State by state
What each state asks you to keep on file
Most of what a nursing home holds on a person is federal, and it is the same in every state. A handful of things are not, and those are the ones a director of nursing who moved states, or took the job last week, has no way of knowing. Here is both halves, with the section number next to every line.
The eleven states we have read
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Four things on top of the federal list
California
California adds four things to the federal list, and the biggest of them is the one most buildings get wrong: a yearly TB test, on everybody, with nobody left off it.
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Two things on top of the federal list
Florida
Florida is the only state in this set that puts a named deadline on dementia training measured in days from a person's first shift, and the first of those falls at 30 days.
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Two things on top of the federal list
Illinois
Illinois puts a ten working day deadline on the fingerprint check, which means the clock starts before you know whether the person is going to work out.
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One thing on top of the federal list
North Carolina
North Carolina asks for a national check as well as a state one when somebody has lived here less than five years, and that question is asked once, at interview.
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One thing on top of the federal list
New Jersey
New Jersey names a two-step skin test at hire, which is two visits and a waiting week, and that is a different scheduling job from a single blood draw.
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Two things on top of the federal list
New York
New York is the only state in this set that makes proof of measles and rubella immunity a nursing home rule rather than a recommendation, and it asks for it on every person.
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One thing on top of the federal list
Ohio
Ohio adds one thing to the federal list and no training hours at all. The catch is the opposite of the usual one: an Ohio nurse aide can lose the registration by not working, without any date running out.
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Two things on top of the federal list
Oregon
Oregon re-runs the background check every two years on anybody who goes near a resident, and that reaches contractors and volunteers as well as staff.
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Two things on top of the federal list
Pennsylvania
Pennsylvania writes its own annual in-service list on top of the federal one, and it names topics the federal list does not, including fire safety.
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Two things on top of the federal list
Texas
Texas is one of the few states that makes you check the same two lists again every year, not just before somebody starts. That yearly repeat is what a Texas building forgets.
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Four things on top of the federal list
Washington
Washington has the busiest state layer in this set. Four of its own items, three of which come back around, and a TB test within three days of somebody starting.
The state that is not here
A page goes up when every line on it names a section somebody can read: a CMS tag, a piece of the federal code, or a state code. One state did not clear that, and saying so is more useful than a page that fills the gap with something vaguer.
- Michigan. Michigan adds no row with a state code behind it, so the page would be the federal page with a different headline.
The part that is the same everywhere
These twenty-eight apply to every Medicare and Medicaid certified nursing home in the country. Get these right and you have done most of the job in any state. Miss one on one person and that is the person a surveyor asks about, because a list of names is where a survey starts.
Licences and certificates
| What we track | How often | Where the rule comes from |
|---|---|---|
| A current RN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current LPN license | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| Nurse aide certification, still active on the state list | When it runs out. Most last a year. | F728 · 42 CFR 483.35(d) |
| A current license for therapy, social work and pharmacy staff | When it runs out. Most last 2 years. | F839 · 42 CFR 483.70(e) |
| A current administrator license | When it runs out. Most last a year. | F836 · 42 CFR 483.70(a) |
| Proof the food service director is qualified, where no dietitian works full time | When it runs out. Most last 3 years. | F801 · 42 CFR 483.60(a)(2) |
| Proof the activities lead is qualified | When it runs out. Most last 2 years. | F680 · 42 CFR 483.24(c)(2) |
Checks you run on a person
| What we track | How often | Where the rule comes from |
|---|---|---|
| A look at the state nurse aide list before the first shift | Before their first shift, then every 2 years | F729 · 42 CFR 483.35(d)(4) |
| A check for any finding of abuse or neglect against them | Every year | F606 · 42 CFR 483.12(a)(3) |
Health and safety
| What we track | How often | Where the rule comes from |
|---|---|---|
| A first TB check: history, symptoms and a test | Once, in their first two weeks | CDC 2019 via 42 CFR 483.80(a)(2) |
| The hepatitis B shot offered free, and their answer written down | Once, within ten working days of starting | 29 CFR 1910.1030(f) |
| A mask fit test for anyone who wears an N95 | When it runs out. Most last a year. | 29 CFR 1910.134(f) |
| A current CPR card at the healthcare level | When it runs out. Most last 2 years. | F678 · 42 CFR 483.24(a)(3) |
Teaching and in-service
| What we track | How often | Where the rule comes from |
|---|---|---|
| Orientation, before they work on their own | Once, in their first week | F940 · 42 CFR 483.95 |
| Teaching on abuse, neglect and dementia care | Every year | F943 · 42 CFR 483.95(c) |
| Teaching on residents' rights | Every year | F942 · 42 CFR 483.95(b) |
| Teaching on stopping infection spreading | Every year | F945 · 42 CFR 483.95(e) |
| Teaching on the quality program | Every year | F944 · 42 CFR 483.95(d) |
| Teaching on the compliance and ethics program, if your company runs five or more buildings | Every year | F946 · 42 CFR 483.95(f) |
| Teaching on mental health and behavior needs | Every year | F949 · 42 CFR 483.95(i) |
| Teaching on talking with residents, for hands-on staff | Every year | F941 · 42 CFR 483.95(a) |
| Teaching on what to do in an emergency | Every year | 42 CFR 483.73(d)(1) |
| Teaching on blood and needle safety | Every year | 29 CFR 1910.1030(g) |
| Teaching on the chemicals they handle | When they start, and again when a new chemical arrives | 29 CFR 1910.1200(h) |
| Twelve hours of teaching for each nurse aide | 12 hours every year, counted from their own start date | F947 · 42 CFR 483.95(g) |
| A written look at how each nurse aide is doing | Every year | F730 · 42 CFR 483.35(d)(7) |
| Teaching on keeping resident information private | When they start, and again whenever your privacy policy changes | 45 CFR 164.530(b)(1) |
Employment paperwork
| What we track | How often | Where the rule comes from |
|---|---|---|
| Form I-9, filled in and kept | Once, in their first three days of work | 8 CFR 274a.2(b)(1)(ii) |
Three more that nearly every building does anyway
Not on the tables above, and the reason is narrow: they rest on federal guidance or on a reporting program rather than on a rule with a section number. Almost every building does all three.
- A check against the federal list of people barred from Medicare and Medicaid work. Every month. A name that was clear in January can be on it in February, so this is one to run on employees and contractors alike.
- Teaching on the signs of TB. Every year. What the signs are, who is at risk, and what to do about it. Teaching, not a test.
- A flu shot, or their reason for saying no. Every year. Their answer either way, written down. The count of who said yes is what goes in the yearly report.