Nursing Home Staffing Requirements by State
When elderly individuals have ongoing medical needs, they can move into nursing homes to receive long-term care. Nursing homes are equipped to assist these residents with daily living activities and provide medical treatment plans for each patient.
The effectiveness of these care facilities depends on adequate staffing, especially with the nurse staff. To ensure all residents receive proper care and support, federal and state governments have established minimum staffing requirements for nursing homes to ensure all residents have access to proper care and support.
Overview of Federal Minimum Staffing Standards
Nursing homes nationwide must adhere to the minimum staffing standards set by federal entities. The primary agency that enforces these regulations is the Centers for Medicare & Medicaid Services. Here are some of the nursing home staffing requirements laid out by this entity.
Centers for Medicare & Medicaid Services (CMS) Requirements
There are several requirements for skilled nursing care for nursing homes participating in the Medicare and Medicaid networks. The total nursing care time must be at least 3.48 hours per resident day.
If inspections or complaints reveal that a nursing home is not meeting this requirement, corrective actions may be taken, such as levying fines against the facility or withholding reimbursement payments from Medicare and Medicaid.
A nursing home must employ a full-time director of nursing. Additionally, at least one registered nurse must be on duty for eight hours straight each day, and a registered nurse or licensed practical nurse must be on duty 24 hours a day.
Registered Nurse (RN) Coverage
Of those 3.48 hours of care per resident day, .55 must come from registered nurses. Nursing facilities must also provide 2.45 hours of direct nurse aide care per resident daily. Any other type of nursing staff can fulfill the remaining .48 hours of care.
Licensed Practical Nurse (LPN) and Certified Nursing Assistant (CNA) Staffing
Licensed practical nurses and certified nursing assistants fall under the direct nurse aide care category. As such, these types of nurse staff can help meet the standard of 2.48 hours of care per resident day. They can also provide care for the additional 0.48 HRPD required outside of registered nurse care.
Limitations of Federal Standards
Enforcing these nursing home staffing standards is challenging at the federal level. The primary method of enforcement is through inspections, which only happen annually. Additionally, many states have stricter requirements for nursing staff at care facilities, so the federal regulations are only the bare minimum.
Even if there are not enough care workers in a facility, the timeline for fining or punishing the nursing home is prolonged, so current residents may not benefit from the corrective measures for months.
State-Specific Staffing Requirements
In addition to the federal mandates for direct care workers in nursing homes, state regulations across the country must be followed. Most states enforce stricter standards than the CMS since the federal regulations cover the bare minimum. Here are some specific states and the requirements they enforce for staffing in nursing facilities.
Florida
Nursing facilities in the Sunshine State must adhere to several requirements that go above and beyond the federal standards from the Centers for Medicare & Medicaid Services. There cannot be less than one certified nursing assistant per twenty residents or one licensed nurse per forty residents.
Facilities must provide a weekly average of 3.6 hours of care per resident per day, which includes 2 hours of direct care by a certified nursing assistant and one hour of direct care by a licensed nurse.
Direct care staff, as defined by federal regulations, must include certified nursing assistants (CNAs) and licensed nurses. CNAs must hold state certification, while nurses must be licensed under Florida’s Nursing Practice Act.
California
California has no minimum staffing ratio requirement as long as the facility can meet residents’ needs. The only requirements that must be met are the care hours. Nursing home residents must receive at least 3.5 hours of care per day, including 2.4 hours of daily care from certified nursing assistants.
California nursing homes must staff doctors for medical oversight and Registered Nurses for complex care management. Licensed Practical Nurses handle tasks like medication administration, while Certified Nursing Assistants provide daily hands-on care. All staff must undergo ongoing education and specialized training.
New York
New York also has stricter requirements for nursing staff than the federal standard. Nursing homes are required to provide 3.5 hours per resident per day. 2.2 hours must come from certified nurse aides or regular nurse aides, while 1.1 hours must come from a registered professional nurse or licensed practical nurse.
The facilities must maintain sufficient numbers of RNs, LPNs, CNAs, and other nursing personnel around the clock, with a registered professional nurse or LPN serving as a charge nurse on each shift.
Challenges and Controversies Surrounding Minimum Staffing Requirements
Nursing homes frequently fall short of the requirements for care hours per resident per day. These facilities often face challenges related to staffing shortages, enforcement practices, and changing standards.
Staffing Shortages
Nurse staffing shortages are common in the nursing home sector, especially for rural facilities. Many homes find it difficult to maintain sufficient numbers of employees to meet the nurse staffing requirements of federal and state mandates. With a smaller nurse staff, the facility may struggle to provide enough care hours per resident per day.
Enforcement and Compliance
It can be frustrating for nursing home residents and their family members when a proper standard of care is not enforced. Often, state and federal agencies are unaware of a facility’s total nursing staff inadequacies until an inspection is conducted, which can cause residents to receive insufficient care for months.
These community-based services are so localized that enforcing the staffing requirements is not an immediate solution.
Advocacy for Stronger Standards
Advocacy groups are working to improve the total nurse staffing requirements in nursing homes. These groups work with lawmakers to hold nursing facilities accountable and enforce more excellent standards of care. Some tools used to improve care in nursing homes are new laws, stronger enforcement practices, and withholding Medicare or Medicaid payments to facilities.
The Role of Nursing Home Law Firms in Minimum Nurse Staffing Standards
Residents should not have to worry about the quality of care they will receive in a nursing facility. Once they enter those doors, they should feel safe and cared for by the direct care staff and licensed nurses. Nursing home law firms can be crucial in holding a facility accountable when it falls short of expectations.
Advocating for Residents’ Rights
If a nursing home provides inadequate staffing and fails to meet the standard of care, an experienced law firm can advocate for the resident’s rights. These rights include dignity, autonomy, and access to high-quality care. If these rights are violated and the resident suffers as a result, they can hold the facility accountable with the help of a lawyer.
Often, when victims of abuse or neglect go up against these facilities, they feel overwhelmed by the resources of the defendant. With the right lawyer, you will have an advocate who understands nursing home law and can protect your rights throughout the legal proceedings.
Legal Action for Negligence and Understaffing in Nursing Facilities
In many cases, nursing home residents suffer harm or injuries because of abuse and neglect. Neglect in a nursing home could occur due to staffing shortages. With an attorney, you can file a legal claim against the facility to pursue compensation for damages.
Winning a case against a resourceful defendant can be challenging, so hiring an attorney is the best way to level the playing field and increase your chances of earning a fair settlement.
Pushing for Reform
Nursing home law firms are also essential in advocating for policy changes. If no one holds these facilities accountable for their shortcomings, they are less incentivized to improve.
However, when residents and their families step up to file lawsuits and hold administrators and staff responsible for their actions, nursing homes are forced to make amends and change their policies.
For example, a small nursing home could fly under the radar if it does not meet state or federal regulations for care hours per resident per day. If one resident files a successful claim with the help of a lawyer, that facility can be improved for every other patient living there.
Call a Nursing Home Lawyer to Protect Your Loved Ones
Awareness is the first step toward holding nursing homes accountable. You must understand the staffing requirements for your state and from the CMS to know if your specific facility violates those standards.
If you or a loved one suffered because of an insufficient direct care staff, you have the right to pursue legal action and recover compensation for legal damages like medical bills, emotional distress, physical pain, and loss of quality of life.
The Nursing Home Law Center specializes in protecting residents’ rights in care facilities. Our legal team can help you decide the best path forward with sound advice and persistent advocacy. Together, we can hold the at-fault party accountable for your suffering and create a safer environment for all residents in that nursing home.
Call us today at 800-926-7565 for a free consultation about your case or complete the online form.