Law and rules pertaining to the operation of nursing homes in the state can be located in sections 3701 of the Ohio’s Revised and Administrative Codes. Staffing requirements, including requirements for registered nurses are contained within 3701-17-08 OAC: Personnel Requirements.
Conditions for the provision of nursing care by registered nurses to residents of nursing homes are limited, with most RNs assuming supervisory or administrative roles. Each nursing home must employ a registered nurse to assume the role of director of nursing. This RN is required to work at least five days per week, primarily in daylight hours, to oversee the provision of nursing care. The name of the RN nursing director must be posted and accessible to all residents, family members, and staff. Two co-directors may be hired to fulfill the requirements of this rule.
Staff providing bedside care to nursing home residents may consist of nurse aides, RNs, and LPNs. A specific number of each level of staff is not required; instead, each home must have enough nursing staff collectively to meet the needs of the residents and to provide at least 2.5 hours of direct nursing care per resident, per day. Registered nurses and LPNs whose primary responsibility is administration or supervision may be counted in the calculation of nursing hours per resident, per day.
In previous years, “a minimum daily average of two-tenths of an hour per resident per day” (or 12 minutes) was to be provided by registered nurses. This rule was rescinded in 2011.
If there is no RN on duty, a nursing home must have a registered nurse on-call. As required of the nursing director, the name of the RN on-call must be posted in a place where all may access it easily.
The nursing home must have enough staff to cover for vacations, emergencies, and other absences. The home must also be able to meet the level of nursing care occasioned by the changing needs of the patients.
Staff of a nursing home may not be “double counted” as staff of an adjoining assisted living, day-care, or other type of facility in order to meet the rule requirements regarding nursing staff.
So…when a nurse calls me to ask if she can be made to “care for” fifty patients, I have to tell them that the requirements for nursing homes do not include a mandated ratio of patients to staff, but a formula requiring so many hours of nursing care per patient per day.
An assisted living facility is defined as a “residential care facility” under 3701-17-50 OAC (FF):
“Residential care facility" means a home that provides either of the following:
(1) Accommodations for seventeen or more unrelated individuals and supervision and personal care services for three or more of those individuals who are dependent on the services of others by reason of age or physical or mental impairment;
(2) Accommodations for three or more unrelated individuals, supervision and personal care services for at least three of those individuals who are dependent on the services of others by reason of age or physical or mental impairment, and to at least one of those individuals, any of the skilled nursing care authorized by section 3721.011 of the Revised Code.”
Staffing requirements for assisted living are somewhat different than that of a nursing home. First, the administrator of a residential care facility may provide personal care services to the residents and be counted as staff in facilities of 16 or fewer beds (3701-17-54 (B)(1) OAC). Administrators must be present at least 20 hours per calendar week between the hours of 8 am and 6 pm.
Staff providing personal care services such as assistance with activities of daily living, assistance with self-administration of medications, or preparing special diets (See 3701-17-50 (Z) OAC), must be at least 18 years old (Sixteen year olds are allowed, but must be have on-site supervision by someone at least 18 years of age), read-write-and-understand English if assisting residents with self-administration of medications, and be trained in appropriate activities for residents who have cognitive impairments, mental illness, or special emotional needs. Health exams, finger printing, and some background checks are required. First-aid training must be completed within sixty days of hire.
At least one staff member prepared to provide personal care services must be on duty at all times (3001-17-54 (C)(1) OAC).
Only if a residential care facility chooses to provide skilled nursing care must a registered nurse be hired. Should that skilled care include medication administration, a licensed nurse, physician, or another person authorized by law to administer medication, such as a medication aide, must be on duty for sufficient time to observe acceptance and reaction to a medication (3701-17-54 (F) OAC).
And the regulations go on, but with little guidance as to staffing, other than adequate to meet patient needs.
Did you know?
Average costs for long-term care in the United States in 2010 were:
- $205 per day or $6,235 per month for a semi-private room in a nursing home
- $229 per day or $6,965 per month for a private room in a nursing home
- $3,293 per month for care in an assisted living facility (for a one-bedroom unit)
- $21 per hour for a home health aide
- $19 per hour for homemaker services
- $67 per day for services in an adult day health care center
The Commonwealth Fund reports that people 65 years of age and older are the sickest and most like to have problems paying medical bills or getting their necessary health care.
Retrieved from http://www.commonwealthfund.org/publications/newsletters/ealerts/2014/nov/older-adults-in-us-sickest?omnicid=EALERT624238firstname.lastname@example.org.
Under federal nursing home regulations, nursing homes must:
- Have sufficient nursing staff. (42 CFR §483.30)
- Conduct initially a comprehensive and accurate assessment of each resident’s functional capacity. (42 CFR §483.20)
- Develop a comprehensive care plan for each resident. (42 CFR §483.20)
- Prevent the deterioration of a resident’s ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to communicate. (42 CFR §483.25)
- Provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming, and personal oral hygiene. (42 CFR §483.25)
- Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities. (42 CFR §483.25)
- Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. (42 CFR §483.25)
- Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible. (42 CFR §483.25)
- Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (42 CFR §483.25)
- Maintain acceptable parameters of nutritional status. (42 CFR §483.25)
- Provide each resident with sufficient fluid intake to maintain proper hydration and health. (42 CFR §483.25)
- Ensure that residents are free of any significant medication errors. (42 CFR §483.25)
- Promote each resident’s quality of life. (42 CFR §483.15)
- Maintain dignity and respect of each resident. (42 CFR §483.15)
- Ensure that the resident has the right to choose activities, schedules, and health care. (42 CFR §483.40)
- Provide pharmaceutical services to meet the needs of each resident. (42 CFR §483.60)
- Be administered in a manner that enables it [the nursing home] to use its resources effectively and efficiently. (42 CFR §483.75)
- Maintain accurate, complete, and easily accessible clinical records on each resident. (42 CFR §483.75)