Amd Pub Health L, generally; amd S97-aaaa, St Fin L
Enacts the "safe staffing for quality care act" to require acute care facilities and nursing homes to implement certain direct-care nurse to patient ratios in all nursing units; sets minimum staffing requirements; requires every such facility to submit a documented staffing plan to the department on an annual basis and upon application for an operating certificate; requires acute care facilities to maintain staffing records during all shifts; authorizes nurses to refuse work assignments if the assignment exceeds the nurse's abilities or if minimum staffing is not present; requires public access to documented staffing plans; imposes civil penalties for violations of such provisions; establishes private right of action for nurses discriminated against for refusing any illegal work assignment.
STATE OF NEW YORK
________________________________________________________________________
921
2011-2012 Regular Sessions
IN ASSEMBLY(Prefiled)
January 5, 2011
___________
Introduced by M. of A. GOTTFRIED, GUNTHER, MILLMAN, JACOBS, PHEFFER,
CLARK, DESTITO, PEOPLES-STOKES, MAGNARELLI, MARKEY, HOYT, ROSENTHAL,
JAFFEE, COLTON, BENEDETTO, REILLY, GABRYSZAK, LANCMAN, SCHROEDER --
Multi-Sponsored by -- M. of A. ARROYO, BARRON, BING, BRENNAN,
BROOK-KRASNY, BURLING, CAHILL, CAMARA, COOK, CRESPO, CUSICK, CYMBROW-
ITZ, DINOWITZ, ENGLEBRIGHT, GLICK, HEASTIE, HOOPER, KELLNER, LATIMER,
LAVINE, LIFTON, LUPARDO, MAISEL, MAYERSOHN, McDONOUGH, McENENY, McKEV-
ITT, MENG, J. MILLER, MONTESANO, ORTIZ, PAULIN, PERRY, PRETLOW,
RABBITT, RAMOS, J. RIVERA, P. RIVERA, ROBINSON, RUSSELL, SALADINO,
SCARBOROUGH, SCHIMEL, SPANO, SWEENEY, THIELE, TITONE, TITUS, TOWNS,
WEISENBERG, WRIGHT -- read once and referred to the Committee on
Health
AN ACT to amend the public health law, in relation to enacting the "safe
staffing for quality care act" and to amend the state finance law, in
relation to moneys deposited into the improving quality of patient
care fund
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Short title. This act shall be known and may be cited as
2 the "safe staffing for quality care act".
3 § 2. Paragraphs (a) and (b) of subdivision 2 of section 2805 of the
4 public health law, paragraph (a) as amended by chapter 923 of the laws
5 of 1973 and paragraph (b) as added by chapter 795 of the laws of 1965,
6 are amended to read as follows:
7 (a) Application for an operating certificate for a hospital shall be
8 made upon forms prescribed by the department. The application shall
9 [contain] include the name of the hospital, the kind or kinds of hospi-
10 tal service to be provided, the location and physical description of the
11 institution, a documented staffing plan, as defined in section twenty-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02400-01-1
A. 921 2
1 eight hundred twenty-four of this article, and such other information as
2 the department may require.
3 (b) An operating certificate shall not be issued by the department
4 unless it finds that the premises, equipment, personnel, documented
5 staffing plan, rules and by-laws, standards of medical care, and hospi-
6 tal service are fit and adequate and that the hospital will be operated
7 in the manner required by this article and rules and regulations there-
8 under.
9 § 3. The public health law is amended by adding nine new sections
10 2823, 2824, 2825, 2826, 2827, 2828, 2829, 2830 and 2831 to read as
11 follows:
12 § 2823. Policy and purpose. The legislature finds and declares all of
13 the following:
14 1. Health care services are becoming complex and it is increasingly
15 difficult for patients to access integrated services;
16 2. The quality of patient care is jeopardized because of nurse staff-
17 ing shortages and improper utilization of nursing services;
18 3. To ensure the adequate protection of patients in health care
19 settings, it is essential that qualified registered nurses and other
20 licensed nurses be accessible and available to meet the needs of
21 patients; and
22 4. The basic principles of staffing in the health care setting should
23 be based on the patient's care needs, the severity of condition,
24 services needed and the complexity surrounding those services.
