resident to Cna Ratio

I am a nursing assistant as well. I am sorry but I do not know what the law requires. I am surprised that no one answered your question. I have worked as a CNA for over seven years. I have at times been taking care of a wing of forty residents on my own. We CNA's need to stick up for ourselves and for are patients. Thankyou for addressing this issue.

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Nursing assistant

I am a licensed [but not practicing] nursing home administrator, and here is the answer [sort of] to your question:

subsection 483.30 (a) of the of the Medicare/Medicaid requirements for LTC faciliites states that "The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with the resident care plan: licensed nurses and other nursing personnel." I guess I don't need to tell you how ambigious this is. Each state has laws in addition to this. Call your department of health, division of skilled nursing facilities and ask.

Here in PA., the requirement is 1 nursing staff member per 20 residents. Now [here is where it gets cheezy...] A 'nursing staff member' includes all nurses in the building, who, if called upon, could provide nursing care. This includes the RNAC [who, as we all know doesn't even have the time to get his/her own work done], the assistant DON, and the med nurses [even though they are too busy passing medications, usually to provide a lot of hands on care].

I know that many of the facilities in my area are getting cited on complaint surveys to DOH because they do not have the basic number of nursing staff hours [2.7 per patient/day]. LTC is in a horrible state, and it looks like it is just going to keep getting worse.

I hope this helps

It is often tough to get administation to listen. I left administration because I was a nurse and I knew that my old people had to come before profit. Since I could not reconcile the goals of for-profit health care with my duty to be a patient advocate as a nurse, I kissed administration goodbye and went back into patient care full-time.
The money isn't as good, but I could look at myself in the mirror in the morning, and feel good that I come home knowing I have made a difference in someone elses life.

I kept the administrators license, because it forces me to keep up on my knowledge of LTC rules & regulations [our board requires mandatory continuing education hours every 2 years]. I like having the knowledge because it has been my experience that administrators like to lie to nursing staff when they don't have good answers to real concerns. I love to tell things that administrators hope nurses will never find out.

Like in the case of the question you asked. Depending upon your facilities CMI [case mix index], if nursing staff hours aren't up to par [that is, high enough to justify the case mix that your administration is submitting to HCFA]- and if the medicare/medicaid surveyors determine that the care isn't being rendered as the facility claims it is [and is being reimbursed for] the the possibility of medicare/medicaid fraud exists.

I wonder how many LTC nurses know that? I would wager not many.

I would think that a refusal by a resident should be considered a toileting attempt, at least. If I"m not mistaken, the Medicare rules take "care" or "assistance" of the patient into account (in whatever language it uses)... Let's face it, it's the patient's right to refuse, but we have to make the attempt or the offer to toilet. If they say "no", we are still doing our job. Ask your DON how to document such efforts. There has got to be a way, as long as you document SOMETHING, since that is what gets the bills paid.




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Annette, LPN from Massachusetts