Concerned about how to efficiently yet safely staff your certified nursing assistant personnel? Our ultimate guide to the CNA-to-patient staffing ratio can help. We know that simply staffing more isn’t always possible or sustainable, yet too few nursing assistants can cause safety and regulatory problems for your facility. Know your limits by checking the regulations in your state.
What Is the Legal CNA-to-Patient Ratio?
The legal CNA-to-patient ratio requirements for your facility are contingent on location—specifically, on the state. Not all states place staffing ratio requirements on certified nursing assistants. Indeed, even registered nurses (RNs) and licensed practical nurses (LPNs) are not always held to a staffing ratio regulation in nursing facilities. Alternatively, what we often see are regulations imposed on the number of hours per resident per day (HPRD). This term refers to the number of care hours each resident receives each day by nursing personnel or direct care staff.
What Are the Nursing Home Staffing Requirements by State?
Long-term care facilities (LTCs), assisted living residences, and skilled nursing facilities (SNFs) are often called nursing homes and are strictly regulated by the Centers for Medicare & Medicaid (CMS) and state legislation. Staffing requirements vary by level of licensure or certification of healthcare professionals and—in some cases—also by facility type.
Learn about the Importance of Safe Staffing Ratios
CNA Patient Ratios by State
Below, you can find the CNA staffing requirements for nursing home facilities in each state. CNA staffing for other types of facilities may be different.
*Information was sourced in September 2023. For reader convenience, source links are supplied.
Alabama
Alabama’s Administrative Code does not provide a specific ratio for CNAs, it only indicates that sufficient staff is required at all times.
Source: Alabama Administrative Code 420-5-10.11 Nursing Services (2) Revised 5/15/2022.
Alaska
Alaska’s Administrative Code does not provide a specific ratio for CNAs, it only indicates that sufficient staffing is required to meet resident needs.
Source: Alaska Administrative Code 7 AAC 12.275 Nursing and Medical Services.
Arizona
Arizona’s Administrative Code does not provide a specific ratio for CNAs, although it does indicate that sufficient nursing personnel is required to meet resident needs.
Source: Arizona Administrative Code 9 A.A.C. 10 codified 10/2022-12/2022 R9-10-412. Nursing Services.
Arkansas
Arkansas regulations do not specify a required CNA staffing ratio. However, current legislation enforces a mandatory average of 3.36 HPRD.
Additionally, the Arkansas Office of Long Term Care (OLTC) offers an online portal and tool called the “Minimum Staffing Calculator” to facilitate easier reporting and calculation of staffing requirements for nursing facilities.
Sources: Arkansas Act 715 Regular Session of 2021 and Arkansas OLTC regulations.
California
California’s Health and Safety Code does not provide a specific ratio for CNAs. Nevertheless, it does state that all skilled nursing facility residents must receive 3.5 HPRD, of which 2.4 HPRD must be provided by a CNA.
Source: California Health and Safety Code HSC § 1276.65.
Colorado
Colorado regulations do not provide a specific ratio for CNA staffing. However, they do indicate that sufficient staff is required to offer “prompt assistance.”
Source: Code of Colorado Regulations 6 CCR 1011-1 Chapter 05. Section 9. Nursing Services.
Connecticut
The Connecticut Public Health Code stipulates CNA staffing ratios as follows:
- In a “Rest Home,” under licensed nurse supervision, there must be at least one CNA on duty on each resident floor at all times. Additionally, between 7 a.m. and 9 p.m., the nursing and CNA personnel must provide .70 HPRD, and between 9 p.m. and 7 a.m., nursing and CNA personnel must provide .17 HPRD.
- In a “Chronic and Convalescent Nursing Home,” during the hours of 7 a.m. and 9 p.m., patients must receive 1.4 HPRD from nursing and CNA personnel. From 9 p.m. to 7 a.m., patients must receive .5 HPRD from nursing and CNA personnel.
Moreover, effective on January 1, 2022, in Public Act 21-185, “the Department of Public Health shall establish minimum staffing level requirements for nursing homes of three hours of direct care per resident per day.”