25 § 2824. Safe staffing; definitions. The following words and phrases,
26 as used in this article, shall have the following meanings unless the
27 context otherwise plainly requires:
28 1. "Acute care facility" shall mean a general hospital, and shall also
29 include any chronic disease hospital, maternity hospital, outpatient
30 department, emergency center or surgical center, and shall also include
31 any facility that provides health care services pursuant to the mental
32 hygiene law, article nineteen-G of the executive law or the correction
33 law if such facility is operated by the state or a political subdivision
34 of the state or a public authority or public benefit corporation.
35 2. "Acuity system" shall mean an established measurement instrument
36 which (a) predicts nursing care requirements for individual patients
37 based on severity of patient illness, need for specialized equipment and
38 technology, intensity of nursing interventions required, and the
39 complexity of clinical nursing judgment needed to design, implement and
40 evaluate the patient's nursing care plan; (b) details the amount of
41 nursing care needed, both in number of direct-care nurses and in skill
42 mix of nursing personnel required, on a daily basis, for each patient in
43 a nursing department or unit; and (c) is stated in terms that readily
44 can be used and understood by direct-care nurses. The acuity system
45 shall take into consideration the patient care services provided not
46 only by registered professional nurses but also by licensed practical
47 nurses, social workers and other health care personnel.
48 3. "Assessment tool" shall mean a measurement system that compares the
49 staffing level in each nursing department or unit against actual patient
50 nursing care requirements in order to review the accuracy of an acuity
51 system.
52 4. "Direct-care nurse" and "direct-care nursing staff" shall mean any
53 nurse who has principal responsibility to oversee or carry out medical
54 regimens, nursing or other bedside care for one or more patients.
55 5. "Documented staffing plan" shall mean a detailed written plan
56 setting forth the minimum number and classification of direct-care nurs-
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1 es required in each nursing department or unit in an acute care facility
2 for a given year, based on reasonable projections derived from the
3 patient census and average acuity level within each department or unit
4 during the prior year, the department or unit size and geography, the
5 nature of services provided and any foreseeable changes in department or
6 unit size or function during the current year.
7 6. "Nurse" shall mean a registered professional nurse or licensed
8 practical nurse licensed pursuant to article one hundred thirty-nine of
9 the education law.
10 7. "Nursing care" shall mean that care which is within the definition
11 of the practice of nursing pursuant to section sixty-nine hundred two of
12 the education law, or otherwise encompassed with the recognized stand-
13 ards of nursing practice, including assessment, nursing diagnosis, plan-
14 ning, intervention, evaluation and patient advocacy.
15 8. "Safe staffing requirements" shall mean the provisions of sections
16 twenty-eight hundred twenty-three through twenty-eight hundred thirty-
17 one of this article and all rules and regulations adopted pursuant ther-
18 eto.
19 9. "Skill mix" shall mean the differences in licensing, specialty and
20 experience among direct-care nurses.
21 10. "Staffing level" shall mean the actual numerical nurse to patient
22 ratio within a nursing department or unit.
23 11. "Unit" shall mean a patient care component, as defined by the
24 department, within an acute care facility.
25 12. "Non-nursing direct-care staff" shall mean any employee who is not
26 a nurse or other person licensed, certified or registered under title
27 eight of the education law whose principal responsibility is to carry
28 out patient care for one or more patients or provides direct assistance
29 in the delivery of patient care.
30 § 2825. Commissioner and council; powers and duties. The commissioner
31 shall:
32 1. promulgate, after consultation with the council, the rules and
33 regulations necessary to carry out the purposes and provisions of the
34 safe staffing requirements, including regulations defining terms,
35 setting forth direct-care nurse to patient ratios, setting forth non-
36 nursing direct-care staff to patient ratios and prescribing the process
37 for approving acuity systems, which may include a system for class
38 approval of acuity systems; and
39 2. assure that the provisions of safe staffing requirements are
40 enforced, including the issuance of regulations which at a minimum
41 provide for an accessible and confidential system to report the failure
42 to comply with such requirements and public access to information
43 regarding reports of inspections, results, deficiencies and corrections
44 pursuant to such requirements.
