CNA-to-Patient Staffing Ratios by State Guide

nurses using a lift with the proper amount of staff present
Written by
Lori Fuqua
Reviewed by
Miranda Kay, RN
September 26, 2023

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.

Table of Contents

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

The table below shows CNA staffing requirements for nursing home facilities. CNA staffing for other types of facilities may be different. For reader convenience, source links are supplied.

State CNA Staffing Requirements Regulatory Language Source
Alabama A specific ratio for CNAs is not provided. Sufficient staff is required at all times. Alabama Administrative Code
420-5-10-.11 Nursing Services (2) Revised 5/15/2022
Alaska A specific ratio for CNAs is not provided. Sufficient staffing is required to meet resident needs. Alaska Administrative Code
7 AAC 12.275 Nursing and Medical Services
Arizona A specific ratio for CNAs is not provided. Sufficient nursing personnel is required to meet residents’ needs. Arizona Administrative Code
9 A.A.C. 10 codified 10/2022-12/2022 R9-10-412. Nursing Services
Arkansas A required staffing ratio for CNAs is not specified.
Current legislation enforces a mandatory average of 3.36 HPRD.
The Arkansas Office of Long Term Care (OLTC) offers an online portal and downloadable tool called the “Minimum Staffing Calculator” to facilitate easier reporting and calculation of staffing requirements for nursing facilities. Arkansas Act 715
Regular Session of 2021
Arkansas OLTC regulations
California A specific ratio for CNAs is not provided. All skilled nursing facility residents must receive 3.5 HPRD, of which 2.4 HPRD must be provided by a CNA. California Health and Safety Code
HSC § 1276.65
Colorado A specific ratio for CNAs is not provided. Sufficient staff is required to proffer “prompt assistance.” Code of Colorado Regulations
6 CCR 1011-1 Chapter 05. Section 9. Nursing Services
Connecticut 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.
Sufficient nurse’s aides should be staffed to provide patient care 24-7.
Connecticut Public Health Code
Title 19, Sec. 19-13-D8t. (m) Nursing Staff
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.”
Delaware CNA staffing ratios are as follows:
Day: One CNA to seven residents
Evening: One CNA to 10 residents
Night: One CNA to 15 residents
Adequate staffing must be in place to meet all residents’ needs and 3.67 HPRD. Delaware Code Title 16 Health and Safety
§ 1162. Nursing Staffing (e) Effective May 2003.
District of Columbia A specific ratio for CNAs is not provided. D.C. Municipal Regulations Title 22 B3208 Nursing Services
Florida A minimum ratio of one CNA per 20 residents is required. Residents must receive a minimum of two HPRD from a CNA. Sufficient staffing is required to meet residents’ needs and meet a weekly average of 3.6 HPRD. Florida Statutes
400.23
Georgia A specific ratio for CNAs is not provided.
At least one of every seven nursing staff (excludes dining assistants) must be a licensed nurse.
Residents must receive at least two HPRD. Georgia Rules and Regulations
Rule 111-8-56-.04. Nursing Services
State CNA Staffing Requirements Regulatory Language Source
Hawaii A specific ratio for CNAs is not provided. Sufficient nursing personnel are required to meet residents’ needs. Hawaii Administrative Rules
Adopted September 2022
Title 11 Chapter 94.2-39 Nursing Services
Idaho A specific ratio for CNAs is not provided for SNF staffing requirements.
A specific ratio for CNAs is not provided for Residential Assisted Living Facility staffing requirements.
SNF residents must receive at least two HPRD.
There are no HPRD requirements listed for Residential Assisted Living Facilities.
Idaho Administrative Rules
16.03.02 Skilled Nursing Facilities
16.03.22 Residential Assisted Living Facilities
Illinois A specific ratio for CNAs is not provided; 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. A licensed nurse must provide 25 percent of HPRD. Illinois Administrative Code
Title 77 Chapter 1. Section 300.1230 Direct Care Staffing
Indiana A specific ratio for CNAs is not provided. Sufficient staff is required to provide nursing and related services to each resident. Indiana Administrative Code
410 16.2-3.1-17 Nursing Services
Iowa A specific ratio for CNAs is not provided. The facility must provide required nursing care services on a 24-7 basis through qualified nurses and ancillary coverage. Iowa Code
58.11(2) Nursing Supervision and Staffing
58.19(135C) Required Nursing Services for Residents
Kansas A specific ratio for CNAs is not provided. Each resident must receive a weekly average of two HPRD and a daily average no lower than 1.85 HPRD. Kansas Administrative Regulations
Article 39. 28-39-154. Nursing services.
Kentucky A specific ratio for CNAs is not provided. Adequate staffing is required to meet patient needs. Kentucky Administrative Regulations