Source: Connecticut Public Health Code Title 19, Sec. 19-13-D8t. (m) Nursing Staff.
Delaware
According to the Delaware Code, required CNA staffing ratios are as follows:
- Day: One CNA to seven residents
- Evening: One CNA to 10 residents
- Night: One CNA to 15 residents
Furthermore, the Code indicates that adequate staffing must be in place to meet all residents’ needs and 3.67 HPRD.
Source: Delaware Code Title 16 Health and Safety § 1162. Nursing Staffing (e) Effective May 2003.
District of Columbia
The Washington, D.C. Municipal Regulations do not provide a specific CNA staffing ratio.
Source: D.C. Municipal Regulations Title 22 B3208 Nursing Services.
Florida
According to the Florida Statutes, a minimum ratio of one CNA per 20 residents is required. Residents must receive a minimum of two HPRD from a CNA. Additionally, Sufficient staffing is required to meet residents’ needs and meet a weekly average of 3.6 HPRD.
Source: Florida Statutes 400.23.
Georgia
Georgia Rules and Regulations do not provide a staffing ratio specific to CNAs. However, they do indicate that at least one of every seven nursing staff (excludes dining assistants) must be a licensed nurse, and residents must receive at least two HPRD.
Source: Georgia Rules and Regulations Rule 111-8-56-.04. Nursing Services.
Hawaii
Hawaii’s Administrative Rules do not indicate a specific CNA staffing ratio. Nevertheless, they do indicate that sufficient nursing personnel are required to meet resident needs.
Source: Hawaii Administrative Rules. Adopted September 2022. Title 11 Chapter 94.2-39 Nursing Services
Idaho
Idaho’s Administrative Rules do not specify a staffing ratio requirement for CNAs in SNF settings or residential assisted living facility settings. They do, however, indicate that SNF residents must receive at least two HPRD. There are no HPRD requirements listed for Residential Assisted Living Facilities.
Source: Idaho Administrative Rules 16.03.02 Skilled Nursing Facilities and 16.03.22 Residential Assisted Living Facilities.
Illinois
The Illinois Administrative Code does not provide a specific staffing ratio requirement for CNAs. However, CNAs are identified as direct care staff. Staffing ratios must meet 3.8 HPRD for residents requiring skilled care and 2.5 HPRD for residents requiring intermediate care. Furthermore, a licensed nurse must provide 25 percent of the HPRD.
Source: Illinois Administrative Code Title 77 Chapter 1. Section 300.1230 Direct Care Staffing.
Indiana
The Indiana Administrative Code does not specify a CNA staffing ratio requirement, although it does indicate that sufficient staff is required to provide nursing and related services to each resident.
Source: Indiana Administrative Code 410 16.2-3.1-17 Nursing Services.
Iowa
The Iowa Code does not provide a specific CNA staffing ratio requirement. Nevertheless, it does indicate that a facility must provide required nursing care services on a 24-7 basis through qualified nurses and ancillary coverage.
Source: Iowa Code 58.11(2) Nursing Supervision and Staffing and 58.19(135C) Required Nursing Services for Residents.
Kansas
Kansas Administrative Regulations do not specify a CNA staffing ratio requirement, although they do indicate that each resident must receive a weekly average of two HPRD and a daily average no lower than 1.85 HPRD.
Source: Kansas Administrative Regulations Article 39. 28-39-154. Nursing services.
Kentucky
Kentucky Administrative Regulations do not provide a specific CNA staffing ratio requirement, stating only that adequate staffing is required to meet patient needs.
Source: Kentucky Administrative Regulations Section 902 KAR 20:048 - Operation and Services; Nursing Homes.
Louisiana
Louisiana Administrative Code does not specify a CNA staffing ratio requirement, although it does indicate that sufficient staff is required to provide nursing and related services to each resident, and each resident must receive a minimum of 2.35 HPRD.