45 3. establish a committee to advise in the development of regulations,
46 including registered professional nurse to patient staffing requirements
47 and non-nursing direct-care staff to patient ratios that are not speci-
48 fied in this article. The committee shall advise the commissioner on
49 the efficacy of acuity systems submitted for approval, and review and
50 make recommendations on approval of staffing plans prior to the granting
51 of an operating certificate by the department. The committee shall have
52 thirteen members. No less than sixty percent of the members of the
53 committee shall be registered professional nurses. The committee shall
54 include registered professional nurse direct care providers, represen-
55 tatives of acute care facilities, and representatives of nursing profes-
56 sional associations and recognized or certified collective bargaining
A. 921 4
1 representative of nurses and of non-nursing direct-care staff. The
2 governor shall appoint the chair and six other members, two members
3 shall be appointed by the speaker of the assembly, one member shall be
4 appointed by the minority leader of the assembly, two members shall be
5 appointed by the temporary president of the senate and one member shall
6 be appointed by the minority leader of the senate.
7 § 2826. Staffing requirements. 1. Staffing requirements. Each acute
8 care facility shall ensure that it is staffed in a manner that provides
9 sufficient, appropriately qualified direct-care nurses in each depart-
10 ment or unit within such facility in order to meet the individualized
11 care needs of the patients therein. At a minimum, each such facility
12 shall meet the requirements of subdivisions two and three of this
13 section.
14 2. Staffing plan. The department shall not issue an operating certif-
15 icate to any acute care facility unless such facility annually submits
16 to the department a documented staffing plan and a written certification
17 that the submitted staffing plan is sufficient to provide adequate and
18 appropriate delivery of health care services to patients for the ensuing
19 year. The documented staffing plan shall:
20 (a) meet the minimum requirements set forth in subdivision three of
21 this section;
22 (b) be adequate to meet any additional requirements provided by other
23 laws, rules or regulations;
24 (c) employ and identify an approved acuity system for addressing fluc-
25 tuations in actual patient acuity levels and nursing care requirements
26 requiring increased staffing levels above the minimums set forth in the
27 plan;
28 (d) factor in other unit or department activity such as discharges,
29 transfers and admissions, and administrative and support tasks that is
30 expected to be done by direct-care nurses in addition to direct nursing
31 care;
32 (e) include a plan to meet necessary staffing levels and services
33 provided by non-nursing direct-care staff in meeting patient care needs
34 pursuant to subdivision one of this section; provided, however, that the
35 staffing plan shall not incorporate or assume that nursing care func-
36 tions required by laws, rules or regulations, or accepted standards of
37 practice to be performed by a registered professional nurse are to be
38 performed by other personnel;
39 (f) identify the assessment tool used to validate the acuity system
40 relied on in the plan;
41 (g) identify the system that will be used to document actual staffing
42 on a daily basis within each department or unit;
43 (h) include a written assessment of the accuracy of the prior year's
44 staffing plan in light of actual staffing needs;
45 (i) identify each nurse staff classification referenced in such plan
46 together with a statement setting forth minimum qualifications for each
47 such classification; and
48 (j) be developed in consultation with a majority of the direct-care
49 nurses within each department or unit or, where such nurses are repres-
50 ented, with the applicable recognized or certified collective bargaining
51 representative or representatives of the direct-care nurses and of other
52 supportive and assistive staff.
53 3. Minimum staffing requirements. (a) The documented staffing plan
54 shall incorporate, at a minimum, the following direct-care nurse-to-pa-
55 tient ratios:
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1 (i) one nurse to one patient: operating room and trauma emergency
2 units and all critical care areas including emergency critical care and
3 all intensive care units and maternal/child care units for the second or
4 third stage of labor;
5 (ii) one nurse to two patients: maternal/child care units for the
6 first stage of labor, and postanesthesia units;
7 (iii) one nurse to three patients: antepartum, emergency room, pedia-
8 trics, step-down and telemetry units and units for newborns and interme-
9 diate care nursery units;
10 (iv) one nurse to three patients: postpartum mother/baby couplets
11 (maximum six patients per nurse);
12 (v) one nurse to four patients: non-critical antepartum patients, and
13 medical/surgical and acute care psychiatric units;
14 (vi) one nurse to five patients: rehabilitation units; and
15 (vii) one nurse to six patients: well-baby nursery units.
