Nurse to resident ratio in LTCF

  1. Need help please...
    Does anyone know the 'legal' nurse to resident (patient) ratio in a long term care facility?
  2. Visit Trixxy profile page

    About Trixxy

    Joined: Dec '03; Posts: 50; Likes: 69


  3. by   Hellllllo Nurse
    There is no legal staff to resident ratio.

    Here are two articles from federal gov't related to this:

    In this next article read under the heading "Federal Policy Solutions"
  4. by   longtermcarern
    in the state of Michigan it is 1 nursing staff to 8 patients day shift, 1 to 12 on the afternoon shift and 1 to 15 on the night shift. Keep in mind that those besides the direct care staff can count in that ratio such as the ADON, the MDS nurse etc. I am sure this could vary state to state. While I have never seen it happen, the law says providing you have enough nursing assistants to meet the ratio, you only have to have one nurse for every 125 patients on the night shift.
  5. by   Hellllllo Nurse
    There are no fed staffing laws, but states can impose their own.

    When I worked LTC in AZ, I was the only nurse for 65 res w/ 3 CNAs. Funny, when I lived in MI, I was a CNA and couldn't get a job anywhere.

    One nurse to 125 res?

    I bet laws saying how many dogs per worker at the Humane Society are better.
    Last edit by Hellllllo Nurse on Dec 21, '03
  6. by   longtermcarern
    Hello nurse is correct when she says that there are no federal requirements. What the federal guideline says is there must be adequate staff to provide care and there must a RN for 8 hours a day for 7 days a week. There are 33 states that have min staffing requirements beyond what the federal requirements are. However, even if you follow the requirements for your state and have the staffing your state demands, you could still be cited on a federal survey under the adequate staff to provide care rule if the survey team finds that your residents have care needs not being met.
  7. by   Hellllllo Nurse
    Study: 90 percent of nursing homes understaffed

    The Associated Press

    WASHINGTON (AP) - The vast majority of the nation's nursing homes - about 90 percent - are staffed too thinly to properly provide such basic services as dressing, grooming, feeding and cleaning, according to a new federal study.

    The report was ordered by Congress and a final version is being prepared by the Department of Health and Human Services. It concludes that it would cost $7.6 billion a year for nursing homes to achieve proper staffing.

    Tuesday, Bush administration officials were unwilling to say whether they will mandate minimum staffing levels for nursing home, as critics have long demanded.

    Instead they pointed to plans to force all nursing homes to make public their staff-to-patient ratio. Bush officials said public demand for more staffing will pressure nursing homes to do a better job.

    HHS Secretary Tommy Thompson "has identified the shortage as a major issue we have to deal with in this country," said spokesman Bill Pierce. "And its not just nursing homes. There is a shortage of nurses across the board."

    Several health care workers and watchdog groups said the government is directly responsible for patients who are suffering because of a lack of care.

    "You just don't have enough time to give patients the proper care that you are required to - to bathe them and dress them," said Jeannie Holly, a nurse at Mariner Healthcare in Huntington, W.Va.

    ************************************************** *

    When I worked LTC, there were plenty of nurses. Mgmt just purposely staffs too short. $$$ you know.
  8. by   Trixxy
    I think the government needs to take a close look at this. Getting to be very dangerous.
  9. by   GPatty
    It is getting very unsafe...
    The normal ratio is 1 nurse:30-35 patients.
    I have worked 1 nurse: 68 patients.
    It was horrid, but I learned to get around some of the greater hurdles, and get my work done. Had no choice..the facility wouldn't/couldn't hire anyone to work with me for about 6 months, so I did it on my own all that time.
  10. by   Havin' A Party!
    Hi there, Crispy RN.

    Can you advise on the date of the posted news item. Thanks!
  11. by   Marti Ann


    1. Determine facility census 120
    2. Multiply census by 1.0 hours to obtain minimum total hours 120
    3. From time sheets, total licensed nurse work-hours: 130
    4. Line 3 exceeds Line 2 MINIMUM STAFFING IS SATISFIED


    1. Determine facility Census 120
    2. Multiple census by 1.0 hours to obtain minimum total hours 120
    3. From time sheets, total licensed nurse work-hours: 110
    4. Line 2 exceeds Line 3 MINUM STAFFING IS NOT SATISFIED

    The above hours do NOT include non-resident care hours, such as lunch and work breaks. These are "patient care" hours, according to Pat Hall, Agency for Health Care Administration.

    These above figures are a "minimum". Nursing Home are require to staff over the minimum if necessary to meet the needs of the residents, according to Peggy Rigsby, Florida Health Care Association.

    The above hours are for a 24-horus period on a single date. There is no requirement for any particular eight hours shift.