Source: Louisiana Administrative Code Title 48 Subchapter B Nursing Services. §9821. General Provisions
Maine
The Code of Maine Rules indicates that the direct care staff-to-patient ratio for facilities shall not fall below the following:
- Day shift: one to five
- Evening shift: one to 10
- Night shift: one to 15
Furthermore, the Code indicates that CNAs are considered direct care staff alongside RNs, LPNs, and personal support specialists.
Source: Code of Maine Rules 10.144 Chapter 110 Section 9 Resident Care Staffing A.4. Minimum Staffing Ratios.
Maryland
The Maryland Code Regulations do not specify a CNA staffing ratio requirement. They do, however, indicate that the ratio of “nursing service personnel” may not fall below one to 15. Additionally, sufficient staff of supervisory and support personnel is required to provide a minimum of three HPRD for every resident.
Source: Maryland Code Regulations 10.07.02.19 - Nursing Services - Staffing
Massachusetts
According to the Code of Massachusetts Regulations, residents must receive a minimum of 3.58 HPRD, .508 of which must be provided by an RN. Level III Facilities must have at least one CNA on duty during the night shift. Moreover, an adequate number of trained and experienced nursing personnel must be on duty 24-7.
Source: 105 Code of Massachusetts Regulations 150.000: Standards for Long-Term Care Facilities Section 150.007 Nursing Services.
Michigan
The Michigan Compiled Laws do not provide a specific CNA staffing ratio requirement. However, they do provide direct care staff-to-patient ratios as follows:
- Morning shift: one to eight
- Afternoon shift: one to 12
- Night shift: one to 15
Furthermore, nursing homes must provide sufficient staff to provide no less than 2.25 HPRD.
Source: Michigan Compiled Laws Section 333.21720a.
Minnesota
Minnesota Administrative Rules do not dictate a CNA staffing ratio requirement. Nevertheless, they do indicate that sufficient staff is required to provide nursing and related services to each resident. Residents in nursing homes not participating in the medical assistant program must receive a minimum of two HPRD. Furthermore, residents in participating nursing homes must receive the greater of the following:
- Two hours per resident per 24 hours
- 0.95 hours per standardized resident day
Source: Minnesota Administrative Rules 4658.0510 Nursing Personnel.
Mississippi
The Mississippi Health Facilities Regulations do not specify a CNA staffing ratio requirement. Nevertheless, they do indicate that sufficient staff is required so that all residents receive a minimum of 2.8 HPRD.
Source: Mississippi Health Facilities Regulations Rule 45.4.1 Nursing Facility.
Missouri
The Missouri Code of State Regulations does not specify a CNA staffing ratio requirement for SNFs, indicating only that an adequate number and type of staff is required to provide proper care to each resident. For residential care and assisted living facilities, the minimum staffing ratios are as follows:
- Day shift: one to 15
- Evening shift: one to 20
- Night shift: one to 25
Furthermore, if a residential care or assisted living facility is directly adjacent to another LTC, other staffing ratios may apply.
Source: Missouri Code of State Regulations Title 19 CSR 30-85.042 and CSR 30-86.043.
Montana
The Montana Administrative Rules do not provide a CNA staffing ratio requirement, indicating only that staffing levels must be appropriate to comply with federal laws and regulations.
Source: Montana Administrative Rules 37.40.135.
Nebraska
Nebraska’s Health and Human Services Regulations do not specify a CNA staffing ratio requirement, although they do indicate that sufficient qualified nursing personnel are required to meet residents’ needs.
Source: Nebraska Health and Human Services Regulation Title 175. 12-006.04 Staff Requirements.
Nevada
Nevada’s Administrative Code does not provide a CNA staffing ratio requirement, indicating only that sufficient qualified nursing personnel are required to meet residents’ needs.
Source: Nevada Administrative Code NAC 654.164.
North Carolina
The North Carolina Administrative Code states that a CNA should be on duty at all times on each patient floor. Furthermore, sufficient staff is required to provide nursing and related services to each resident.