16 For any units not listed in this paragraph, including psychiatric
17 units, and acute care facilities operated pursuant to the mental hygiene
18 law or the correction law, the department shall establish by regulation
19 the appropriate direct-care nurse-to-patient ratio.
20 (b) The nurse-to-patient ratios set forth in paragraph (a) of this
21 subdivision shall reflect the maximum number of patients that may be
22 assigned to each direct-care nurse in a unit during one shift. A nurse,
23 including a nurse administrator or supervisor, who does not have princi-
24 pal responsibility as a direct-care nurse for a specific patient shall
25 not be included in the calculation of the nurse-to-patient ratio.
26 4. Licensed practical nurses. In any situation in which licensed prac-
27 tical nurses are included in the documented staffing plan, any patients
28 assigned to the licensed practical nurse shall also be included in
29 calculating the number of patients assigned to any registered profes-
30 sional nurse who is required by law, rule, regulation, contract or prac-
31 tice to supervise or oversee the direct-nursing care provided by the
32 licensed practical nurse.
33 5. Skill mix. The skill mix shall not incorporate or assume that nurs-
34 ing care functions required by section sixty-nine hundred two of the
35 education law or accepted standards of practice to be performed by a
36 registered professional nurse are to be performed by a licensed practi-
37 cal nurse or unlicensed assistive personnel, or that nursing care func-
38 tions required by section sixty-nine hundred two of the education law or
39 accepted standards of practice to be performed by a licensed practical
40 nurse are to be performed by unlicensed assistive personnel.
41 6. Adjustments. The minimum staffing requirement and nurse-to-patient
42 ratio set forth in this section shall be adjusted as necessary to
43 reflect the need for additional direct-care nurses necessary to ensure
44 adequate staffing of each nursing department or unit, in accordance with
45 an approved acuity system.
46 7. Department regulations. Nothing in this section shall be deemed to
47 preclude the department by rule or regulation from establishing and
48 requiring a documented staffing plan to have higher nurse-to-patient
49 ratios than those set forth in this section.
50 8. Nothing contained in this section shall be deemed to alter, affect
51 the validity of, modify the terms of, or impair any collective bargain-
52 ing agreement.
53 § 2827. Compliance with staffing plan and recordkeeping. 1. As a
54 condition for the maintenance of an operating certificate, each acute
55 care facility shall at all times staff in accordance with its documented
56 staffing plan and the staffing standards set forth in section twenty-
A. 921 6
1 eight hundred twenty-six of this article; provided, however, that noth-
2 ing in this section shall be deemed to preclude any such facility from
3 implementing higher direct-care nurse-to-patient staffing levels, nor
4 shall the requirements set forth in such section twenty-eight hundred
5 twenty-six of this article be deemed to supersede or replace any higher
6 requirements otherwise mandated by law, rule, regulation or contract.
7 2. For purposes of compliance with the minimum staffing requirements
8 standards set forth in section twenty-eight hundred twenty-six of this
9 article, no nurse shall be assigned, or included in the nurse-to-patient
10 ratio count in a nursing unit or a clinical area within an acute care
11 facility unless that nurse has an appropriate license pursuant to arti-
12 cle one hundred thirty-nine of the education law, has received prior
13 orientation in that clinical area sufficient to provide competent nurs-
14 ing care to the patients in that unit or clinical area, and has demon-
15 strated current competence in providing care in that unit or clinical
16 area. Acute care facilities that utilize temporary nursing agencies
17 shall have and adhere to a written procedure to orient and evaluate
18 personnel from such sources to ensure adequate orientation and competen-
19 cy prior to inclusion in the nurse-to-patient ratio. In the event of an
20 emergency staffing situation in which insufficient staffing may lead to
21 unsafe patient care, nurses may be temporarily assigned to a different
22 unit or clinical area, provided that such nurses shall be assigned
23 patients appropriate to their skill and competency level. The facility
24 shall establish a consistent plan for addressing emergency staffing
25 situations and monitor outcomes. Emergencies are defined as natural
26 disasters, declared emergencies, mass casualty incidents or other events
27 not reasonably anticipated and planned for and not regularly occurring
28 within the facility.
