TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER c: LONG-TERM CARE FACILITIES
PART 300 SKILLED NURSING AND INTERMEDIATE CARE FACILITIES CODE
SECTION 300.1230 DIRECT CARE STAFFING
Section 300.1230 Direct Care Staffing
a) For the purposes of this Section, the following definitions shall apply:
1) Direct care is the provision of nursing care or personal care as defined in Section 300.330, therapies, and care provided by staff listed in subsection (f).
2) Skilled care is skilled nursing care, continuous skilled nursing observations, restorative nursing, and other services under professional direction with frequent medical supervision.
3) Intermediate care is basic nursing care and other restorative services under periodic medical direction.
b) The number of staff who provide direct care who are needed at any time in the facility shall be based on the needs of the residents, and shall be determined by figuring the number of hours of direct care each resident needs on each shift of the day.
c) If residents participate in regularly scheduled therapeutic programs outside the facility, such as school or sheltered workshops, the minimum hours per day of direct care staffing in the facility are reduced for the hours the residents are not in the facility.
d) Each facility shall provide minimum direct care staff by:
1) Determining the amount of direct care staffing needed to meet the needs of its residents; and
2) Meeting the minimum direct care staffing ratios set forth in this Section.
e) The direct care staffing requirements in this Section apply to the number of persons actually on duty and not to the number of persons scheduled to be on duty.
f) For the purpose of computing staff to resident ratios, direct care staff shall include the following, as long as the person is assigned to duties consistent with the identified job title and documented in employee time schedules as required by Section 300.650(i):
1) registered nurses;
2) licensed practical nurses;
3) certified nurse assistants;
4) psychiatric services rehabilitation aides (see Section 300.4090);
5) rehabilitation and therapy aides;
6) psychiatric services rehabilitation coordinators (see Section 300.4090);
7) assistant directors of nursing;
8) 50% of the Director of Nurses' time;
9) 30% of the Social Services Directors' time (Section 3-202.05 of the Act); and
10) licensed physical, occupational, speech and respiratory therapists.
g) Facilities subject to Subpart S may utilize specialized clinical staff, as defined in Section 300.4090, to count towards the staffing ratios. (Section 3-202.05(a) of the Act)
h) Care Determinations
When differences of opinion occur between facility staff and Department surveyors regarding the care an individual resident may require, the surveyor shall determine whether the resident is receiving appropriate care. If the resident is receiving appropriate care, the surveyor will accept the facility's determination of the number of direct care hours the facility shall provide.
i) The facility shall schedule nursing personnel so that the nursing needs of all residents are met.
j) Skilled Nursing and Intermediate Care
For the purpose of this subsection, "nursing care" and "personal care" mean direct care provided by staff listed in subsection (f).
1) Effective July 1, 2010, for each resident needing skilled care, a minimum staffing ratio of 2.5 hours of nursing and personal care each day must be provided; for each resident needing intermediate care, 1.7 hours of nursing and personal care each day must be provided.
2) Effective January 1, 2011, the minimum staffing ratios shall be increased to 2.7 hours of nursing and personal care each day for a resident needing skilled care and 1.9 hours of nursing and personal care each day for a resident needing intermediate care.
3) Effective January 1, 2012, the minimum staffing ratios shall be increased to 3.0 hours of nursing and personal care each day for a resident needing skilled care and 2.1 hours of nursing and personal care each day for a resident needing intermediate care.
4) Effective January 1, 2013, the minimum staffing ratios shall be increased to 3.4 hours of nursing and personal care each day for a resident needing skilled care and 2.3 hours of nursing and personal care each day for a resident needing intermediate care.
5) Effective January 1, 2014, the minimum staffing ratios shall be increased to 3.8 hours of nursing and personal care each day for a resident needing skilled care and 2.5 hours of nursing and personal care each day for a resident needing intermediate care. (Section 3-202.05(d) of the Act)
k) Effective September 12, 2012, a minimum of 25% of nursing and personal care time shall be provided by licensed nurses, with at least 10% of nursing and personal care time provided by registered nurses. Registered nurses and licensed practical nurses employed by a facility in excess of these requirements may be used to satisfy the remaining 75% of the nursing and personal care time requirements. (Section 3-202.05(e) of the Act)
l) To determine the numbers of direct care personnel needed to staff any facility, the following procedures shall be used:
1) The facility shall determine the number of residents needing skilled or intermediate care.
2) The number of residents in each category shall be multiplied by the overall hours of direct care needed each day for each category.
3) Adding the hours of direct care needed for the residents in each category will give the total hours of direct care needed by all residents in the facility.
4) Multiplying the total minimum hours of direct care needed by 25% will give the minimum amount of licensed nurse time that shall be provided during a 24-hour period. Multiplying the total minimum hours of direct care needed by 10% will give the minimum amount of registered nurse time that shall be provided during a 24-hour period.
5) Additional Direct Care Hours Equal to at Least 75% of the Minimum Required
The remaining 75% of the minimum required direct care hours may be fulfilled by other staff identified in subsection (f) as long as it can be documented that they provide direct care and as long as nursing care is provided in accordance with the Nurse Practice Act.
6) The amount of time determined in subsections (l)(4) and (5) is expressed in hours. Dividing the total number of hours needed by the number of hours each person works per shift (usually 7.5 or 8 hours) will give the number of persons needed to staff each shift. Calculations shall not include time for scheduled breaks or scheduled in-service training. The number of residents used to calculate staff ratios shall be based on the facility's midnight census.
m) Example of Staffing Calculations
1) Following is an example of this computation assuming a l00-bed Skilled Nursing Facility that has 25 residents needing skilled care and 75 residents needing intermediate care, and assuming that the identified needs of the residents have led the facility to assign 45% of the staff to the day shift; 35% to the evening shift and 20% to the night shift.
2) Under the subsection (j) requirements for January 1, 2014, staffing would be computed as follows:
A) Total Minimum Hours of Care Needed
B) Minimum Total Hours Needed Per Shift
C) Licensed Nurse Time Per Shift
D) Licensed Nurses Required
E) Registered Nurse Time
F) Registered Nurses Required
G) Additional Direct Care Hours*
H) Additional Direct Care Staff* Required
*See subsection (l)(5).
(Source: Amended at 36 Ill. Reg. 14090, effective August 30, 2012)