Source: North Carolina Administrative Code Title 10A 13D .2303 Nurse Staffing Requirements.
North Dakota
The North Dakota Regulatory Code does not provide a specific ratio for CNA staffing. It does, however, indicate that sufficient qualified nursing personnel are required to meet residents’ nursing care needs.
Source: North Dakota Regulatory Code 33-07-03.2-14 Nursing Services.
New Hampshire
The New Hampshire Code of Administrative Rules does not specify a CNA staffing ratio requirement. Although they do indicate that facilities should provide sufficient and appropriate staff to provide core services.
Source: New Hampshire Code of Administrative Rules He-P 803.15 - Required Services.
New Jersey
The New Jersey Administrative Code does not provide CNA staffing ratio requirements. However, it does indicate that sufficient licensed and ancillary staff are required. Furthermore, residents require a minimum of 2.5 HPRD, 20 percent of which RNs or LPNs must provide.
Source: New Jersey Administrative Code Title 8, Chapter 39.
New Mexico
The New Mexico Administrative Code indicates sufficient nursing staff is required to meet the specific needs of each patient and provides the following direct care staff ratios.
SNF:
- Day shift: one to seven
- Evening shift: one to 10
- Night shift: one to 12
Intermediate Care Facilities:
- Day shift: one to eight
- Evening shift: one to 10
- Night shift: one to 13
Furthermore, the Code stipulates a seven-day average of 2.5 HPRD is required per resident in SNF settings, and a seven-day average of 2.3 HPRD per resident is required in Intermediate Care Facilities.
Source: New Mexico Administrative Code Effective June 2020, 7.9.2.51 Nursing Staff.
New York
The New York Codes, Rules, and Regulations stipulate that no less than 2.2 HPRD must be provided by a CNA, effective January 1, 2023. Furthermore, sufficient qualified nursing personnel are required to meet residents’ nursing care needs, and each resident must receive a total of 3.5 HPRD.
Source: New York Codes, Rules and Regulations Section 415.13 Nursing Services and Minimum Nursing Staff Requirements.
Ohio
The Ohio Administrative Code does not specify a CNA staffing ratio. However, it does indicate that sufficient qualified nursing personnel are required to meet residents’ nursing care needs, and each resident must receive a minimum of 2.5 HPRD.
Source: Ohio Administrative Code 3701 Nursing Homes -17-08 Personnel Requirements.
Oklahoma
Oklahoma Administrative Rules do not provide a specific CNA staffing ratio. Nevertheless, they do indicate that facilities should be staffed to provide nursing and health services at all times.
Source: Oklahoma Administrative Rules 310:675-13-5. Nursing Services.
Oregon
The Oregon Administrative Rules provide the following minimum CNA-to-patient staffing ratios:
- Day shift: one to seven
- Evening shift: one to 9.5
- Night shift: one to 17
Furthermore, the Rules stipulate that facilities must have sufficient staff to meet the minimum requirements listed in the rules regarding CNA-to-patient ratios.
Source: Oregon Administrative Rules 411-086-0100 Nursing Services: Staffing.
Pennsylvania
The Pennsylvania Administrative Code provides requirements for CNA-to-resident staffing ratios, effective July 1, 2024, as follows:
- Day shift: one to 10
- Evening shift: one to 11
- Night shift: one to 15
Additionally, effective July 1, 2024, residents shall receive a minimum of 3.2 HPRD.
Source: Pennsylvania Administrative Code Title 28 § 211.12. Nursing Services.
Rhode Island
Although the Rhode Island Code of Regulations does not specify a CNA staffing ratio, it does stipulate that at least one nursing assistant must be included in creating the staffing pattern plan. Furthermore, a sufficient number of nursing service staff is required at all times.
Source: Rhode Island Code of Regulations Title 216, 40-10-1.16.6 Nursing Services and Minimum Staffing.
South Carolina
Although the South Carolina Code of State Regulations does not provide CNA staffing ratio requirements, they do stipulate that an adequate number of direct care staff is required at all times.
