Section 300.1230  Staffing

a)         Staffing shall be based on the needs of the residents, and shall be determined by figuring the number of hours of nursing time each resident needs on each shift of the day.  This determination shall be made separately for both licensed and nonlicensed nursing personnel.  (A, B)

b)         In a facility whose residents participate in regularly scheduled therapeutic programs outside the facility, such as school or sheltered workshops, the minimum hours per day of nursing care are reduced proportionately.  Exceptions to the shift distribution will be allowed if more than 50% of the residents are regularly scheduled to be out of the facility, but the total required hours must be provided daily. For example:  an ICF resident requires 1.75 hours of care per day, but attends a workshop for six hours five days a week. The resident's required minimum hours of care is reduced by 25% in calculating staffing hours required on week days.

c)         It is the responsibility of each facility to determine the staffing needed to meet the needs of its residents.

d)         In determining the level of care a resident needs, the patient evaluation system in Medical Review/Utilization Review program may be used.  The facility may use other methods of determining skilled and intermediate level residents, but must make the method of determination used available to the Department.  Residents whose care is reimbursed by the State shall be at the level determined by the Medical Review/Utilization Review patient evaluation system.

e)         The designations used for shifts in the following tables are used for illustrative purposes only, and are not meant to imply that other shift designations cannot be used by the facility.

f)          The following figures apply to numbers of persons actually on duty and not to numbers of persons scheduled to be on duty.

g)         The director of nursing's time shall not be included in staffing ratios.

h)         Level of Care Determinations

1)         The following figures are also considered to be minimum requirements, and each facility, except those of 250 or more occupied beds, shall provide at least the amount of staffing indicated.  However, it is recognized that there may be occasional differences of opinion between facility staff and Department surveyors regarding the level of care an individual resident may require.  When such differences occur, the surveyor shall determine whether or not the resident is receiving appropriate care.  If the resident is, the surveyor shall accept the facility's level of care determination in determining the number of nursing hours to be provided by the facility.

2)         Facilities of more than 250 occupied beds must meet the staff-resident ratio for the 250 residents needing the highest level of care.  Additional staff shall be provided to meet resident needs as determined by the facility and verified by the Department.  The Department may, based upon the Department's Patient Care Evaluation System review of resident care, require the facility to provide additional nursing hours to meet resident needs.

i)          In computing the number of persons needed in the following examples, any figure less than .25 will be dropped from the computation and any figure of .75 or higher will go to the next higher number.  Figures in between .25 and .75 will require at least the amount of coverage indicated:  for example, .25 will require two hours of coverage; .3 will require two hours of coverage; .5 will require four hours of coverage; .6 will require five hours of coverage; .74 will require six hours of coverage; .75 or higher will require eight hours of coverage.

j)          These additional hours may be provided by: a part-time person working those hours only on that shift each day; a full-time person working a shift that spans two regular shifts - for example from noon to 8 P.M.; or by an additional full-time person on the shift.  However, these figures are minimal staffing requirements, and it is recommended that a full-time person be provided.

k)         The facility shall schedule nursing personnel in such a manner that the needs of all residents are met.  At least 40% of the minimum required hours shall be on the day shift, at least 25% of the minimum required hours shall be on the evening shift, and at least 15% of the minimum required hours shall be on the night shift.

l)          Skilled Nursing Care

            Residents needing skilled nursing care may only be cared for in facilities licensed as Skilled Nursing Facilities.  Each resident needing skilled care shall be provided at least 2.5 hours of nursing-personal care each day, of which 20% must be licensed nurse time.  (A, B)

m)        Intermediate Nursing Care – General

            Residents needing intermediate care may be cared for in facilities licensed as either Skilled Nursing Facility or Intermediate Care Facility.  Each resident needing intermediate care shall be provided at least 1.7 hours of nursing/personal care each day, of which at least 20% must be licensed nurse time.  (A, B)

n)         Intermediate Nursing Care – Light

            A Long-term care resident needing light intermediate care is one who needs personal care as defined in Section 1-120 of the Act; is mobile; requires some nursing services; needs a program of social services and activities directed toward independence in daily living skills; and needs daily monitoring.  Each resident needing light intermediate care shall be provided with at least one hour of nursing/personal care each day, of which at least 20% must be licensed nurse time.  (A, B)

o)         In order to determine the numbers of nursing personnel needed to staff any facility, the following procedures shall be used:

1)         The facility shall determine the number of residents needing skilled, general intermediate, and light intermediate or sheltered care.

2)         The number of residents in each of the three categories shall be multiplied by the overall hours of coverage needed each day for each category.

3)         Adding the hours of care needed for the residents in each of the three categories will give the total hours of care needed by all residents in the facility.

4)         Multiplying the total hours needed each day by the percentages assigned to each shift will give the total minimum hours of care that must be provided on that shift. (Remember that the percentages assigned to each shift must total 100% each day.)

5)         Multiplying the total minimum hours of care needed on each shift by 20% will give the minimum amount of licensed nurse time that must be provided during a 24-hour period.

6)         The remaining 80% of the minimum required nursing hours of care can be fulfilled by either nursing assistants or licensed nursing personnel as long as it can be documented that they provide restorative/rehabilitative nursing measures, general nursing care, and personal care as defined in Section 300.1210.

7)         The amount of time determined in subsection (5) and (6) is expressed in hours.  Dividing the total number of hours needed by the number of hours each person works per shift (usually seven and one half or eight hours) will give the number of persons needed to staff each shift.

p)         Example of Staffing Calculations

1)         Following is an example of this computation assuming a l00 bed Skilled Nursing Facility which has 25 skilled, 50 general intermediate and 25 light intermediate residents, assigning 45% to day shift; 35% to evening shift and 20% to the night shift.

2)         Staffing would be computed as follows:

A)        Total Minimum Hours of Care Needed

B)        Minimum Total Hours Needed Per Shift

C)        Licensed Nurse Coverage

D)        Licensed Nurses Required

E)         Nurse Aide/Orderly Coverage

F)         Nurse Aides/Orderlies Required

(Source:  Amended at 13 Ill. Reg. 4684, effective March 24, 1989)