State Guide to CNA-to-Patient Staffing Ratios
Are you searching for effective strategies to efficiently and safely manage your certified nursing assistant personnel? Look no further than this comprehensive guide on the CNA-to-patient staffing ratios from Nursa. We understand that increasing staff numbers may not always be feasible or sustainable, but having too few nursing assistants can lead to potential safety and regulatory issues for your facility. Stay informed about the regulations in your state to ensure you stay within the appropriate limits.
Understanding Legal CNA-to-Patient Ratios
The regulations regarding the CNA-to-patient ratio in your facility depend on the state in which you are located. It is important to note that not all states have specific staffing ratio requirements for certified nursing assistants. In fact, even registered nurses (RNs) and licensed practical nurses (LPNs) may not always be subject to staffing ratio regulations in nursing facilities. Instead, many regulations focus on the number of care hours each resident receives per day, known as HPRD (hours per resident per day). This ensures that residents receive the necessary care from nursing personnel or direct care staff.
Understanding State Nursing Home Staffing Requirements
Nursing homes, also known as long-term care facilities (LTCs), assisted living residences, and skilled nursing facilities (SNFs), are subject to strict regulations from the Centers for Medicare & Medicaid (CMS) and state legislation. These regulations dictate the staffing requirements based on the level of licensure or certification of healthcare professionals, and may also take into account the type of facility.
CNA Patient Ratios by State
Here’s a comprehensive table that outlines the specific CNA staffing requirements for nursing home facilities. Keep in mind that staffing ratios may vary for different types of facilities. For your convenience, we have also included source links to provide additional information.
State | CNA Staffing Requirements | Regulatory Language | Source |
---|---|---|---|
Alabama | A specific ratio for CNAs is not provided. | Sufficient staff is required at all times. | Alabama Administrative Code 420-5-10-.11 Nursing Services (2) Revised 5/15/2022 |
Alaska | A specific ratio for CNAs is not provided. | Sufficient staffing is required to meet resident needs. | Alaska Administrative Code 7 AAC 12.275 Nursing and Medical Services |
Arizona | A specific ratio for CNAs is not provided. | Sufficient nursing personnel is required to meet residents’ needs. | Arizona Administrative Code 9 A.A.C. 10 codified 10/2022-12/2022 R9-10-412. Nursing Services |
Arkansas | A required staffing ratio for CNAs is not specified. Current legislation enforces a mandatory average of 3.36 HPRD. | The Arkansas Office of Long Term Care (OLTC) offers an online portal and downloadable tool called the “Minimum Staffing Calculator” to facilitate easier reporting and calculation of staffing requirements for nursing facilities. | Arkansas Act 715 Regular Session of 2021 Arkansas OLTC regulations |
California | A specific ratio for CNAs is not provided. | All skilled nursing facility residents must receive 3.5 HPRD, of which 2.4 HPRD must be provided by a CNA. | California Health and Safety Code HSC § 1276.65 |
Colorado | A specific ratio for CNAs is not provided. | Sufficient staff is required to proffer “prompt assistance.” | Code of Colorado Regulations 6 CCR 1011-1 Chapter 05. Section 9. Nursing Services |
Connecticut | In a “Rest Home,” under licensed nurse supervision, there must be at least one CNA on duty on each resident floor at all times. Additionally, between 7 a.m. and 9 p.m., the nursing and CNA personnel must provide .70 HPRD, and between 9 p.m. and 7 a.m., nursing and CNA personnel must provide .17 HPRD. In a “Chronic and Convalescent Nursing Home,” during the hours of 7 a.m. and 9 p.m., patients must receive 1.4 HPRD from nursing and CNA personnel. From 9 p.m. to 7 a.m., patients must receive .5 HPRD from nursing and CNA personnel. | Sufficient nurse’s aides should be staffed to provide patient care 24-7. | Connecticut Public Health Code Title 19, Sec. 19-13-D8t. (m) Nursing Staff Effective on January 1, 2022, in Public Act 21-185, “the Department of Public Health shall establish minimum staffing level requirements for nursing homes of three hours of direct care per resident per day.” |
