Minimum Required Staffing

Both the federal government and Illinois require that nursing homes have enough staff to meet the needs of their residents.  The federal government does not enforce a minimum number for how much nursing staff a nursing home must have.  It does recommend that each resident who needs skilled care get at least 4.1 hours of nursing care every day, including 1.2 hours  (72 minutes) by a licensed nurse.  The federal government recommends that 45 minutes of the  1.2 hours be care by a registered nurse. In addition to the general requirement that nursing homes have enough staff to meet their residents’ needs, Illinois has always had an actual number for minimum nursing staff.  The 2010 Illinois nursing home reform law is increasing the minimum number; by January 1, 2014, it is scheduled to be one-and-a-half times what it was when the law was passed. 


As of January 1, 2013, Illinois requires that a nursing home have enough staff to give each resident needing skilled care at least 3.4 hours of nursing care, including at least 51 minutes of licensed nurse care.  At least 21 minutes of the licensed nurse time must be care by a registered nurse.  For residents needing intermediate care, the numbers as of January 1, 2013, are 2.3 hours total nursing care, including at least 34 minutes licensed nurse time (14 minutes registered nurse time.)


Minimum staffing is scheduled to increase on January 1, 2014. The final numbers are supposed to be 3.8 hours total nursing time for residents needing skilled care, including 57 minutes licensed nurse time (23 minutes registered nurse time.)  For residents needing intermediate care, the numbers are scheduled to be 2.5 hours total time, 38 minutes total nursing time, (15 minutes registered nurse time.) The nursing staff counted in these numbers includes registered nurses, licensed practical nurses, and certified nursing assistants.  Under some circumstances, therapists and therapy aides may also be counted.  Other staff may be counted for residents who have a diagnosis of a serious mental illness.


Nursing homes are supposed to count as direct care staff, only people who are actually taking care of residents. They are not allowed to count time scheduled for breaks or training. You can see the staffing rule here. 


Nursing homes are required to post publicly, the names and job titles of the nursing staff working each shift.  Because nursing homes do not publicly post how many “skilled” and “intermediate” residents they have on each floor or unit, most of the time it will not be possible to tell automatically if the nursing home is meeting its minimum staffing requirements.  (If a unit obviously has all skilled residents – say,  on ventilators or oxygen – it is easier for an outsider to do a count.)  You can get some idea, however, from the staffing numbers that are posted, and – if you visit during different shifts – from talking to the staff as well as doing a head count.


All employees who examine or care for residents, are required to wear an identification badge with their first name, licensure status (if any,) and their job title or position.


Regardless of the numbers, nursing homes are still required to meet their residents’ needs, even if this means they need more staff than the minimum numbers.