Section 902 KAR 20:048 - Operation and Services; Nursing Homes
Louisiana A specific ratio for CNAs is not provided.
Residents must receive a minimum of 2.35 HPRD.
Sufficient staff is required to provide nursing and related services to each resident. Louisiana Administrative Code
Title 48 Subchapter B Nursing Services. §9821. General Provisions
Maine 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
CNAs are considered direct care staff alongside RNs, LPNs, and personal support specialists. Code of Maine Rules 10.144 Chapter 110 Section 9 Resident Care Staffing A.4. Minimum Staffing Ratios
Maryland A specific ratio for CNAs is not provided. However, the ratio of “nursing service personnel” may not fall below one to 15. Sufficient staff of supervisory and support personnel is required to provide a minimum of three HPRD for every resident. Maryland Code Regulations 10.07.02.19 - Nursing Services - Staffing
Massachusetts 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.
An adequate number of trained and experienced nursing personnel must be on duty 24-7. 105 Code of Massachusetts Regulations 150.000: Standards for Long-Term Care Facilities Section 150.007 Nursing Services
Michigan A specific ratio for CNAs is not provided.
Direct care staff-to-patient ratios are as follows:
Morning shift: one to eight
Afternoon shift: one to 12
Night shift: one to 15
Nursing homes must provide sufficient staff to provide no less than 2.25 HPRD. Michigan Compiled Laws Section 333.21720a
Minnesota A specific ratio for CNAs is not provided.
Residents in nursing homes not participating in the medical assistant program must receive a minimum of two HPRD.
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
Sufficient staff is required to provide nursing and related services to each resident. Minnesota Administrative Rules 4658.0510 Nursing Personnel
Mississippi A specific ratio for CNAs is not provided. Sufficient staff is required so that all residents receive a minimum of 2.8 HPRD. Mississippi Health Facilities Regulations
Rule 45.4.1 Nursing Facility
Missouri For SNFs, a specific ratio for CNAs is not provided.
For residential care and assisted living facilities, minimum staff ratios are as follows:
Day shift: one to 15
Evening shift: one to 20
Night shift: one to 25
An adequate number and type of staff is required to provide proper care to each resident.
If a residential care or assisted living facility is directly adjacent to another LTC, other staffing ratios may apply.
Missouri Code of State Regulations
Title 19 CSR 30-85.042 and CSR 30-86.043
Montana A specific ratio for CNAs is not provided. Staffing levels must be appropriate to comply with federal laws and regulations. Montana Administrative Rules
37.40.135
Nebraska A specific ratio for CNAs is not provided. Sufficient qualified nursing personnel are required to meet residents’ needs. Nebraska Health and Human Services Regulation Title 175. 12-006.04 Staff Requirements
Nevada A specific ratio for CNAs is not provided. Sufficient qualified nursing personnel are required to meet residents’ needs. Nevada Administrative Code NAC 654.164
North Carolina A CNA should be on duty at all times on each patient floor. Sufficient staff is required to provide nursing and related services to each resident. North Carolina Administrative Code Title 10A 13D .2303 Nurse Staffing Requirements
State CNA Staffing Requirements Regulatory Language Source
North Dakota A specific ratio for CNAs is not provided. Sufficient qualified nursing personnel are required to meet residents’ nursing care needs. North Dakota Regulatory Code 33-07-03.2-14 Nursing Services
New Hampshire A specific ratio for CNAs is not provided. Facilities should provide sufficient and appropriate staff to provide core services as listed. New Hampshire Code of Administrative Rules He-P 803.15 - Required Services
New Jersey A specific ratio for CNAs is not provided. Sufficient licensed and ancillary staff are required.
Residents require a minimum of 2.5 HPRD, 20 percent of which RNs or LPNs must provide.
New Jersey Administrative Code Title 8, Chapter 39
New Mexico A specific ratio for CNAs is not provided. However, the direct care staff ratios are as follows:
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
Sufficient nursing staff is required to meet the specific needs of each patient.
In SNFs, a seven-day average of 2.5 HPRD is required per resident.
In Intermediate Care Facilities, a seven-day average of 2.3 HPRD per resident is required.
New Mexico Administrative Code Effective June 2020, 7.9.2.51 Nursing Staff
New York Effective on January 1, 2023, no less than 2.2 HPRD to be provided by a CNA. Sufficient qualified nursing personnel are required to meet residents’ nursing care needs.