Delaware | CNA staffing ratios are as follows: Day: One CNA to seven residents Evening: One CNA to 10 residents Night: One CNA to 15 residents | Adequate staffing must be in place to meet all residents’ needs and 3.67 HPRD. | Delaware Code Title 16 Health and Safety § 1162. Nursing Staffing (e) Effective May 2003 |
District of Columbia | A specific ratio for CNAs is not provided. | — | D.C. Municipal Regulations Title 22 B3208 Nursing Services |
Florida | A minimum ratio of one CNA per 20 residents is required. Residents must receive a minimum of two HPRD from a CNA. | Sufficient staffing is required to meet residents’ needs and meet a weekly average of 3.6 HPRD. | Florida Statutes 400.23 |
Georgia | A specific ratio for CNAs is not provided. At least one of every seven nursing staff (excludes dining assistants) must be a licensed nurse. | Residents must receive at least two HPRD. | Georgia Rules and Regulations Rule 111-8-56-.04. Nursing Services |
Hawaii | A specific ratio for CNAs is not provided. | Sufficient nursing personnel are required to meet residents’ needs. | Hawaii Administrative Rules Adopted September 2022 Title 11 Chapter 94.2-39 Nursing Services |
Idaho | A specific ratio for CNAs is not provided for SNF staffing requirements. A specific ratio for CNAs is not provided for Residential Assisted Living Facility staffing requirements. | SNF residents must receive at least two HPRD. There are no HPRD requirements listed for Residential Assisted Living Facilities. | Idaho Administrative Rules 16.03.02 Skilled Nursing Facilities 16.03.22 Residential Assisted Living Facilities |
Illinois | A specific ratio for CNAs is not provided; however, CNAs are identified as direct care staff. Staffing ratios must meet 3.8 HPRD for residents requiring skilled care and 2.5 HPRD for residents requiring intermediate care. | A licensed nurse must provide 25 percent of HPRD. | Illinois Administrative Code Title 77 Chapter 1. Section 300.1230 Direct Care Staffing |
Indiana | A specific ratio for CNAs is not provided. | Sufficient staff is required to provide nursing and related services to each resident. | Indiana Administrative Code 410 16.2-3.1-17 Nursing Services |
Iowa | A specific ratio for CNAs is not provided. | The facility must provide required nursing care services on a 24-7 basis through qualified nurses and ancillary coverage. | Iowa Code 58.11(2) Nursing Supervision and Staffing 58.19(135C) Required Nursing Services for Residents |
Kansas | A specific ratio for CNAs is not provided. | Each resident must receive a weekly average of two HPRD and a daily average no lower than 1.85 HPRD. | Kansas Administrative Regulations Article 39. 28-39-154. Nursing services. |
Kentucky | A specific ratio for CNAs is not provided. | Adequate staffing is required to meet patient needs. | Kentucky Administrative Regulations Section 902 KAR 20:048 – Operation and Services; Nursing Homes |
Louisiana | A specific ratio for CNAs is not provided. Residents must receive a minimum of 2.35 HPRD. | Sufficient staff is required to provide nursing and related services to each resident. | Louisiana Administrative Code Title 48 Subchapter B Nursing Services. §9821. General Provisions |
Maine | Direct care staff-to-patient ratio for facilities shall not fall below the following: Day shift: one to five Evening shift: one to 10 Night shift: one to 15 | CNAs are considered direct care staff alongside RNs, LPNs, and personal support specialists. | Code of Maine Rules 10.144 Chapter 110 Section 9 Resident Care Staffing A.4. Minimum Staffing Ratios |
Maryland | A specific ratio for CNAs is not provided. However, the ratio of “nursing service personnel” may not fall below one to 15. | Sufficient staff of supervisory and support personnel is required to provide a minimum of three HPRD for every resident. | Maryland Code Regulations10.07.02.19 – Nursing Services – Staffing |
Massachusetts | Residents must receive a minimum of 3.58 HPRD, .508 of which must be provided by an RN. Level III Facilities must have at least one CNA on duty during the night shift. | An adequate number of trained and experienced nursing personnel must be on duty 24-7. | 105 Code of Massachusetts Regulations150.000: Standards for Long-Term Care Facilities Section 150.007 Nursing Services |
