While the determination of how the skilled nursing facility (SNF) staffs is based on the results of the facility assessment (FA) to recognize the specific needs of the organization, the intent of this information is to review the minimum staffing considerations to be incorporated as well based on recent provider questions.
Minimum weekly considerations [400.23(3)]
Skilled nursing facilities (SNF) are required to have the following clinical staffing in place:
- A minimum weekly average of certified nursing assistants (CNAs) and licensed nursing staffing combined at 3.6 hours of direct care per resident per day. As used in this sub-subparagraph, a week is defined as Sunday through Saturday.
- A minimum certified nursing assistant staffing of 2.5 hours of direct care per resident per day. In addition, remember that SNFs may not staff below one certified nursing assistant per 20 residents at any time.
- A minimum licensed nursing staffing of 1.0 hour of direct care per resident per day. In addition, remember that SNFs may not staff below one licensed nurse per 40 residents at any time.
Compliance considerations (400.141)
Complying with minimum staffing requirements include a variance based on having a conditional license. A SNF that has failed to comply with state minimum staffing requirements for two consecutive days is prohibited from accepting new admissions until the SNF has achieved the minimum staffing requirements for six consecutive days.
The requirement further notes that for purposes of this subparagraph, any person who was a resident of the facility and was absent from the facility for the purpose of receiving medical care at a separate location or was on a leave of absence is not considered a new admission. It should
be noted that the requirement includes that failure by the SNF to impose such an admissions moratorium is subject to a fine of $1,000.
A facility that does not have a conditional license may be cited for failure to comply with the standards in s. 400.23(3)(a)1.b. and c. only if it has failed to meet those standards on two consecutive days or if it has failed to meet at least 97% of those standards on any one day. A facility that has a conditional license must be in compliance with the standards in s. 400.23(3)(a) at all times.
As noted, these are applicable clinical staffing required minimums only. The determination of the actual number, credentialing type, assignments and shift determinations are to be established by your individualized SNF facility assessment. Thus, your actual staffing pattern would be best reflective of your evaluated needs to meet the challenges of your resident characteristics, internal and external considerations, etc.