There is a consistently-proven link between staffing issues and poor quality of care for nursing home residents. In the following article, we’ll explore the question: What are Kentucky’s minimum nursing home staffing requirements, and how do they impact our state’s older adult population? After reading, please feel welcome to contact Thomas Law Offices if you have further questions about potential violations of Kentucky nursing home regulations.
Nursing Home Staffing Requirements in Kentucky
An excess of data has shown us the dangers of negligent hiring and supervision in nursing homes. In a place expressly designed to care for high-needs patients, it is imperative that the people running the facility are competent, compassionate, and conscientious—and in large enough numbers to provide the full spectrum of care residents need.
When this is not the case, residents often suffer injury, illness, neglect, and overall lowered quality of life. Our state has witnessed numerous and nuanced challenges related to nursing home staffing in the years since the pandemic’s onset. More than ever, Kentucky residents are forced to ask the question: are our current nursing home staffing requirements enough?
According to Kentucky Administrative Regulations for the operation and services of nursing homes (902 KAR 20:048), the following minimum staffing standards are mandatory for all nursing homes operating in the state:
- All facilities must have “adequate personnel” to meet the needs of residents 24/7. “Adequate personnel” is based on the number of patients, the amount and type of care patients require, and the staff and supervision needed to run the facility and meet resident needs.
- If a facility is considered to be understaffed, the Kentucky Cabinet for Health and Family Services’ (CHFS) Division for Licensing and Regulation will inform administration in writing about the number of additional staff required and what jobs they should perform.
- A “responsible staff member” must be on duty and awake 24/7 in case of injury, illness, fire, or other emergencies.
- There must be a 24-hour nursing service. It must include registered nurses, licensed practical nurses, aides, and orderlies and be ample enough to meet patient needs.
- Every nursing home must have a Director of Nursing who is a registered nurse and works full-time during the day. If the Director has administrative responsibilities, there must also be an Assistant Director of Nursing. Both of these positions must meet a number of specific requirements regarding skills, background, and duties.
- There must also be a Supervising Nurse who may serve as either Director or Assistant Director of Nursing. The Supervising Nurse must make daily rounds to all nursing units and handle tasks such as visiting every patient, reviewing medical records, checking patient care plans, and accompanying physicians visiting patients.
- There must be at least one registered nurse or licensed practical nurse on duty at all times.
- Nursing homes must hire a licensed pharmacist on a full-time, part-time, or consultant basis.
- If rehabilitative therapy services are offered by the nursing home, therapists (such as physical, speech, or occupational therapists) must meet certain qualifications and perform certain duties.
- There must be a position to oversee all food service operations that meet residents’ dietary needs. This person must work at least 35 hours every week.
- Every nursing home must have one employee explicitly responsible for each of the following areas: medical records, social services, and activities and recreation program development and implementation.
- Volunteers don’t count toward minimum staffing requirements.
- All volunteers, support personnel, consultants, and assistants must be supervised and meet the same standards that apply to full-time employees of the nursing home.
- No employee with an infectious disease can come to work until their medical condition is no longer transmissible.
- All new employees must undergo a comprehensive orientation process, in-service training, and ongoing education with programs that occur at least quarterly.
- Every resident must be under the care of a qualified physician who evaluates the patient’s immediate and long-term health care needs and who prescribes a care plan covering medications, treatments, rehabilitative services, diet, activities, and plans for continuing care.
State laws in Kentucky do not place a minimum requirement on the number of direct care staff that must be on the premises at a given moment, only specifying that at least one “responsible staff member” be awake and on duty at all times. State legislators have made numerous proposals over the past several years in an effort to tighten the reins on Kentucky nursing home staffing requirements. Proposals for stricter legislation such as Senate Bill 206 advocated for implementing a system of minimum staff-to-resident ratios as a condition of licensure or re-licensure for all nursing home facilities in the state. To date, most proposals have been unsuccessful in reaching the stage of enactment into law.
The Rights of Nursing Home Residents in Kentucky
The Nursing Home Ombudsman Agency of the Bluegrass (NHOA) advocates for the rights of residents living in long-term care facilities in Central Kentucky. As part of their mission, the NHOA works to inform nursing home residents of the rights they are entitled to enjoy under both federal and Kentucky state law. Nursing home resident rights are guaranteed under the U.S. Code for the Requirements for, and assuring quality of care in, skilled nursing facilities and under Kentucky Regulatory Statutes (KRS 216.515).
The rights of nursing home residents in Kentucky include at least the following minimum rights:
- The Right to Be Informed. Older adults (and oftentimes their family members and legal representatives) have the right to be fully informed of certain topics before or at the time of admissions and throughout their tenure as residents. These details might include details about the facility’s services and fees, any Medicaid benefits available and how to use them, the patient care plan and any changes to it, facility inspection reports, and how to submit a complaint against the nursing home.
- The Right to Be Involved. Nursing home residents have the right to participate in their own health care. Residents should know and fully understand how they will be treated and cared for, receive the results of tests and examinations, choose their own physician, and have access to their medical records.
- The Right to Decision-Making. Prospective residents must be informed of all the rules instated by the nursing home when touring different facilities. A potential resident must be able to choose to agree to the guidelines instated by the facility. Residents can decide to what degree they want to participate in facility activities, events, and accommodations.
- The Right to Privacy. This privilege includes the right to personal privacy in treatment, care, guest visits, personal communications via phone or letters, bathing and restroom use, and other aspects of the resident’s life. Except when mandated by law, the resident has the power to approve or deny the release of medical documents.
How Better Staffing Practices Improve Quality of Care
Without an adequate number of staff members on hand, it’s difficult, if not impossible, to recognize and prevent potential issues that threaten the wellbeing of residents. In order to provide residents with the best quality of care, staff members need to be well-rested, well-trained, alert, and carrying a reasonable number of responsibilities—not fatigued, stretched to their limit, and suffering extreme job dissatisfaction.
Recognizing and reducing hazards for residents at risk of suffering a fall, for example, is only possible when employees have the time and energy to notice facility surroundings. Other important preemptive care tasks like preventing self-neglect in high-risk residents, noticing signs of emotional or physical abuse, identifying financial exploitation, or averting an elopement are only feasible when staff are present and engaged.
We invite you to consult with our team to learn more about raising the standards of accountability for long-term care facilities in our state. Our office further specializes in defending the rights of veterans who suffer abuse or neglect in U.S. Department of Veterans Affairs (VA) nursing homes. We offer free and confidential case evaluations for families exploring legal options after nursing home malpractice.