Michigan | A specific ratio for CNAs is not provided. Direct care staff-to-patient ratios are as follows: Morning shift: one to eight Afternoon shift: one to 12 Night shift: one to 15 | Nursing homes must provide sufficient staff to provide no less than 2.25 HPRD. | Michigan Compiled Laws Section 333.21720a |
Minnesota | A specific ratio for CNAs is not provided. Residents in nursing homes not participating in the medical assistant program must receive a minimum of two HPRD. Residents in participating nursing homes must receive the greater of the following: Two hours per resident per 24 hours 0.95 hours per standardized resident day | Sufficient staff is required to provide nursing and related services to each resident. | Minnesota Administrative Rules 4658.0510 Nursing Personnel |
Mississippi | A specific ratio for CNAs is not provided. | Sufficient staff is required so that all residents receive a minimum of 2.8 HPRD. | Mississippi Health Facilities Regulations Rule 45.4.1 Nursing Facility |
Missouri | For SNFs, a specific ratio for CNAs is not provided. For residential care and assisted living facilities, minimum staff ratios are as follows: Day shift: one to 15 Evening shift: one to 20 Night shift: one to 25 | An adequate number and type of staff is required to provide proper care to each resident. If a residential care or assisted living facility is directly adjacent to another LTC, other staffing ratios may apply. | Missouri Code of State Regulations Title 19 CSR 30-85.042 and CSR 30-86.043 |
Montana | A specific ratio for CNAs is not provided. | Staffing levels must be appropriate to comply with federal laws and regulations. | Montana Administrative Rules 37.40.135 |
Nebraska | A specific ratio for CNAs is not provided. | Sufficient qualified nursing personnel are required to meet residents’ needs. | Nebraska Health and Human Services Regulation Title 175. 12-006.04 Staff Requirements |
Nevada | A specific ratio for CNAs is not provided. | Sufficient qualified nursing personnel are required to meet residents’ needs. | Nevada Administrative Code NAC 654.164 |
North Carolina | A CNA should be on duty at all times on each patient floor. | Sufficient staff is required to provide nursing and related services to each resident. | North Carolina Administrative Code Title 10A 13D .2303 Nurse Staffing Requirements |
North Dakota | A specific ratio for CNAs is not provided. | Sufficient qualified nursing personnel are required to meet residents’ nursing care needs. | North Dakota Regulatory Code 33-07-03.2-14 Nursing Services |
New Hampshire | A specific ratio for CNAs is not provided. | Facilities should provide sufficient and appropriate staff to provide core services as listed. | New Hampshire Code of Administrative RulesHe-P 803.15 – Required Services |
New Jersey | A specific ratio for CNAs is not provided. | Sufficient licensed and ancillary staff are required. Residents require a minimum of 2.5 HPRD, 20 percent of which RNs or LPNs must provide. | New Jersey Administrative CodeTitle 8, Chapter 39 |
New Mexico | A specific ratio for CNAs is not provided. However, the direct care staff ratios are as follows: SNF Day shift: one to seven Evening shift: one to 10 Night shift: one to 12 Intermediate Care Facilities Day shift: one to eight Evening shift: one to 10 Night shift: one to 13 | Sufficient nursing staff is required to meet the specific needs of each patient. In SNFs, a seven-day average of 2.5 HPRD is required per resident. In Intermediate Care Facilities, a seven-day average of 2.3 HPRD per resident is required. | New Mexico Administrative CodeEffective June 2020, 7.9.2.51 Nursing Staff |
New York | Effective on January 1, 2023, no less than 2.2 HPRD to be provided by a CNA. | Sufficient qualified nursing personnel are required to meet residents’ nursing care needs. Each resident must receive a total of 3.5 HPRD. | New York Codes, Rules and RegulationsSection 415.13 Nursing Services and Minimum Nursing Staff Requirements |
Ohio | A specific ratio for CNAs is not provided. | Sufficient qualified nursing personnel are required to meet residents’ nursing care needs. Each resident must receive a minimum of 2.5 HPRD. | Ohio Administrative Code 3701 Nursing Homes -17-08 Personnel Requirements |