29 3. As a condition for the maintenance of an operating certificate,
30 each acute care facility shall maintain accurate daily records showing:
31 (a) the number of patients admitted, released and present in each
32 nursing department or unit within such facility;
33 (b) the individual acuity level of each patient present in each nurs-
34 ing department or unit within such facility; and
35 (c) the identity and duty hours of each direct-care nurse in each
36 nursing department or unit within such facility.
37 4. As a condition for the maintenance of an operating certificate,
38 each acute care facility shall maintain daily statistics, by nursing
39 department and unit, of mortality, morbidity, infection, accident, inju-
40 ry and medical errors.
41 5. All records required to be kept pursuant to this section shall be
42 maintained for a period of seven years.
43 6. All records required to be kept pursuant to this section shall be
44 made available upon request to the department and to the public;
45 provided, however, that information released to the public shall comply
46 with the applicable patient privacy laws, rules and regulations, and
47 that in facilities operated pursuant to the correction law the identity
48 and hours of staff shall not be released to the public.
49 § 2828. Work assignment policy. 1. General. As a condition for the
50 maintenance of an operating certificate, each acute care facility shall
51 adopt, disseminate to direct-care nurses and comply with a written work
52 assignment policy, that meets the requirements of subdivisions two and
53 three of this section, detailing the circumstances under which a
54 direct-care nurse may refuse a work assignment.
55 2. Minimum conditions. At a minimum, the work assignment policy shall
56 permit a direct-care nurse to refuse an assignment:
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1 (a) for which the nurse is not prepared by education, training or
2 experience to safely fulfill the assignment without compromising or
3 jeopardizing patient safety, the nurse's ability to meet foreseeable
4 patient needs or the nurse's license; or
5 (b) would otherwise violate the safe staffing requirements.
6 3. Minimum procedures. At a minimum, the work assignment policy shall
7 contain procedures for the following:
8 (a) reasonable requirements for prior notice to the nurse's supervisor
9 regarding the nurse's request and supporting reasons for being relieved
10 of an assignment or continued duty;
11 (b) where feasible, an opportunity for the supervisor to review the
12 specific conditions supporting the nurse's request, and to decide wheth-
13 er to remedy the conditions, to relieve the nurse of the assignment, or
14 to deny the nurse's request to be relieved of the assignment or contin-
15 ued duty;
16 (c) a process that permits the nurse to exercise the right to refuse
17 the assignment or continued on-duty status when the supervisor denies
18 the request to be relieved if:
19 (i) the supervisor rejects the request without proposing a remedy or
20 the proposed remedy would be inadequate or untimely,
21 (ii) the complaint and investigation process with a regulatory agency
22 would be untimely to address the concern, and
23 (iii) the employee in good faith believes that the assignment meets
24 conditions justifying refusal; and
25 (d) recognition that a nurse who refuses an assignment pursuant to a
26 work assignment policy as set forth in this section shall not be deemed,
27 by reason thereof, to have engaged in negligent or incompetent action,
28 patient abandonment, or otherwise to have violated any law relating to
29 nursing.
30 § 2829. Public disclosure of staffing requirements. Every acute care
31 facility shall:
32 1. post in a conspicuous place readily accessible to the general
33 public a notice prepared by the department setting forth a summary of
34 the safe staffing requirements applicable to that facility together with
35 information about where detailed information about the facility's staff-
36 ing plan and actual staffing may be obtained;
37 2. upon request, make copies of the documented staffing plan filed
38 with the department available to the public; and
39 3. upon request make readily available to the nursing staff within a
40 department or unit, during each work shift, the following information:
41 (a) a copy of the current staffing plan for that department or unit,
42 (b) documentation of the number of direct-care nurses required to be
43 present during the shift, based on the approved adopted acuity system,
44 and
45 (c) documentation of the actual number of direct-care nurses present
46 during the shift.
47 § 2830. Enforcement responsibilities. The department shall not dele-
48 gate its responsibilities to enforce the safe staffing requirements
49 promulgated pursuant to this article.
