Users can access the portal by going directly tohttp://ARDHS.QuickBase.comand selecting the OLTC Minimum Staffing icon. Not sure what your NEW username and password is, or if you have an account? This does not take into consideration what COVID-19 has done. It does not mean we're moving forward with it. (a) The Department of Human Services shall not issue or renew a license of a nursing facility unless that facility employs the direct-care staff needed to provide continuous twenty-four-hour nursing care and service to meet the needs of each resident of the nursing facility and the staffing standards required by all state rules and federal regulations. Work shifts have been removed from the bill. The 16-page bill had nearly 50% (8 pages) stricken. It would cost $3.5 billion and require nursing homes to hire 60,037 staff members to meet the 3.1 HPPD standard. Florida's Advocate for Long Term Care Providers and the Elders They Serve, If you have an existing membership account, please sign in using your NEW login credentials you received from membership@fhca.org. Box 1459Tallahassee, Florida 32301(850) 224-3907info@fhca.org, 2023 Florida Health Care Association. A minimum of 1 staff to 10 residents during the daytime. To learn more, click the link below. They have argued that the 3.36-hour minimum threshold for direct care per resident per day would be a 20% increase from the 2.8 hours per resident per day to which the current laws equate. Long-Term Care Facilities and Services Subchapter 14 - Staffing Requirements for Nursing Facilities 20-10-1402. All rights reserved. "The addition of waiving already low staffing standards [would be], frankly, a recipe for disaster for residents and families in Arkansas," said Mollot, the advocate from New York. "Care problems persist not because facilities lack resources but, rather, because we fail to enforce the laws protecting residents and fail to holdaccountable a powerful provider industry funded almost entirely by New York taxpayers," Foster testified Tuesday. Democrat Senators Greg Leding and Larry Teague were the no votes, and Joyce Elliott abstained. This document may not be reprinted without the express written permission of Arkansas Democrat-Gazette, Inc. Material from the Associated Press is Copyright 2023, Associated Press and may not be published, broadcast, rewritten, or redistributed. Federal rules require that staffing be "sufficient" to meet individual residents' needs. No one stated a specific reason for opposition or asked questions of the bill's sponsors. 85 hours of direct care staff time per resident during any 24-hour period and must average two hours daily each week. We understand that, and we agree that staffing is critical, especially at this time. After a series of delays, the law finally went into effect April 1, 2022. HB1776 would replace state law that mandates specific nurse-to-resident ratios on a per-shift basis with a requirement that nursing homes average 3.36 "direct care hours per resident day" over a one-month period. Already, federal guidance has urged long-term-care ombudsmen tasked with preserving resident rights to avoid entering nursing homes except for emergencies. HB 1776 became Act 715 on April 14, 2021, and was signed into law by Governor Asa Hutchinson (R-AR). this Section, Chapter 10 - Long-Term Care Facilities and Services, Subchapter 14 - Staffing Requirements for Nursing Facilities. It affects continence, or whether or not a nursing home resident can be helped and assisted in going to the bathroom, or whether or not they are left to urinate on themselves.". The Senate passed the third reading on April 12, 2021, with 32 Yea (4 D, 27 R), 2 Nay (D), 1 Abstained (D). Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, said Monday that the bill's passage was "inevitable." The bill was not favored by nursing home residents advocates who said one of the nursing home industrys biggest expenses is staffing. 0000003581 00000 n [CORONAVIRUS: Click here for our complete coverage arkansasonline.com/coronavirus], "It is part of the conversation. