(a) Except for nursing facilities that the Office of Long-Term Care designates as Eden Alternative nursing facilities or Green House Project nursing facilities, all nursing facilities shall maintain the following minimum direct-care staffing-to-resident ratios:

(1) One (1) direct-care staff to every six (6) residents for the day shift. Of this direct-care staff, there shall be at least one (1) licensed nurse to every forty (40) residents;

(2) One (1) direct-care staff to every nine (9) residents for the evening shift. Of this direct-care staff, there shall be at least one (1) licensed nurse to every forty (40) residents; and

(3) One (1) direct-care staff to every fourteen (14) residents for the night shift. Of this direct-care staff, there shall be at least one (1) licensed nurse to every eighty (80) residents.

(b)

(1) Licensed direct-care staff shall not be excluded from the computation of the ratios of direct-care staff to residents while serving in a staffing capacity that requires less education and training than is commensurate with their professional licensure.

(2) Licensed direct-care staff who serve in a staffing capacity that requires less education and training than is commensurate with their professional licensure shall not be restricted from providing direct-care services within the scope of their professional licensure in order to be included in the computation of the ratios of direct-care staff to residents.

(c) Nursing facilities shall provide in-service training to their direct-care staffs pursuant to regulations promulgated by the office.

(d) Upon any expansion of resident census by the facility, the facility shall be exempt from any increase in staffing ratios for a period of nine (9) consecutive shifts from the date of the expansion of resident census.

(e)

(1) The computation of the direct-care minimum staffing ratios shall be carried to the hundredth place.

(2) If the application of the ratios listed in subsections (a)-(c) of this section results in other than a whole number of direct-care staff for a shift or shifts, the number of required direct-care staff shall be rounded to the next higher whole number when the resulting ratio, carried to the hundredth place, is fifty-one hundredths (.51) or higher.

(3) In no event shall a facility have fewer than one (1) licensed nurse per shift for direct-care staff.

(4) All computations shall be based on the midnight census for the day in which the shift or shifts begin.

(f)

(1) Facilities may vary the starting hour and the ending hour for up to twenty-five percent (25%) of the minimum direct-care staff of the day shift or the evening shift, or both, to meet resident care needs.

(2) Before varying the starting hour and the ending hour of direct-care staff of the day shift or the evening shift, the facility shall inform the office in writing of:

(A) The resident care needs to be met by the change in starting and ending times of the shift;

(B) The number of direct-care staff to whom the changes will apply;

(C) The starting hour and ending hour of the shift for the direct-care staff to whom the change will apply; and

(D) The length of time the variations will be used, if known.

(3)

(A) The facility shall receive written approval from the office before the facility may vary the starting hour and ending hour of a shift for selected direct-care staff.

(B) The office may deny approval upon determination that:

(i) The reason for the request to vary the starting and ending time of a shift for selected direct-care staff does not meet resident care needs;

(ii) The facility was in a pattern of failure for any month in the three (3) months immediately preceding the request; or

(iii) The variation will result in a period of more than two (2) hours in which there is less than the minimum required number of direct-care staff under subsection (a) of this section.

(C) The office may revoke approval to vary the starting and ending time of a shift for selected direct-care staff if the office determines that:

(i) The approval has resulted in resident care needs being unmet; or

(ii) The facility is in a pattern of failure.

(4) If a facility varies the starting and ending times for direct-care staff of the day shift or the evening shift, or both, the facility shall be deemed to have met minimum staffing requirements for that shift if the number of direct-care staff whose starting and ending times are varied and the number of direct-care staff whose starting and ending times are not varied together equal the number of direct-care staff required for the shift.