77 Ill. Adm. Code 300.1230
Direct Care Staffing
Section 300
Section 300.1230Â Direct Care
Staffing
a)
For purposes of the minimum staffing ratios in Section
3-202.05 of the Act
and this Section,
all residents shall be classified
as requiring either skilled care or intermediate care
. (Section 3-202.05(b-5)
of the Act)
b)Â Â Â Â Â Â Â Â For the purposes of this Section, the following definitions
shall apply:
1)        "Direct care" − the provision of nursing care
or personal care as defined in Section 300.330, therapies, and care provided by
staff listed in subsection (i). Direct care staff are those individuals who,
through interpersonal contact with residents or resident care management,
provide care and services to allow residents to attain or maintain the highest
practicable physical, mental and psychosocial well-being. Direct care staff
does not include individuals whose primary duty is maintaining the physical
environment of the facility (e.g., housekeeping).
2)
"Skilled care" – skilled nursing care, continuous
skilled nursing observations, restorative nursing, and other services under
professional direction with frequent medical supervision
. (Section
3-202.05(b-5) of the Act) Â Skilled nursing services are either nursing or
therapy care services, furnished pursuant to physician orders, that require the
skills of a licensed nurse to treat, manage, and observe a resident's condition
and evaluate a resident's care. The skilled nursing services may be provided by
a CNA, under the supervision of a licensed nurse to ensure the safety of the
patient and to achieve the medically desired result. A resident in a skilled
nursing facility is classified as receiving skilled care if:
A)Â Â Â Â Â Â Â The resident is receiving care covered by Medicare under any
arrangement allowed by Title XVIII of the Social Security Act;
B)Â Â Â Â Â Â Â The resident is receiving care that would be covered by
Medicare, but the resident has exhausted his or her Medicare benefits; or
C)Â Â Â Â Â Â Â The resident is not Medicare eligible, but is receiving care
that would be covered by Medicare if the resident were eligible.
3)
"Intermediate care" – basic nursing care and
other restorative services under periodic medical direction
. (Section
3-202.05(b-5) of the Act)Â Services not classified as skilled care will be
classified as intermediate care.
c)
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)
d)
The minimum staffing ratios shall be 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
.Â
(Section 3-202.05(d) of the Act)Â For the purpose of this subsection,
"nursing care" and "personal care" mean direct care
provided by staff listed in subsection (i).
e)Â Â Â Â Â Â Â Â The facility shall schedule nursing personnel so that the
nursing needs of all residents are met.
f)Â Â Â Â Â Â Â Â 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 per day.
g)Â Â Â Â Â Â Â Â Each facility shall provide minimum direct care staff by complying
with subsection (f) and meeting the minimum direct care staffing ratios set
forth in this Section.
h)Â Â Â Â Â Â Â Â The direct care staffing calculations in this Section shall
include only the number of staff actually on duty on site. The following shall
not be included in direct care staffing calculations:
1)Â Â Â Â Â Â Â Â Meal and break times (paid or unpaid);
2)Â Â Â Â Â Â Â Â Scheduled training; and
3)Â Â Â Â Â Â Â Â When a facility is utilized as a clinical site for nurse aide
training, if the facility is not paying the employee for the services provided.
i)
For
the purpose of computing staff to resident ratios, direct care staff shall
include
the following:
1)
Registered
professional nurses
;
2)
Licensed practical nurses
;
3)
Certified
nurse assistants
;
4)
Psychiatric
services rehabilitation aides
;
5)
Rehabilitation
and therapy aides
;
6)
Psychiatric
services rehabilitation coordinators
;
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)Â Â Â Â Â Â Â Â Licensed
physical, occupational, speech and respiratory therapists.
j)
Facilities
subject to Subpart S may utilize specialized clinical staff, as defined in
Section
300.4090(c) and (f)
, to count towards the staffing ratios.
(Section
3-202.05(a) of the Act)
k)Â Â Â Â Â Â Â Â To
determine the direct care staffing required to meet daily minimum staffing
ratios for skilled care and intermediate care, the following staffing formula
shall be used:
1)Â Â Â Â Â Â Â Â Determine
the number of residents requiring skilled care and the number of residents
requiring intermediate care.
2)Â Â Â Â Â Â Â Â Calculate
the total daily required nursing and personal care hours for each level of
care:
A)Â Â Â Â Â Â Â The
number of residents requiring skilled care shall be multiplied by the required
number of hours (3.8) per resident.
B)Â Â Â Â Â Â Â The
number of residents requiring intermediate care shall be multiplied by the
required number of hours (2.5) per resident.
3)Â Â Â Â Â Â Â Â Add
the total number of hours of direct care required for each level of care to
determine the total number of hours required to provide direct care for all
residents in the facility.
4)Â Â Â Â Â Â Â Â Multiplying
the total minimum hours of direct care hours required for all residents,
determined under subsection (k)(3), by 25% results in the minimum amount of
licensed nurse hours that shall be provided during a 24-hour period.
5)Â Â Â Â Â Â Â Â Multiplying
the total minimum hours of direct care time required for all residents, determined
under subsection (k)(3), by 10% results in the minimum amount of registered
nurse hours that shall be provided during a 24-hour period.
6)Â Â Â Â Â Â Â Â The
remaining 75% of the minimum required direct care hours may also be fulfilled
by other staff identified in subsection (i) as long as it can be documented
that those staff provide direct care, and that nursing care and nursing
delegation is in accordance with the Nurse Practice Act.
7)Â Â Â Â Â Â Â Â The
amount of time determined in subsections (k)(4), (5) and (6) is expressed in
hours.
8)Â Â Â Â Â Â Â Â See
Appendix A for an example of staffing calculations.
l)Â Â Â Â Â Â Â Â Â A written work schedule shall be posted at least 10 days
prior to the first day on the schedule. The work schedule shall be posted in a
location conspicuous and accessible only to employees.
1)Â Â Â Â Â Â Â Â This work schedule shall contain the employee's name, job
title, (identifying the job title or titles listed in subsection (i), if
applicable), shift assignment, hours of work, and days off.
2)Â Â Â Â Â Â Â Â If an employee works in more than one job during the same
week, specifically including those job duties listed in subsection (i), if
applicable, the facility shall separately state the hours of work for each job
duty.
3)Â Â Â Â Â Â Â Â The work schedule, whether a hard copy or in an electronic
format, shall be kept on file in the facility in the administrator's office for
a minimum of three years after the week for which the schedule was used.
m)Â Â Â Â Â Â Â Time spent in scheduled breaks and mealtimes, and scheduled
training, when staff are not providing direct care shall be documented.
n)Â Â Â Â Â Â Â Â A facility operating under a waiver from the minimum
registered professional nurse staffing requirements (see Section 300.1232)
shall provide written documentation of the waiver to the Department upon
request.