act
Administrative Code – Part 300 – Skilled Nursing and Intermediate Care Facilities Code
Section 300.1210 – General Requirements for Nursing and Personal Care
Section 300.1230 – Staffing – (p) – Example of Staffing Calculations
A) Total Minimum Hours of Care Needed
|
Level of Care |
# of Residents |
|
Total Hrs. Needed/Day Per Resident |
|
Total Hrs. Needed/Day Per Facility |
|
Skilled |
25 |
[times] |
2.5 |
= |
62.5 |
|
General ICF |
50 |
[times] |
1.7 |
= |
85.0 |
|
Light ICF |
25 |
[times] |
1.0 |
= |
25.0 |
|
|
Total hours needed |
|
172.5 |
||
B) Minimum Total Hours Needed Per Shift
|
Shift |
Total Hrs. Per Day |
|
Minimum Percent |
|
Total Hrs. Needed |
||
|
7-3 |
172.5 |
[times] |
45% |
|
77.6 |
||
|
3-11 |
172.5 |
[times] |
35% |
|
60.4 |
||
|
11-7 |
172.5 |
[times] |
20% |
|
34.5 |
||
|
|
|
|
100% |
|
172.5 |
||
|
|
|
|
|
|
|
|
|
C) Licensed Nurse Coverage
|
Shift |
Minimum Hrs. Per Shift |
|
Minimum Percent |
|
Minimum Nurse Hours Required |
|
7-3 |
77.6 |
[times] |
20% |
|
15.5 |
|
3-11 |
60.4 |
[times] |
20% |
|
12.1 |
|
11-7 |
34.5 |
[times] |
20% |
|
6.9 |
D) Licensed Nurses Required
|
Shift |
Minimum Nurse Hrs. Required |
|
Hrs. Worked Per Shift |
|
# of Nurses Needed |
|
7-3 |
15.5 |
[divided by] |
8 |
= |
1.93 (2) |
|
3-11 |
12.1 |
[divided by] |
8 |
= |
1.51 (1.5) |
|
11-7 |
6.9 |
[divided by] |
8 |
= |
0.86 (1) |
E) Nurse Aide/Orderly Coverage
|
Shift |
Minimum Nurse Hrs. Required |
|
Hrs. Worked Per Shift |
|
# of Nurses Needed |
|
7-3 |
77.6 |
[minus] |
15.6 |
= |
62.1 |
|
3-11 |
60.4 |
[minus] |
12.1 |
= |
48.3 |
|
11-7 |
34.5 |
[minus] |
6.9 |
= |
27.6 |
F) Nurse Aides/Orderlies Required
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Excellent article. Georgia requires a 2.5 ratio based on census. For a long time I have been a proponant of staffing by acuity rather than census. It just makes more sense since those with issues require more care.