50 § 2831. Enforcement and penalties. 1. Civil penalty. Any person,
51 regardless of whether that person possesses an operating certificate,
52 who has committed a violation of any of the provisions of the safe
53 staffing requirements, including failure to correct a serious violation
54 (as defined by regulation) within the time specified in a deficiency
55 citation, may be assessed a civil penalty by order of the department of
56 up to five hundred dollars for each deficiency for each day that each
A. 921 8
1 deficiency continues; provided, however, that an acute health care
2 facility that fails to comply with the requirements of section twenty-
3 eight hundred twenty-six of this article may be assessed a civil penalty
4 by order of the department of up to ten thousand dollars for each day of
5 non-compliance. Civil penalties shall be collected from the date such
6 facility receives notice of violation until the date such violation is
7 corrected.
8 2. Civil penalty for interference with reporting obligations. Any
9 person or acute care facility that fails to report or falsifies informa-
10 tion, or coerces, threatens, intimidates or otherwise influences anoth-
11 er person to fail to report or to falsify information required to be
12 reported under the safe staffing requirements, may be assessed a civil
13 penalty of up to ten thousand dollars for each such incident.
14 3. Private right of action for violations of section twenty-eight
15 hundred twenty-eight of this article. Any acute care facility that
16 violates the rights of an employee pursuant to an adopted work assign-
17 ment policy under section twenty-eight hundred twenty-eight of this
18 article may be held liable to such employee in an action brought in a
19 court of competent jurisdiction for such legal or equitable relief as
20 may be appropriate to effectuate the purposes of the safe staffing
21 requirements, including but not limited to reinstatement, promotion,
22 lost wages and benefits, and compensatory and consequential damages
23 resulting from the violation together with an equal amount in liquidated
24 damages. The court in such action shall, in addition to any judgment
25 awarded to a prevailing plaintiff, award reasonable attorneys' fees and
26 costs of action to be paid by the defendant. An employee's right to
27 institute a private action pursuant to this subdivision shall not be
28 limited by any other right granted by the safe staffing requirements.
29 § 4. Section 2801-a of the public health law is amended by adding a
30 new subdivision 3-b to read as follows:
31 3-b. In considering character, competence and standing in the communi-
32 ty under subdivision three of this section, the public health council
33 shall consider any past violations of state or federal rules, regu-
34 lations or statutes relating to employer-employee relations, workplace
35 safety, collective bargaining or any other labor related practices,
36 obligations or imperatives. The public health council shall give
37 substantial weight to violations of the public health law provisions
38 concerning nurse staff and supportive staff ratios.
39 § 5. Section 2805 of the public health law is amended by adding a new
40 subdivision 3 to read as follows:
41 3. In determining whether to issue or renew an operating certificate
42 to an applicant seeking to operate, or operating, a hospital in accord-
43 ance with this article, the commissioner shall consider any past
44 violations of state or federal rules, regulations or statutes relating
45 to employer-employee relations, workplace safety, collective bargaining
46 or any other labor related practices, obligations or imperatives. The
47 public health council shall give substantial weight to violations of the
48 public health law provisions concerning nurse staff and supportive staff
49 ratios.
50 § 6. Subdivisions 2 and 4 of section 97-aaaa of the state finance law,
51 as added by chapter 24 of the laws of 2002, are amended to read as
52 follows:
53 2. Such fund shall consist of all moneys received from civil penalties
54 assessed in actions commenced pursuant to section seven hundred forty-
55 one of the labor law and civil penalties assessed pursuant to section
56 twenty-eight hundred thirty-one of the public health law.
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1 4. Moneys in the account, following appropriation by the legislature,
2 shall be expended by the department of health for the purpose of improv-
3 ing the direct treatment and care of patients in facilities providing
4 health care services that are licensed pursuant to article twenty-eight
5 or thirty-six of the public health law or which operate and provide
6 health care services under the mental hygiene law, the education law, or
7 the correction law. The department shall give substantial weight to
8 funding initiatives to improve staffing ratios in health care facilities
9 or to reduce the use of excessive overtime among nursing staff.
10 § 7. The public health law is amended by adding a new section 2895-b
11 to read as follows:
12 § 2895-b. Nursing home staffing levels. 1. Definitions. As used in
13 this section, the following terms shall have the following meanings:
14 (a) "Advisory council" means the advisory council on nursing home
15 staffing created in subdivision two of this section.
16 (b) "Certified nurse aide" means any person included in the nursing
17 home nurse aide registry pursuant to section twenty-eight hundred
18 three-j of this chapter.