Each resident must receive a total of 3.5 HPRD.
New York Codes, Rules and Regulations Section 415.13 Nursing Services and Minimum Nursing Staff Requirements
Ohio A specific ratio for CNAs is not provided. Sufficient qualified nursing personnel are required to meet residents’ nursing care needs.
Each resident must receive a minimum of 2.5 HPRD.
Ohio Administrative Code 3701 Nursing Homes -17-08 Personnel Requirements
Oklahoma A specific ratio for CNAs is not provided. Facilities should be staffed to provide nursing and health services at all times. Oklahoma Administrative Rules 310:675-13-5. Nursing Services
Oregon The minimum CNA-to-patient ratios are as follows:
Day shift: one to seven
Evening shift: one to 9.5
Night shift: one to 17
Facilities must have sufficient staff to meet the minimum requirements listed in the rules regarding CNA-to-patient ratios. Oregon Administrative Rules 411-086-0100 Nursing Services: Staffing
Pennsylvania Effective on July 1, 2023, the CNA-to-resident ratios are as follows:
Day shift: one to 12
Evening shift: one to 12
Night shift: one to 20
Effective July 1, 2024, the CNA-to-resident ratios are as follows:
Day shift: one to 10
Evening shift: one to 11
Night shift: one to 15
Effective on July 1, 2023, residents shall receive a minimum of 2.87 HPRD.
Effective on July 1, 2024, residents shall receive a minimum of 3.2 HPRD.
Pennsylvania Administrative Code Title 28 § 211.12. Nursing Services
Rhode Island A specific ratio for CNAs is not provided.
At least one nursing assistant must be included in creating the staffing pattern plan.
A sufficient number of nursing service staff is required at all times. Rhode Island Code of Regulations Title 216, 40-10-1.16.6 Nursing Services and Minimum Staffing
South Carolina A specific ratio for CNAs is not provided. An adequate number of direct care staff is required at all times. South Carolina Code of State Regulations 61-17.600.603 - Direct Care Staff
South Dakota A ratio for CNAs to residents is not provided. An adequate number of direct care staff is required at all times.
The ratio of RNs or LPNs to CNAs must be sufficient for appropriate supervision.
South Dakota Administrative Rules 44:73:06:07 Nursing Service Staffing
Tennessee A specific ratio for CNAs is not provided. Each resident must receive a minimum of two HPRD, of which .4 must be provided by licensed nursing personnel. Tennessee Rules and Regulations CHAPTER 0720-18 Standards for Nursing Homes
Texas A specific ratio for CNAs is not provided. A facility must have sufficient staff with the appropriate skills to provide nursing services for each resident. Texas Administrative Code Title 26 Code § 554.1001 - Nursing Services
Utah A specific ratio for CNAs is not provided. Nursing staff must be present at all times to provide services to residents. Utah Administrative Code R432-150-5. Scope of Services
Vermont A specific ratio for licensed nursing assistants (LNAs) is not provided.
LNAs must provide a minimum of two HPRD for each resident.
Sufficient staff must be on duty at all times to provide resident services.
Each resident must receive a minimum of three HPRD on a weekly average.
Code of Vermont Rules 13-110-005-X 7.13. Nursing Services
Virginia A specific ratio for CNAs is not provided. A facility must provide sufficient qualified nurses and certified nurse aides on all shifts. Virginia Administrative Code 12VAC5-371-210. Nurse Staffing
Washington A specific ratio for CNAs is not provided. Sufficient staff must be on duty at all times to provide resident services. Washington Administrative Code WAC 388-97-1080
West Virginia A specific ratio for CNAs is not provided.
See table 64-13.A. (p.77) for minimum ratios of personnel to residents.
Sufficient nursing personnel are required at all times to provide services.
Each resident must receive no less than 2.25 HPRD.
West Virginia Code of State Rules Title 64. Series 13. Nursing Home Licensure.
8.14 Nursing Services Staffing
Wisconsin A specific ratio for CNAs is not provided. There must be sufficient nursing service personnel to care for the specific needs of each patient. Wisconsin Administrative Code § DHS 132.62 - Nursing Services
Wyoming A specific ratio for CNAs is not provided. Sufficient nursing staff is required to meet resident needs.
Each resident requiring skilled nursing care must receive 2.25 HPRD.
Each resident not requiring skilled nursing care must receive 1.5 HPRD.
Wyoming Rules and Regulations Chapter 11. Section 9. Nursing Services

Table information sourced in September 2023

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.

Lori Fuqua
Blog published on:
September 26, 2023

Lori is a contributing copywriter at Nursa who creates compelling content focusing on location highlights, nurse licensing, compliance, community, and social care.

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