Table 1.
Summary of Changes in State Minimum Staffing Standards, 1998–2001
| State | Regulations Before 1998 (If Any) | 1998 | 1999 | 2000 | 2001 |
|---|---|---|---|---|---|
| Arkansas* | Staffing legislation (staff-to-resident ratio) began in 1989 | By 6/30/2000, for 1–70 beds LN (RN, LPN)—1:30 days, 1:30 evenings, 1:50 nights CNA—1:8 days, 1:12 evenings, 1:18 nights | |||
| By 9/30/2000, for 1–70 beds LN (RN, LPN)—1:15 days, 1:15 evenings, 1:35 nights CNA—1:7 days, 1:12 evenings, 1:18 nights | |||||
| California | First staffing standard in 1980 | 3 direct care staff HPRD averaged daily, LN counted twice in practice known as doubling | 3.2 direct care staff HPRD with no doubling | ||
| Delaware* | From the early 1980s, 2.5 HPRD for SNF and 2.25 HPRD for ICF | Phase-in of ratios began on 3/1/2001: facilities must provide at least 3.0 direct care staff HPRD in Phase I | |||
| Florida | Before 2001, 0.6 LN HPRD averaged daily and 1.7 CNA HPRD averaged daily | Increased HPRD and added ratios in 2001 LN—1 HPRD averaged daily, 1:40 residents CNA—2.6 HPRD averaged daily, 1:20 residents | |||
| Georgia | Increased HPRD LN—1 DON RN full-time day shift and 1 LN charge nurse each shift 24 hours/7 days including 1 LN: 7 residents For SNF, 2 direct care staff HPRD averaged daily For Medicaid levels I and II, 2.5 direct care staff HPRD averaged daily | ||||
| Iowa | Separate ratios for SNF and ICF | Rescinded ratio for SNF, leaving previously higher ICF ratio to apply to all facilities 2 direct care staff HPRD averaged weekly, of which 20% must be LN time | |||
| Maine | Before 2001, direct care staff-to-occupied bed ratios: 1:8 days, 1:12 evenings, 1:20 nights | Increased direct care staff-to-occupied bed ratios effective 6/1/2001: 1:5 days, 1:10 evenings, 1:15 nights | |||
| Minnesota | Before 2001, 0.95 direct care staff HPRD (case-mix adjusted) | Rescinded a ratio and developed standards with conversion to a Medicaid payment methodology based on the Minimum Data Set and Resource Utilization Groups (34 case-mix levels). For all facilities, 2 direct care staff HPRD averaged daily | |||
| Mississippi | 2.2 direct care staff HPRD averaged daily | Increased to 2.8 direct care staff HPRD averaged daily | |||
| New Mexico | (None) | Established HPRD in 2000 For SNF or SNF/ICF, 2.5 direct care staff HPRD averaged weekly For ICF only, 2.3 direct care staff HPRD averaged weekly | |||
| Ohio | Before 2001, 1 attendant: 15 residents on duty 24 hours/7 days and at least 1 person working 40 hours/week for each 4 residents | Added HPRD 1 direct care staff: 15 residents, or major part thereof, and 2.75 direct care staff HPRD averaged daily, of which 0.2 RN HPRD, 2 CNA HPRD, and 0.55 other HPRD | |||
| Oklahoma* | Before 2000, direct care staff ratios: 1:10 days, 1:15 evenings, 1:20 nights | Increased ratios and added HPRD on 9/1/2000 1:8 days, 1:12 evenings, 1:17 nights 0.32 LN HPRD, 2.14 direct care staff HPRD | Increased ratios on 9/1/2001 1:7 days, 1:10 evenings, 1:16 nights 2.44 direct care staff HPRD | ||
| Pennsylvania | Before 1999, 2.5 direct care staff HPRD averaged daily | 2.7 direct care staff HPRD averaged daily and 1 direct care staff: 20 residents | |||
| South Carolina | Before 1999, CNA-to-resident ratios: 1:11 days, 1:15 evenings, 1:22 nights | Increased CNA-to-resident ratios: 1:9 days, 1:13 evenings, 1:22 nights | |||
| Vermont | (None) | Established HPRD on 12/15/2001 3 direct care staff HPRD averaged weekly, of which 2 CNA HPRD | |||
| Wisconsin | Before 1999 For skilled nursing residents, 2.25 direct care staff HPRD averaged daily, of which 0.45 LN HPRD For intermediate care residents, 2 direct care staff HPRD averaged daily, of which 0.4 LN HPRD For limited nursing care residents, 1.25 direct care staff HPRD averaged daily, of which 0.25 LN HPRD | Increased HPRD and added intensive care HPRD category For skilled nursing residents, 2.5 direct care staff HPRD averaged daily, of which 0.5 LN HPRD For intermediate care residents, 2 direct care staff HPRD averaged daily, of which 0.4 LN HPRD For intensive care residents, 3.25 direct care staff HPRD averaged daily, of which 0.65 LN HPRD |
Source: (1) Harrington (2002) and (2) U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability (2003).
*
Multiple changes/phase-in.
HPRD, hours per resident day; LN, licensed nurse; RN, registered nurse; LPN, licensed practical nurse; CNA, certified nursing assistant; DON, director of nursing; SNF, skilled nursing facility; ICF, intermediate care facility.