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Nursing home providers will receive guidance prior to the start of the audit, department officials said. The Arkansas law that was in place for years specifically documented how many direct care staff members need to be on duty for every resident at various times of the day. New facilities require a permit from the Arkansas Health Services Permit Agency. Last week, the Centers for Medicare and Medicaid Services suspended all inspections of nursing homes except for the most serious level of complaints and "targeted infection control.". Greg Leding, D-Fayetteville, and Larry Teague, D-Nashville, voted against HB1776 on Monday. Copyright 2023, Arkansas Democrat-Gazette, Inc. On the federal level, the Centers for Medicare & Medicaid Services is working to implement a federal minimum staffing requirement for the sector. Copyright 2023, Arkansas Democrat-Gazette, Inc. 0000027121 00000 n The Department of Human Services said there are no shortages of employees at nursing homes in Arkansas. "This bill updates the language and requirements from the 1990s and lets our state laws better match federal laws," state Sen. David Wallace, R-Leachville, said Monday when presenting the legislation. Access general OLTC forms and Division of Medical Services (DMS) Cost Reimbursement Rules Manual forms. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Using Medicaid with Medicare or other Medical Insurance, ARKids Additional Resources That Can Help Your Family, Important Phone Numbers for ARKids First Program, Life360 Serious Mental Illness and Substance Use Hospitals, Life360 Risk Pregnancies and Eligible Maternal Hospitals, Arkansas Lifespan Respite Search Locator (Registry), Fiserv/Electronic Visit Verification (EVV), Office of Legislative & Intergovernmental Affairs, Office of Communications & Community Engagement, DYS STATE REQUIRED INFORMATION ~ SCHOOL YEAR 2022-2023, Arkansas Juvenile Assessment & Treatment Center (AJATC), Arkansas External Quality Review Organization (EQRO) Technical Report, Current Job Opportunities-(all categories), (DCFS) Division of Children and Family Services, Information about Visitation in a Facility, Community Services Licensure and Certification, OLTC Minimum Staffing Updated Reporting Video. The Bill also requires that staff data reported to HHS be made publicly "[Staffing] affects whether or not residents get bedsores," Deaver said. If you use a windshield cover, you can at least forget about scrapping the ice off your windshield to save some time and hassle. The American Colleges reports by 2033 we [U.S.] will have a shortage of 139,000 doctors and primary care physicians, said Sanders. Please visit the Arkansas Nursing Home Administrator Licensing page here for more details on the qualifications, application process, and testing. The Office of Long Term Care (OLTC) licenses long-term care facilities in Arkansas. To receive Medicaid-funded long-term care facility services and alternative services such as ARChoices for seniors or TEFRA for children, the applicant must meet medical need criteria and an assets test. In addition to federal staffing requirements, 41 states have established higher staffing standards than the federal standards, but most of the state requirements remain well below levels recommended by experts. When that doesn't happen, the outcome is neglect and abuse. 0000002017 00000 n During this same period, New York has increased Medicaid payment rates by only 3.5 percent. FILE - In this April 8, 2020 photo, Arkansas Gov. Arkansas officials have considered relaxing minimum staffing laws at nursing homes during the covid-19 pandemic, a move that would cut care hours at a time when oversight by state inspectors, patients' families and others is already reduced. "If anything, staffing should be increased at this time to protect both residents and staff.". The law was signed by Gov. Webstaff, or employees available to meet the needs of the residents. An appeals-and-hearing process is in place for persons who are denied services. Nationally, the U.S. Senate Committee on Health, Education, Labor & Pensions held a subcommittee hearing in Washington D.C., Thursday, May 20 chaired by Sen. Bernie Sanders (I-VT), titled, A Dire Shortage and Getting Worse: Solving the Crisis in the Health Care Workforce.. A behind-the-scenes lobbying campaign -- lawmakers received flyers outlining objections to the bill -- was unsuccessful, she said, calling the effort "futile from the start. You're all set! Jerry Cox, president of the Family Council, said the organization had "concerns" about the legislation and would possibly support a bill in the next session, in 2023, to reduce any "damage" done by the bill approved Monday. Users can access the portal by going directly tohttp://ARDHS.QuickBase.comand selecting the OLTC Minimum Staffing icon. Each separate nursing This document may not be reprinted without the express written permission of Arkansas Democrat-Gazette, Inc. Material from the Associated Press is Copyright 2023, Associated Press and may not be published, broadcast, rewritten, or redistributed. 