The federal Nursing Home Reform Act (NHRA), as part of the Omnibus Budget Reconciliation Act (OBRA) of 1987, requires minimum staffing levels for registered nurses (RNs) and licensed practical nurses (LPNs), and a minimum educational training for nurse's aides. Federal law requires Medicare and Medicaid certified nursing homes to have a registered nurse (RN) director of nursing (DON), an RN on duty at least 8 hours a day, 7 days a week, and a licensed nurse (RN or LPN) on duty the rest of the time. There are no minimum staffing levels for nurse's aides and only a minimum of 75 hours of training for nurse's aides is required.
Nursing homes are required “to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident.” This means that federal law does not mandate specific nurse-to-resident staffing ratios and does not require any minimum level of staffing at all for nurse's aides other than the instructions to provide sufficient staff.
Most states have additional requirements above the federal ones. The states take two basic approaches to minimum staffing requirements. Some states require direct care staff to provide a minimum number of care hours to patients each day, others set a specific direct care staff-to-patient ratio and a few states use a combination.
Below is what I was able to find about minimum staffing levels in Mississippi.
Minimum Standards for Personal Care Homes Assisted Living
Rule 47.11.4 Other Personnel. All direct care employees shall be a minimum of 18 years of age, and shall have verification that they are not listed on the "Mississippi Nurses Aide Abuse Registry." ... The following staffing ratio shall apply:
- One (1) resident attendant per fifteen (15) or fewer residents for the hours of 7:00 AM until 7:00 PM.
- One (1) resident attendant per twenty-five (25) or fewer residents for the hours of 7:00 PM until 7:00 AM. ...
- Shall have a licensed nurse on the premises for eight (8) hours a day. Licensed nurses, as required by this section, shall not be included in the resident attendant ratio.
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Minimum Standards for Institutions for the Aged or Infirm (Nursing Homes)
Rule 45.4.1 Nursing Facility. To be classified as a facility, the institution shall comply with the following staffing requirements:
- Minimum requirements for nursing staff shall be based on the ratio of two and eight-tenths (2.80) hours of direct nursing care per resident per twenty-four (24) hours. Staffing requirements are based upon resident census. Based upon the physical layout of the nursing facility, the licensing agency may increase the nursing care per resident ratio.
- Each facility shall have the following licensed personnel as a minimum ...
- Non-Licensed Staff. The non-licensed staff shall be added to the total licensed staff, to complete the required staffing requirements.
- There shall be at least two (2) employees in the facility at all times in the event of an emergency.
Minimum Standards of Operation for Mississippi Hospitals
Rule 41.30.3. Individual staffing patterns shall be developed for each nursing care unit, including the surgical and obstetrical suites, each special care unit, and outpatient services. The staffing patterns shall provide for sufficient nursing personnel and for adequate supervision and direction by registered nurses consistent with the size and complexity of the hospital.
The Mississippi State Department of Health is responsible for enforcement of federal and state regulations for healthcare facilities.