19 (c) "Staffing ratio" means the quotient of the number of personnel in
20 a particular category regularly on duty for a particular time period in
21 a nursing home divided by the number of residents of the nursing home at
22 that time.
23 2. Advisory council on nursing home staffing. There is hereby created
24 in the department an advisory council on nursing home staffing to study
25 and make recommendations relating to the staffing standards under this
26 section. The advisory council shall be appointed by the commissioner and
27 shall be composed of representatives of nursing home operators, consum-
28 ers, and non-administrative nursing home employees and the public. The
29 advisory council shall, from time to time, report to the governor, the
30 legislature, the public and the commissioner any recommendations regard-
31 ing staffing levels in nursing homes.
32 3. Staffing standards. (a) The commissioner, in consultation with the
33 advisory council, shall, by regulation, establish staffing standards for
34 nursing home minimum staffing levels to meet applicable standards of
35 service and care and to provide services to attain or maintain the high-
36 est practicable physical, mental, and psychosocial well-being of each
37 resident of the nursing home. The commissioner shall also require by
38 regulation that every nursing home maintain records on its staffing
39 levels, report on such records to the department, and make such records
40 available for inspection by the department.
41 (b) Every nursing home shall:
42 (i) comply with the staffing standards under this section; and
43 (ii) employ sufficient staffing levels to meet applicable standards of
44 service and care and to provide service and care and to provide services
45 to attain or maintain the highest practicable physical, mental, and
46 psychosocial well-being of each resident of the nursing home.
47 (c) Subject to subdivision five of this section, staffing standards
48 under this section shall, at a minimum, be the staffing standards under
49 subdivision four of this section.
50 (d) In determining compliance with the staffing standards under this
51 section, an individual shall not be counted while performing services
52 that are not direct nursing care, such as administrative services, food
53 preparation, housekeeping, laundry, maintenance services, or other
54 activities that are not direct nursing care.
A. 921 10
1 4. Statutory standard. Beginning two years after the effective date
2 of this section, every nursing home shall maintain a staffing ratio
3 equal to at least the following:
4 (a) from 2.4 to 2.8 hours of care per resident per day by a certified
5 nurse aide;
6 (b) from 1.15 to 1.3 hours of care per resident per day by a licensed
7 practical nurse or a registered nurse; and
8 (c) from 0.55 to 0.75 hours of care per resident per day by a regis-
9 tered nurse.
10 5. Phase-in. (a) The commissioner shall make the first regulations
11 under subdivision three of this section within one year after this
12 section becomes a law.
13 (b) If the commissioner determines that compliance with the statutory
14 standard under subdivision four of this section is not reasonably feasi-
15 ble for nursing homes by the time specified in that subdivision, the
16 commissioner may delay the implementation of that staffing standard for
17 a phase-in period not to exceed five years after this section becomes a
18 law. If the commissioner delays implementation of that staffing stand-
19 ard, the commissioner shall phase in, over the phase-in period, staff-
20 ing standards that gradually increase in each of the years of the phase-
21 in period until the staffing standard meets at least the statutory
22 standard under subdivision four of this section.
23 6. Public disclosure of staffing levels. (a) A nursing home shall post
24 information regarding nurse staffing that the nursing home is required
25 to make available to the public under section twenty-eight hundred
26 five-t of this chapter. Information under this paragraph shall be
27 displayed in a form approved by the department and be posted in a manner
28 which is visible and accessible to residents, their families and the
29 staff, as required by the commissioner.
30 (b) A nursing home shall post a summary of this section, provided by
31 the department, in close proximity to each posting required by paragraph
32 (a) of this subdivision.
33 § 8. If any provision of this act, or any application of any provision
34 of this act, is held to be invalid, or ruled by any federal agency to
35 violate or be inconsistent with any applicable federal law or regu-
36 lation, that shall not affect the validity or effectiveness of any other
37 provision of this act, or of any other application of any provision of
38 this act.
39 § 9. This act shall take effect on the one hundred eightieth day after
40 it shall have become a law, provided that any rules and regulations, and
41 any other actions necessary to implement the provisions of this act on
42 its effective date are authorized and directed to be completed on or
43 before such date.
