Regards direct care staffing hour requirements for nursing homes

As Introduced

136th
General Assembly

Regular
Session
S. B. No. 384

2025-2026

Senator Liston

Cosponsor: Senator Ingram

To
amend section 3721.04 of the Revised Code
to
prohibit counting nurse and nurse aide nondirect care duties towards
the direct care staffing hour requirements for nursing homes.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
section 3721.04 of the Revised Code be amended to read as follows:

Sec.
3721.04.
(A)
The director of health shall adopt and publish rules governing the
operation of homes, which shall have uniform application throughout
the state, and shall prescribe standards for homes with respect to,
but not limited to, the following matters:

(1)
The minimum space requirements for occupants and equipping of the
buildings in which homes are housed so as to ensure healthful, safe,
sanitary, and comfortable conditions for all residents, so long as
they are not inconsistent with Chapters 3781. and 3791. of the
Revised Code or with any rules adopted by the board of building
standards and by the state fire marshal;

(2)
The number and qualifications of personnel, including management and
nursing staff, for each class of home, and the qualifications of
nurse aides, as defined in section 3721.21 of the Revised Code, used
by long-term care facilities, as defined in that section;

(3)
The medical, rehabilitative, and recreational services to be provided
by each class of home;

(4)
Dietetic services, including but not limited to sanitation,
nutritional adequacy, and palatability of food;

(5)
The personal and social services to be provided by each class of
home;

(6)
The business and accounting practices to be followed and the type of
patient and business records to be kept by such homes;

(7)
The operation of adult day-care programs provided by and on the same
site as homes licensed under this chapter;

(8)
The standards and procedures to be followed by residential care
facilities in admitting and retaining a resident who requires the
application of dressings, including requirements for charting and
evaluating on a weekly basis;

(9)
The requirements for conducting weekly evaluations of residents
receiving skilled nursing care in residential care facilities.

(B)
The director may adopt whatever additional rules are necessary to
carry out or enforce the provisions of sections 3721.01 to 3721.09
and 3721.99 of the Revised Code.

(C)
The following apply to the director when adopting rules under
division (A)(1) of this section regarding the equipping of the
buildings in which homes are housed:

(1)
The rules shall not require that each resident sleeping room, or a
percentage of the resident sleeping rooms, have a bathtub or shower
that is directly accessible from or exclusively for the room.

(2)
The rules shall require that the privacy and dignity of residents be
protected when the residents are transported to and from bathing
facilities, prepare for bathing, and bathe.

(D)
The following apply to the director when adopting rules under
division (A)(2) of this section regarding the number and
qualifications of personnel in homes:

(1)
When adopting rules applicable to residential care facilities, the
director shall take into consideration the effect that the following
may have on the number of personnel needed:

(a)
Provision of personal care services;

(b)
Provision of part-time, intermittent skilled nursing care pursuant to
division (C) of section 3721.011 of the Revised Code;

(c)
Provision of skilled nursing care to residents pursuant to division
(D) of section 3721.011 of the Revised Code.

(2)
When adopting rules applicable to nursing homes, the director shall
require each nursing home to do both of the following:

(a)
Have sufficient direct care staff on each shift to meet the needs of
the residents in an appropriate and timely manner;

(b)
Have the following individuals provide a minimum daily average of two
and one-half hours of direct care per resident:

(i)
Registered nurses, including registered nurses who perform
administrative and supervisory duties;

(ii)
Licensed practical nurses, including licensed practical nurses who
perform administrative and supervisory duties;

(iii)
Nurse aides.

(3)

The
rules relating to the calculation of the minimum daily average hours
of direct care per nursing home resident that must be provided by
certain individuals under division (D)(2)(b) of this section shall
not include hours in which a director of nursing, assistant director
of nursing, registered nurse, licensed practical nurse, or nurse aide
are engaging in activities that are not direct care, including all of
the following:

(a)
Staff scheduling, staff training, and staff meetings unrelated to
patient care;

(b)
Billing or billing-related issues;

(c)
Activities that are conducted pursuant to regulatory and
administrative requirements unrelated to patient care, including
licensure renewal and the department of health complaint
investigation process;

(d)
Maintaining the physical environment of the facility, including food
preparation, laundry, and housekeeping.

(4)

The
rules prescribing qualifications of nurse aides used by long-term
care facilities, as those terms are defined in section 3721.21 of the
Revised Code, shall be no less stringent than the requirements,
guidelines, and procedures established by the United States secretary
of health and human services under section 1819 of the "Social
Security Act," 101 Stat. 1330-160 (1987), 42 U.S.C. 1395i-3, as
amended, and section 1919 of the "Social Security Act," 101
Stat. 1330-182 (1987), 42 U.S.C. 1396r, as amended.

(E)
The following apply to the director when adopting rules under
division (A)(2) of this section regarding the number and
qualifications of personnel in nursing homes or rules under division
(A)(5) of this section regarding social services to be provided by
nursing homes:

(1)
The rules shall not prescribe the number of individuals licensed as
social workers under Chapter 4757. of the Revised Code that a nursing
home with one hundred twenty or fewer beds must employ.

(2)
The rules shall require each nursing home with more than one hundred
twenty beds to employ on a full-time basis one individual licensed as
a social worker under Chapter 4757. of the Revised Code.

(3)
The rules shall require each nursing home to offer its residents
medically related social services that assist the residents in
attaining or maintaining their highest practicable physical, mental,
and psychosocial well-being.

Section
2.
That
existing section 3721.04 of the Revised Code is hereby repealed.