Nursing Home Staffing Requirements

Unfortunately, nursing home abuse is more common than it should be. One of the main reasons given to explain the rise in abuse and neglect is the lack of competent staff at the facilities. Problems are caused when there are insufficient staffing numbers, and when there is a lack of staff with requisite training and experience. Both the individual states and the federal government have requirements for staffing nursing homes. This article provides an overview of some of the relevant federal requirements.

Federal Standards for Regulating Nursing Home Staffing

Most nursing homes in the U.S. receive funding through federal programs such as Medicare or Medicaid. If a nursing home receives federal funding, it must comply with the federal statutory and regulatory standards.

Under the federal standards, the staff must provide care for residents that will promote maintenance or enhancement of each resident's quality of life. See U.S.C. §§ 1395i-3(b)(1)(A), 1396r(b)(1)(A), C.F.R. § 483.15. More specifically, a facility must provide the nursing staff and services required to attain or maintain each resident's highest practicable physical, mental, and psychological well-being. See U.S.C §§ 1395i-3(b)(4)(A), 1396r(b)(1)(A), 42 C.F.R. § 483.25.

General Staffing

There are various staffing requirements under federal law. Generally, a facility should have sufficient staff to provide nursing and related services to attain and maintain the well-being of each resident, as determined by resident assessments and individual plans of care. The staffing requirements apply on a 24-hour basis. See 42 U.S.C. §§ 1395i-3(b)(4)(C), 1396r(b)(4)(C), 42 C.F.R. § 483.30.

Nursing and Nursing Aides

Nursing homes must provide 24-hour nursing services to residents. A registered nurse must be employed for at least 8 consecutive hours per day, 7 days per week unless the facility meets certain waiver requirements. Additionally, there must be a full-time director of nursing who is also a registered nurse. See 42 U.S.C. §§ 1395i-3(b)(4)(C), 1396r(b)(4)(C), 42 C.F.R. § 483.30.

Under the federal laws and regulations, there are also requirements for nursing aides. A nursing aide is defined as any individual providing nursing related services to residents in a facility who is not a licensed health care professional, a registered dietitian, or someone who volunteers to provide such services without pay. Nursing homes cannot employ an aide unless that person meets and maintains certain training and competency standards. In general, the training, competency, and evaluation programs must meet federal standards. The federal standards are further supplemented by the individual states and can vary from jurisdiction to jurisdiction. See 42 U.S.C. §§1395i-3(b)(5), 1396r(b)(5), 1396r(e)(2), 42 C.F.R. §§ 483.75, 483.150-483.152.

Physicians

According to the federal standards, each resident's care must be supervised by a physician who is available in the event of an emergency. Additionally, there must be a facility designated physician medical director. The medical director is responsible for implementing resident care policies and coordinating medical care in the facility. See 42 U.S.C. §§ 1395i-3(b)(6), 1396r(b)(6), 42 C.F.R. § 483.40, 483.75(I).

Other Required Services

There are various other federal staffing requirements for services and service providers at nursing homes. For example, there are requirements for:

• Dietary services: 42 U.S.C.§§ 1395i-3(b)(4)(A)(iv), 1396r(b)(4)(A)(iv), 42 C.F.R. § 483.35
• Pharmaceutical services: 42 U.S.C. §§ 1395i-3(b)(4)(A)(iii), 1396r(b)(4)(A)(iii), 1396r(b)(4)(A)(iii), 42 C.F.R. § 483.60
• Rehabilitative services: 42 U.S.C. §§ 1395i-3(b)4)(A)(i), 1396r(b)(4)(A)(i), 1396r(b)(4)(A)(i), 42 C.F.R. § 483.45
• Dental services: 42 U.S.C. §§ 1395i-3(b)(4)(A)(vi), 1396r(b)(4)(A)(vi), 42 C.F.R. § 483.55
• Vision and hearing services: 42 C.F.R. 483.25(b)
• Social services: 42 U.S.C. §§ 1395i-3(b)(4)(A)(ii), 1396r(b)(4)(A)(ii), 42 C.F.R. § 483.15(g)
• Therapeutic services: 42 U.S.C. §§ 1395i-3(b)(4)(A)(v), 1396r(b)(4)(A)(v), 42 C.F.R. § 483.15(f)
• Mental health services: 42 U.S.C. §§ 1395i-3(b)(2)(A)(i), 1396r(b)(2)(A)(i), 1396r(b)(2)(A)(vii), 42 C.F.R. §§ 483.25(f), 483.45.

Conclusion

An insufficient number of competent staff is one of the main contributors to nursing home abuse and neglect. Reviewing the above federal standards will allow you to make sure that the nursing home in which you or a loved one resides is following the law.

Form: Nursing Home Staffing Requirements

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Nursing Home Staffing Requirements

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