Oklahoma | A specific ratio for CNAs is not provided. | Facilities should be staffed to provide nursing and health services at all times. | Oklahoma Administrative Rules310:675-13-5. Nursing Services |
Oregon | The minimum CNA-to-patient ratios are as follows: Day shift: one to seven Evening shift: one to 9.5 Night shift: one to 17 | Facilities must have sufficient staff to meet the minimum requirements listed in the rules regarding CNA-to-patient ratios. | Oregon Administrative Rules 411-086-0100 Nursing Services: Staffing |
Pennsylvania | Effective on July 1, 2023, the CNA-to-resident ratios are as follows: Day shift: one to 12 Evening shift: one to 12 Night shift: one to 20 Effective July 1, 2024, the CNA-to-resident ratios are as follows: Day shift: one to 10 Evening shift: one to 11 Night shift: one to 15 | Effective on July 1, 2023, residents shall receive a minimum of 2.87 HPRD. Effective on July 1, 2024, residents shall receive a minimum of 3.2 HPRD. | Pennsylvania Administrative CodeTitle 28 § 211.12. Nursing Services |
Rhode Island | A specific ratio for CNAs is not provided. At least one nursing assistant must be included in creating the staffing pattern plan. | A sufficient number of nursing service staff is required at all times. | Rhode Island Code of Regulations Title 216, 40-10-1.16.6 Nursing Services and Minimum Staffing |
South Carolina | A specific ratio for CNAs is not provided. | An adequate number of direct care staff is required at all times. | South Carolina Code of State Regulations61-17.600.603 – Direct Care Staff |
South Dakota | A ratio for CNAs to residents is not provided. | An adequate number of direct care staff is required at all times. The ratio of RNs or LPNs to CNAs must be sufficient for appropriate supervision. | South Dakota Administrative Rules44:73:06:07 Nursing Service Staffing |
Tennessee | A specific ratio for CNAs is not provided. | Each resident must receive a minimum of two HPRD, of which .4 must be provided by licensed nursing personnel. | Tennessee Rules and Regulations CHAPTER 0720-18 Standards for Nursing Homes |
Texas | A specific ratio for CNAs is not provided. | A facility must have sufficient staff with the appropriate skills to provide nursing services for each resident. | Texas Administrative Code Title 26 Code § 554.1001 – Nursing Services |
Utah | A specific ratio for CNAs is not provided. | Nursing staff must be present at all times to provide services to residents. | Utah Administrative Code R432-150-5. Scope of Services |
Vermont | A specific ratio for licensed nursing assistants (LNAs) is not provided. LNAs must provide a minimum of two HPRD for each resident. | Sufficient staff must be on duty at all times to provide resident services. Each resident must receive a minimum of three HPRD on a weekly average. | Code of Vermont Rules 13-110-005-X 7.13. Nursing Services |
Virginia | A specific ratio for CNAs is not provided. | A facility must provide sufficient qualified nurses and certified nurse aides on all shifts. | Virginia Administrative Code 12VAC5-371-210. Nurse Staffing |
Washington | A specific ratio for CNAs is not provided. | Sufficient staff must be on duty at all times to provide resident services. | Washington Administrative CodeWAC 388-97-1080 |
West Virginia | A specific ratio for CNAs is not provided. See table 64-13.A. (p.77) for minimum ratios of personnel to residents. | Sufficient nursing personnel are required at all times to provide services. Each resident must receive no less than 2.25 HPRD. | West Virginia Code of State Rules Title 64. Series 13. Nursing Home Licensure. 8.14 Nursing Services Staffing |
Wisconsin | A specific ratio for CNAs is not provided. | There must be sufficient nursing service personnel to care for the specific needs of each patient. | Wisconsin Administrative Code § DHS 132.62 – Nursing Services |
Wyoming | A specific ratio for CNAs is not provided. | Sufficient nursing staff is required to meet resident needs. Each resident requiring skilled nursing care must receive 2.25 HPRD. Each resident not requiring skilled nursing care must receive 1.5 HPRD. | Wyoming Rules and Regulations Chapter 11. Section 9. Nursing Services |