About Us

Services

Long Term Care
> Facilities
> Services
> Complaints

One of the most frequently expressed concerns about nursing homes involves the lack of adequate staff. This Fact Sheet summarizes Michigan and federal staffing requirements in nursing homes.

Administrator: A nursing home must be run by a licensed administrator. The administrator

must work at a single home full-time if the facility had 50 or more beds.

Medical Director: Medicare and Medicaid approved nursing homes must designate a physician

to serve as Medical Director. The Medical Director is responsible for coordinating medical care

within the facility and establishing policies and procedures regarding medical care. The Medical

Director may or may not also serve as the attending physician for some residents in the facility.

Attending Physician: Each resident must have a physician in charge for their overall medical

treatment. The resident has the right to choose an attending physician.

Director of Nursing: Each nursing home must ha a registered nurse (RN) employed full-time

as Director of Nursing (DON). The DON must have specialized training or relevant experience

in the area of gerontology and is responsible for managing the nursing services of the facility.

Registered Nurses: A Medicare or Medicaid approved nursing home must have at least one

registered nurse on duty at least eight consecutive hours per day, seven days a week.

Charge Nurses: Each nursing home must have a licensed registered nurse (RN) or a licensed

practical nurse (LPN) on each shift to serve as charge nurse. The charge nurse is responsible for

the immediate direction and supervision of nursing care provided to residents. In homes with 30

or more beds, the Director of Nursing cannot serve as charge nurse.

Ratio of Licensed Nurses to Residents: A certified nursing facility must have at least:

• one licensed nurse for each 64 residents on the day shift,
• one licensed nurse for each 96 residents on the afternoon shift,
• one licensed nurse for each 120 residents on the night shift.

Additional licensed nurses are required if needed to meet resident care needs.

Nurses Aides and Orderlies: In most nursing homes, unlicensed aides and orderlies provide

the majority of personal care needed by residents. Aides and orderlies who provide direct care

to residents are counted in determining if the minimum staffing requirements are met.

Staff to Resident Ratios: Michigan nursing homes must have a sufficient licensed and unlicensed

nursing staff to provide an average of at least 2.25 hours of nursing care per resident per day. In

addition, nursing homes must meet the following ratios of nursing staff members to residents:

These ratios must be met on a facility wide basis. Licensed nurses, aides and orderlies are all counted

In determining if the above ratios are met. The Director of Nursing is not counted in nursing homes

with 30 or more beds.

Note* In 1994, The Michigan House of Representatives pass a bill (HB4441) that would substantially

increase these outdated requirements. If passed by the Senate and signed by the governor, it will require

worker. Facilities with more than 120 beds must have a full-time social worker with a bachelor’s

degree in social work or a bachelor’s degree in a human services field plus one year of social work

experience in a health care setting. Private nursing homes must designate a staff member to provide

social services but State rules do not include any specific qualifications for this position.

Dietary Staff: The nursing home must have a dietary or food service supervisor who meets State

training requirements. If the food services supervisor is not a registered dietician, the supervisor

must receive a least four hours supervision from a registered dietician each 60 days. Sufficient

numbers of other food service personnel must be employed to meet dietary requirements and to

provide staffing at least 12 hours per day.

Activities Staff: All nursing homes must have at least one qualified person designated to plan and

carry out activities with residents. Additional staff members must be employed as needed to provide

a stimulating activity program, seven days a week.

Other Staff: Nursing homes must employ qualified staff members to carry out other responsibilities

such as housekeeping, business management, admissions and security. Nursing homes must also

ensure that residents receive needed medical services from qualified professionals, such as doctors, dentists, therapists, and radiologists. Often, these medical professionals are not regular employees of

the nursing home but they may work for the facility under contract or some less official arrangement.

Rev: 92, 96, 97, 98, 99, 03/00,04/04