What Are the Staff-to-Patient Ratio Requirements in Alabama Nursing Homes?
When you make the difficult decision to place your loved one in a nursing home, one of the most important considerations is whether there will be adequate staff numbers to ensure proper medical care for your loved one. The staff-to-patient ratio divides the number of qualified staff members by the number of patients. A lower number generally means more people will be available to provide care for your loved one.
Siniard Law, LLC wants to protect your loved ones in Alabama nursing homes. We use a client-focused approach that focuses on educating and informing our clients of their rights and providing sage legal counsel throughout the claims process. Our dedicated client advocacy has garnered results, culminating in over $175 million for our deserving clients.
If you suspect your loved one is being mistreated, our nursing home abuse attorneys can investigate and gather evidence regarding staff-to-patient ratios and complaints made against the home.
Here is everything you should know about Alabama’s staff-to-patient ratio requirements.
Alabama Requirements for Nursing Home Staffing
Alabama law requires nursing homes to “have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” Sufficient numbers are based on resident assessments and individual plans of care.
Specifically, the facility must provide sufficient numbers of licensed nurses and other types of nursing personnel on a 24-hour basis according to resident care plans. The nursing home is required to use the services of a registered nurse for at least eight consecutive hours a day, seven days a week. Additionally, the nursing home must designate a registered nurse who serves as the director of nursing on a full-time basis. That nurse can only serve as a charge nurse when the nursing home has an average daily occupancy of 60 or fewer residents.
Minimum Staff-to-Resident Ratios
Alabama law does not require a specific staff-to-patient ratio. The Alabama Board of Nursing explains that the nursing home’s decisions regarding the staff-to-patient ratio and the hours nurses work should be based on the Alabama’s Board of Nursing Administrative Code, which states the registered nurse and practical nurse are responsible and accountable for the quality of nursing care delivered to patients based on factors such as the nurses’:
- Scope of education
- Demonstrated competence
- Nursing experience
Alabama’s Board of Nursing Administrative Code also states that registered nurses and licensed practical nurses are responsible for the quality of nursing care for medical personnel under their supervision.
Similar to state law, federal law does not require a specific staff-to-patient ratio in nursing homes. Instead, the law only requires that nursing homes have sufficient staff to safely care for residents.
Qualification for Nursing Home Staff
Under Alabama’s Board of Nursing Administrative Code, nurses’ competence is measured in different ways, including their:
- Knowledge and compliance with applicable statutes and regulations, standards of nursing practice, and standardized procedures for nursing practice
- Continued education and skill development in nursing
- Assuming responsibility for recognizing personal limits of knowledge and experience
- Consulting with or referring patients to other healthcare providers that go beyond the nurse’s expertise
Policies and procedures must be in place for any procedures beyond a nurse’s basic education, requiring successful completion of an organized program of study, supervised clinical practice, and demonstration of competency.
If a nursing home patient or concerned loved one makes a complaint about a nurse, these training and personnel records can be subpoenaed.
Role of Administrative Staff
The administrative staff is not responsible for patient care. Instead, administrators focus on managing the facility, filing insurance claims, and ensuring the nursing home remains compliant with applicable licensing regulations.
Special Regulations for Specific Facilities
Alabama’s rules regarding staff-to-patient ratios are based on resident assessments and individual plans of care. Therefore, what may be sufficient in one situation may not be in another. For patients who require more intensive care and supervision, a lower staff-to-patient ratio may be more appropriate.
Federal law also states that staffing ratings consider differences in the levels of residents’ care needs in each nursing home and that homes with residents with more health problems would be expected to have more nursing staff than homes where residents require less care.
While some homes may be able to rely upon the director of nursing to serve as the charge nurse, this is only applicable when the nursing home has an average daily occupancy of 60 or fewer residents.
Recording Nursing Home Staff Hours
Nursing homes that receive payments from Medicare are required to record their nursing home staff hours with the federal program. Medicare uses this information to calculate a ratio of staffing hours per resident per day and other metrics. Numbers are recorded for various types of nursing staff, including:
- Registered nurse: A registered nurse (RN) is responsible for the delivery of care to residents. An RN is required to be present for at least eight consecutive hours a day, seven days a week.
