Carolyn's Law

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Amendment Title
Nursing Facility Patients’ Bill of Rights

This Amendment would add section 12a to Article XV of the Ohio Constitution to require certain staff-to-patient ratios in nursing facilities and require certain minimum daily amounts of direct care to nursing facility patients. In addition to other provisions, the Amendment would:

• Provide that the provisions of the Amendment adopted by the voters will also be known as Carolyn’s Law.

• Require the Ohio Department of Health or its successor to provide by regulation for the following:
- that no nursing facility, or employee or agent of a nursing facility, shall cause harm to patients due to neglect, mistreatment, abuse, or willful intent.
- that in each skilled nursing facility, and regardless of the daily patient census, there shall be at least 1 licensed nurse on duty at any time for every 5 patients with higher medical acuity needs, at least 1 certified nurse aide on duty at any time for every 6 patients with higher medical acuity needs, and at least 1 licensed nurse and 1 certified nurse aide on duty at any time for every 8 patients with lower medical acuity needs.
- that in each nursing facility, except for skilled nursing facilities and regardless of the daily patient census, there shall be at least one 1 licensed nurse and 1 certified nurse aide on duty at any time for every 8 patients with higher medical acuity needs, and at least 1 licensed nurse and 1 certified nurse aide on duty at any time for every 10 patients with lower medical acuity needs.
- that each skilled nursing facility and inpatient rehabilitation facility shall provide each patient, regardless of medical acuity needs, with at least a combined daily average of 4.8 hours of direct care, including an average of 3 hours of direct care from certified nurse aides and an average of 1.8 hours of direct care from licensed nurses.
- that each nursing home, short-term care facility, and long-term care facility shall provide each patient with lower medical acuity needs with a combined daily average of 4.1 hours of direct care, including an average of 2.8 hours of direct care from nurse aides and an average of 1.3 hours of direct care from licensed nurses.
- that each nursing home, short-term care facility, and long-term care facility shall provide each patient with higher medical acuity needs with a combined daily average of 4.5 hours of direct care, including an average of 3 hours of direct care from nurse aides and an average of 1.5 hours of direct care from licensed nurses.
- that each nursing facility shall have at least 1 licensed nurse and 1 certified nurse aide on duty at any time who are assigned to assist other nurses and nurse aides, as needed, in providing care to patients, and that such licensed nurse and certified nurse aide may count toward the minimum staff-to-patient ratios required by this Amendment.
- that, for purposes of this Amendment, patients’ medical acuity needs shall be determined by the nursing facility in accordance with standards set by the Ohio Department of Health or its successor.
- that each nursing facility shall employ or contract with a patient advocate to address the needs and issues of patients and to increase patient satisfaction.
- that each nursing facility shall implement protocols requiring as prompt a response as possible to a call light signal from a patient, if the facility utilizes such technology.
- that each nursing facility shall implement protocols requiring hourly rounds based on each patient’s medical acuity needs to ensure that safe, quality, and compassionate care is provided.
- that each nursing facility shall provide notice in their facilities informing staff of the standards of care required by the Amendment, laws and regulations issued pursuant to the Amendment, and other laws and regulations governing nursing facilities.
- the development and utilization of competency tests, personal attribute tests, simulations, and trainings to exemplify extraordinary nurse aides in meeting the expectations of providing safe, quality, and compassionate care to patients in nursing facilities.
- that each nursing facility shall promptly identify and correct any staffing or practice deficiencies that have led to or caused any harm, damage, or debilitating injury to patients due to neglect, mistreatment, abuse, or willful intent.
- the imposition of civil and criminal penalties on nursing facilities, and employees or agents of nursing facilities for noncompliance with this Amendment or with the laws and regulations issued pursuant to the Amendment, and that such penalties may include, but are not limited to, fines, requiring additional education or training, temporary or permanent suspension of a license or certification, termination from employment, and reporting of conduct to regulatory entities and law enforcement.

• Require the Ohio Board of Nursing or its successor to provide by regulation for the following:
- the development and utilization of competency tests, personal attribute tests, simulations, and trainings to exemplify extraordinary nurses in meeting the expectations of providing safe, quality, and compassionate care to patients in nursing facilities.
- the imposition of civil and criminal penalties on licensed nurses for noncompliance with this Amendment or the laws and regulations issued pursuant to this Amendment, and that such penalties may include but are not limited to fines, requiring additional education or training, temporary or permanent suspension of a license or certification, termination from employment, and reporting of conduct to regulatory entities law enforcement.

• Provide that the Amendment shall be liberally construed to effectuate its purpose.

• Provide it shall take effect at the earliest date allowed by the Constitution, and require the Ohio Department of Health, or its successor, and the Ohio Board of Nursing, or its successor, to provide that the regulations required by the Amendment are in effect within one year of the Amendment’s effective date.

• Provide that all provisions of the Amendment are severable, and that the Amendment shall supersede all conflicting state laws and regulations.

• Provide that any provision of the Amendment that is not contrary to the provision of a separate initiative that receives a higher total vote on the same statewide ballot is valid.

• Declare that the People of the State of Ohio find that patients of nursing facilities, which include nursing homes, skilled nursing facilities, and inpatient rehabilitation facilities, are an especially vulnerable group of individuals that require safe, quality, and compassionate medical care every day, and also find that adequate nurse and nurse aide staffing is key to providing safe patient care and is key to nurse and nurse aide retention.

• Declare that it is a vital state interest that nursing facilities providing such care have enough highly-skilled and adequately-trained nurses and nurse aides to serve their patients in order to reduce medical errors and to prevent harm, damage, and debilitating injuries caused by neglect, mistreatment, abuse, or willful intent.

• State that the purpose of this Section is to ensure that nursing facilities provide such safe, quality, and compassionate medical care to their patients, and to hold those accountable who cause harm to patients.

The Amendment defines “abuse,” “acuity needs,” “adequately-trained,” “certified nurse aide,” “damage,” “debilitating injury,” “direct care,” “harm,” “highly-skilled,” “inpatient rehabilitation facility,” “licensed nurse,” “long-term care facility,” “mistreatment,” “neglect,” “nursing facility,” “nursing home,” “short-term care facility,” “skilled nursing facility,” and “willful intent.”

Certification of the Attorney General
Without passing on the advisability of the approval or rejection of the measure to be referred, but pursuant to the duties imposed upon the Attorney General’s Office under Section 3519.01(A) of the Ohio Revised Code, I hereby certify that the summary is a fair and truthful statement of the proposed amendment.
Dave Yost, Ohio Attorney General
June 30, 2021

Certifications & Awards

Certification of the Attorney General, without passing on the advisability of the approval or rejection of the measure to be referred, but pursuant to the duties imposed upon the Attorney General’s Office under Section 3519.01(A) of the Ohio Revised Code,