    (a) Minimum staffing:
    1. Facility Shall maintain the following minimum staff hours per week:
    Number of Residents Staff Hours/Week
    0 - 5 168
    6 - 15 212
    16 - 25 253
    26 - 35 294
    36 - 45 335
    46 - 55 375
    56 - 65 416
    66 - 75 457
    76 - 85 498
    86 - 95 539
    For every 20 residents over 95 add 42 staff hours per week.
    2. At least one staff member who has access to facility and resident
    records in case of an emergency shall be within the facility at all times when residents are in the facility. Residents serving as paid or volunteer staff may not be let solely in charge of other residents while the facility administrator, manager or other staffs are absent from the facility.
    3. In facilities with 17 or more residents, there shall be one staff member
    awake at all hours of the day and night.
    4. At least one staff member who is trained in Fist Aid and CPR, as
    provided under Rule 58A-5.0191, shall be within the facility at all times when residents are in the facility.
    5. During periods of temporary absence of the administrator or manager
    when residents are on the premises, a staff member who is at least 18 years of age must be designated in writing to be in charge of the facility.
    6. Staff whose duties are exclusively building maintenance, clerical, or
    food preparation shall not be counted toward meeting the minimum staffing hours requirements.
    7. The Administrator or manager's time may be counted for the purpose
    of meeting the required staffing hours provided the administrator is actively involved in the day-to-day operation of the facility, including making decisions and providing supervision for all aspects of resident care, and is listed on the facility's staffing schedule.
    8. Only on the job-staff may be counted in meeting the minimum staffing
    hours. Vacant positions or absent staff may not be counted.

    (b) Notwithstanding the minimum staffing requirements specified in paragraph (a), all facilities including those composed of apartments, shall have enough qualified staff to provide resident supervision, and to provide or arrange for resident services in accordance with the residents scheduled and unscheduled service needs, resident contracts and resident care standards as described in Rule 58A-5.0182.
    (c) The facility shall maintain a written work schedule which reflects the facility's 24-hour staffing pattern for a given time period.

    To make the above calculations:

    1. Obtain the Daily Nursing Assignment and Signature Sheet or nurse assignment sheet for the date (s) in question. It may be called something different at each nursing home.

    There may be a nursing assignment sheet for each of the day's three shifts. In addition, each wing or floor may have a separate sheet. If there are two floors in the Nursing Home, with a north and south wing on each floor, there may be 12 Daily Nursing Assignment and Signature Sheets for the Day: three sheets for each of the four wings. Each sheet will have the names of staff with the names of hours worked.

    The assignment sheets are not valid indications of work hours unless each name is accompanied by a signature.

    If you have questions if any of the people actually worked the hours documented on the sheets, you can ask the administrator or assistant if the documentation on the sheets can be supported by time cards.

    2. Obtain the facility census sheet for the date (s) in questions.
    3. If the Nursing Home also has an ALF on the premises, ask if any of the staffs names found on the Nursing Home assignment sheets can be documented for the same date on the ALF work schedule. If they can be, then ask for proof of the number of hours this staff worked solely in the Nursing Home. If it can't be proven, you can't count these hours.
    4. If in interviews with residents, you are told that staff do not assist in eating, turn bed bound residents every two hours at a minimum, reposition people in wheelchairs, etc., or provide showers only twice a week when residents have asked to be showered three times a week, then even if the staffing meets the minimum as calculated above, there is insufficient staff.

    The federal law states staffing must be sufficient to meet the needs of residents.

    SB 1202 page 72 (section 30)

    Hours of Direct Care per Resident per Day

    Certified Nursing Assistants Licensed Nurses
    - 1/1/02 - 2.3. Hours - Effective 1/1/02
    Never Below 1:20 - 1.0 Hours
    - 1/1/03 - 2.6 Hours - Never Below 1:40
    - 1/1/04 - 2.9 Hours

    Never Below 1:20 CNA and 1:40 Licensed Nurse is an Alternative to Per Shift Ratios.
  12. by   Trixxy
    tyvm :kiss
  13. by   Hellllllo Nurse
    Date study was released: May 10, 2002.
  14. by   Nurse Soc Mom
    There is no federally mandated patient/staff ratio. Dependent upon the state you live in there are many ppd mandates. In Colorado it is a 2.0 with the exception of VA nursing homes it is 2.5 direct patient care staff. The way that I personally try to staff is based on the resident acuity score from the MDS. That is as accurate as I can get in LTC. Many LTC try to undercut the direct patient care which is biting off your right arm. Work with your DON and MDS nurse with the RUGGS scoring to see what the acuity is. You can even narrow down the acuity by wings or groupings as pods to make assignments more fair. There is legislation to try to mandate RN-patient and CNA to patient ratio, but with the state of the economy and the difficulty it is to recruit staff that will be a challenge to pass.