- Licensed Practical Nurse: A licensed practical nurse (LPN) provides care to patients under the RN’s direction.
- Licensed vocational nurse: A licensed vocational nurse (LVN) also works under the RN’s direction. LPNs and LVNs ensure the nursing home is following each resident’s plan of care and that they are meeting their needs. Nursing homes must have an RN, LPN, or LVN must be on duty 24 hours each day.
- Certified nurse aide: A certified nurse aide (CNA) works under a licensed nurse and assists residents with activities of daily living (ADL). Alabama does not have a specific ratio for CNAs, requiring only that sufficient staff is present at all times. CNAs provide round-the-clock care.
- Physical therapist: A physical therapist (PT) helps residents improve their movement, muscle strength, and flexibility. They can sometimes assist patients with being more mobile. PTs may work with other healthcare providers in creating individual therapy plans.
- Administrator: Nursing homes must have an administrator licensed in the state according to its requirements. Medicare tracks administrator turnover in addition to staffing hours.
Medicare calculates staffing hours per resident per day by dividing the total number of hours worked by each type of staff member by the total number of residents. These numbers only represent averages, so they do not clearly reflect the amount of care various staff members provided to residents.
Impact of Staffing on Resident Care
A major reason why staff-to-patient ratios are so important is because they can impact the quality of care your loved one receives in a nursing home. Nursing homes with higher staff-to-patient ratios may be more likely to suffer injuries from nursing home abuse or neglect due to:
- Bedsores: With higher staff-to-patient ratios, patients may not receive the individual care they need. This can lead to pressure ulcers caused when patients are left in the same position for multiple hours without being turned. If left untreated, these sores can become infected or even fatal.
- Falls: Fewer nursing home workers means that staff may not be present to monitor residents, which can lead to falls. They may also not be familiar with patients in their charge or their fall risk.
- Assaults: Nursing homes are responsible for monitoring their workers to protect residents from criminal acts, including assault. Nursing homes with fewer workers may not notice abuse happening under their watch because other workers might not see it or report it.
- Sexual assaults: Nursing homes without adequate staffing may not properly monitor their workers, which can lead to workers violating vulnerable residents.
- Fatigue: Nursing homes with staff shortages may overwork their current staff, leading to abuse or mistakes in care because of provider fatigue or burnout.
- Overmedication: Overworked nursing home staff may try to manage residents by overmedicating them, which can harm their health and alter their personalities.
- Missing medication doses: Nursing homes with staff shortages may accidentally skip medication doses, leading to patients not receiving critical medicine they depend on to treat serious medical conditions.
- Undiagnosed medical conditions: Nursing homes with higher staff-to-patient ratios may not notice when a patient’s care changes, leading to undiagnosed medical conditions and lower quality of care.
If you suspect that your loved one has been harmed due to staff shortages, contact our legal team today. We can investigate your claim and gather evidence to establish negligence.
Evidence to Establish Nursing Home Abuse and Negligence
Evidence is crucial to substantiate allegations of abuse or neglect. An experienced attorney can investigate the case, use discovery tools, and search for publicly available information to support your legal claim. Depending on the circumstances, this information may include:
- A history of health or safety inspection violations
- A history of state or federal fines and penalties
- Prior accusations of abuse or neglect
- Nursing home resident care plans
- Documentation regarding the average staff-to-patient ratios
- Personnel records that indicate knowledge of staff members’ abuse or neglect of patients
- A lack of background checks
- Pictures of unsanitary conditions
- Statements from residents or workers regarding unsafe conditions
- Videos of misconduct or neglect
- Criminal records for nursing staff employees
Contact Our Experienced Nursing Home Abuse Lawyers for Help with Your Legal Claim
If the nursing home your loved one is living in is not providing proper care, you may have legal recourse. Your loved one has the right to be free of abuse and neglect. Our experienced attorneys can investigate your case, gather evidence surrounding high staff-to-patient ratios, and fight to preserve your loved one’s dignity. Contact us today for a free case review to discuss your legal options.