Source: South Carolina Code of State Regulations 61-17.600.603 - Direct Care Staff.
South Dakota
The South Dakota Administrative Rules do not specify a CNA staffing ratio. However, they do stipulate that the ratio of RNs or LPNs to CNAs must be sufficient for appropriate supervision and an adequate number of direct care staff is required at all times.
Source: South Dakota Administrative Rules 44:73:06:07 Nursing Service Staffing.
Tennessee
The Tennessee Rules and Regulations do not set a CNA staffing ratio requirement. However, they do stipulate that each resident must receive a minimum of two HPRD, of which .4 must be provided by licensed nursing personnel.
Source: Tennessee Rules and Regulations CHAPTER 0720-18 Standards for Nursing Homes.
Texas
Although the Texas Administrative Code does not provide specific CNA staffing ratios, it does indicate that a facility must have sufficient staff with the appropriate skills to provide nursing services for each resident.
Source: Texas Administrative Code Title 26 Code § 554.1001 - Nursing Services.
Utah
The Utah Administrative Code does not specify a CNA staffing ratio requirement. Nevertheless, it does indicate that nursing staff must be present at all times to provide services to residents.
Source: Utah Administrative Code R432-150-5. Scope of Services.
Vermont
Although the Code of Vermont Rules does not provide a specific staffing ratio for licensed nursing assistants (LNAs), it does indicate that LNAs must provide a minimum of two HPRD for each resident. Furthermore, sufficient staff must be on duty at all times to provide resident services, and each resident must receive a minimum of three HPRD on a weekly average.
Source: Code of Vermont Rules 13-110-005-X 7.13. Nursing Services.
Virginia
The Virginia Administrative Code does not specify a CNA staffing ratio requirement, although it does indicate that a facility must provide sufficient qualified nurses and certified nurse aides on all shifts.
Source: Virginia Administrative Code 12VAC5-371-210. Nurse Staffing.
Washington
The Washington Administrative Code does not provide a CNA staffing ratio requirement. It does, however, indicate that sufficient staff must be on duty at all times to provide resident services.
Source: Washington Administrative Code WAC 388-97-1080.
West Virginia
The West Virginia Code of State Rules stipulates that sufficient nursing personnel are required at all times to provide services and each resident must receive no less than 2.25 HPRD. Ratios specific to CNA staff are not provided.
Source: West Virginia Code of State Rules Title 64. Series 13. Nursing Home Licensure. 8.14 Nursing Services Staffing. Resident Care Personell to Resident Ratios in table 64-13.A. (p. 77).
Wisconsin
The Wisconsin Administrative Code does not specify a CNA staffing ratio requirement, although it does stipulate that there must be sufficient nursing service personnel to care for the specific needs of each patient.
Source: Wisconsin Administrative Code § DHS 132.62 - Nursing Services.
Wyoming
Wyoming Rules and Regulations do not provide a CNA staffing ratio requirement, only indicating that sufficient nursing staff is required to meet resident needs. Nevertheless, they do stipulate that each resident requiring skilled nursing care must receive 2.25 HPRD and each resident not requiring skilled nursing care must receive 1.5 HPRD.
Source: Wyoming Rules and Regulations Chapter 11. Section 9. Nursing Services.
What Are the Minimum Nurse Staffing Requirements by State?
For the purposes of this guide, we focused specifically on CNA staffing requirements in each state. Regulations for staffing requirement ratios or HPRD requirements specifically for registered nurses and licensed practical nurses are common. Learn more about the topic with our article, “A Deeper Look at Nurse-to-Patient Staffing Ratios.”
Meet CNA Staffing Regulations Affordably and Efficiently
Join Nursa today and start sourcing local CNAs looking for shifts. When intake numbers fluctuate heavily, it can be difficult to manage safe CNA staffing ratios without the bulky overhead cost of hiring several new full- or part-time CNAs. Contract CNAs only when you need them one shift at a time by posting per diem shifts on Nursa.