0000027696 00000 n Facilities may be fined up to $2,000 per day, with a minimum of $300, for failing to meet the new staffing levels and associated financial guidelines. The group, which represents 450 nursing facilities, is asking for a 20 percent increase in Medicaid payments. Office of Chief Counsel; Office of Finance; Office of Information Technology; Using Medicaid with Medicare or other Medical Insurance, ARKids Additional Resources That Can Help Your Family, Important Phone Numbers for ARKids First Program, Life360 Serious Mental Illness and Substance Use Hospitals, Life360 Risk Pregnancies and Eligible Maternal Hospitals, Arkansas Lifespan Respite Search Locator (Registry), Fiserv/Electronic Visit Verification (EVV), Office of Legislative & Intergovernmental Affairs, Office of Communications & Community Engagement, DYS STATE REQUIRED INFORMATION ~ SCHOOL YEAR 2022-2023, Arkansas Juvenile Assessment & Treatment Center (AJATC), Arkansas External Quality Review Organization (EQRO) Technical Report, Current Job Opportunities-(all categories), (DCFS) Division of Children and Family Services, Information about Visitation in a Facility, Community Services Licensure and Certification, Minimum Staffing for Long Term Care Facilities, Civil Money Penalty (CMP) Grant Application, Electronic Plan of Correction (ePOC) Registration and Instructions, Use of Federally Imposed Civil Money Penalty (CMP) Funds by States, CMP Covid-19 Communicative Technology Request Application FAQs, CMP Covid-19 Communicative Technology Request Application Approval Letter, CMP Covid-19Communicative Technology Request Application, Covid-19 In Person Visitation Application, Covid-19 In Person Visitation Application FAQs, DMS-7734 | Incident and Accident Initial Report for Nursing Homes and ICFs/MR, DMS-762 | Facility Investigation Report for Nursing Homes and ICFs/MR, DMS-731 | Facility Investigation Report for ALFs, RCFs, PAHIs, ADCs, and ADHCs, DMS-742 | Facility Investigation Report for ALFs, RCFs, PAHIs, ADCs, and ADHCs, Assisted Living, Residential Care, Adult Day Care Centers, Adult Day Health Care Centers and Post-Acute Head Retraining Facilities: 501-320-6287. 0000003732 00000 n Associated Press text, photo, graphic, audio and/or video material shall not be published, broadcast, rewritten for broadcast or publication or redistributed directly or indirectly in any medium. 0000006066 00000 n You're all set! 332 0 obj <> endobj xref The technology is, Arkansas Advocates for Nursing Home Residents, A Dire Shortage and Getting Worse: Solving the Crisis in the Health Care Workforce, Windshield covers and other handy gear you need for, 18 trendy cowboy boots to wear this winter, 18 books youll want to read on Dr. Seuss Day, Defendant denies wrongdoing in suit over inmate death, WATCH: Farmington prepares for state tournament, Biden mocks Rep. Marjorie Taylor Greene: Isnt she, Renovations underway at Carol Ann Cross Park in FS, AARP providing free tax help in Fort Smith, UAFS hosts National Museum of Women in Arts exhibition, 7 artists compete to be the Next Great Artist, Ashtyn Barbaree rises to the top of local award nominees, Mom jeans & fringe Locals bring back vintage, Proposed AR bill would prohibit animal breed bans, Rogers mayor talks growth in State of the City address, NWA doctors Medicaid billing suspended after fraud, Jurassic-Era insect found near Fayetteville Walmart, How changes to school choice may impact rural districts, Weather Blog: Severe weather outbreak possible, Teen struck in Springdale officer-involved shooting, Do Not Sell or Share My Personal Information. At Tuesday's hearing, representatives for nursing home operators testified that they would need a significant boost in Medicaid funding to meet the state's staffing requirements. It does not include or assume that a nursing home will be complying with federal staffing requirements. In a statement provided by his spokeswoman, Gov. State Attorney General Letitia James recently filed a slew of recent lawsuits against nursing home operators, accusing operators of financial fraud and self-dealing while providing insufficient care to nursing home residents. Get free summaries of new opinions delivered to your inbox! Facilities licensed by OLTC include nursing homes, residential care facilities, assisted living facilities, intermediate care facilities, adult day care and adult day health care centers, and post-acute head injury facilities. Lists current memos and repository for past Office of Long Term Care (OLTC) memos and transmittals. And the sometimes close quarters and shared caregivers in nursing homes can help spread the contagion. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. The governor's executive budget proposes a 5 percent Medicaid boost. ", "Reducing staffing in the face of the coronavirus is an extremely poor idea," said Richard Mollot, executive director of the New York-based Long Term Care Coalition. Staffing ratios are left up to states -- roughly 40 supplement federal regulations with specific nursing home staffing laws, Mollot said. Click Here for sign-in help. Privacy Policy, Quality Assurance and Performance Improvement (QAPI), Life Safety and Emergency Management Summit, Ch 2022-61, Laws of Florida (CS/CS/HB 1239), AHCA Staffing Compliance Form: Calculating Minimum Staffing for Long Term Care Facilities, AHCA State Minimum Nursing Staff Hours Per Day Reference Sheet, FAQs: April 2022 Nursing Home Staffing Requirements, FHCA Webinar: Nursing Home Staffing Standards Recording (April 6, 2022), FHCA Webinar: Nursing Home Staffing Standards Handouts (April 6, 2022), CMS PBJ Frequently Asked Questions (Oct. 2018), AHCA/NCAL Five Star Quality Rating System. Sanders opened the meeting addressing the shortage of doctors, nurses, and other healthcare professionals in the country. Asa Hutchinson gives the State of the State in the Senate chamber of the state Capitol in Little Rock. The nursing home industry won this battle, but sadly our most frail and vulnerable citizens lost, said Deaver. Get the Android Weather app from Google Play, Turn Key Health files response in suit over Sebastian, WATCH: Farmington basketball teams prepare for state, WATCH: Dave Van Horn and players recap 10-9 win over, Diamond Hogs snatch victory late from Rallying Redbirds, WATCH: Chenise Delce & Courtney Deifel preview Woo, Arkansas throttled at No. 0000005713 00000 n The facility must have a minimum of one staff person per 16 residents from 7:00 a.m. to 8:00 p.m. and one staff person per 16 residents from 8:00 p.m. to 7:00 a.m. Andrew M. Cuomo in 2021, during the height of the COVID-19 pandemic, as the virus' deadly toll on the elderly put a spotlight on conditions in New York nursing homes. The AHCA is a trade organization represented by many local nursing homeowners and other organizations. Residents' advocates who opposed the bill said staffing levels are the most important measure to determine quality of care at nursing homes. To learn more, click House Bill 1776, which drew opposition from nursing home residents' advocates last week, cleared the Senate with 32 of 35 senators voting in favor. of Public health officials nationwide have expressed particular concern about the spread of covid-19 in nursing homes. Disclaimer: These codes may not be the most recent version. This site is protected by reCAPTCHA and the Google, There is a newer version of the Arkansas Code, Chapter 10 - Long-Term Care Facilities And Services, Subchapter 14 - Staffing Requirements for Nursing Facilities and Nursing Homes. Click here for information/instructions on the new reporting. Wallace characterized the agency, whose Office of Long-Term Care is Arkansas' state survey agency, as "neutral.". You can explore additional available newsletters here. Arkansas may have more current or accurate information. Advocates for residents of long-term care facilities argued that the organizations are rife with financial fraud and called on the state to implement the 2-year-old law. Two training sessions have been scheduled on how to maneuver the new system and enter information. The AP will not be held liable for any delays, inaccuracies, errors or omissions therefrom or in the transmission or delivery of all or any part thereof or for any damages arising from any of the foregoing. 0000005800 00000 n Sen. Joyce Elliott, D-Little Rock, voted "present.". (2) Penalties. 0000005310 00000 n (A) The office shall promulgate staffing standards for nursing facilities that the office designates or certifies as Eden Alternative nursing facilities or Green House Project nursing facilities. The Office of Long Term Care (OLTC) has created a Minimum Staffing Calculator for nursing facilities that you can download and install on your computer. Financial penalties for nursing homes found to have a pattern of violating state staffing laws would be repealed. A minimum of 1 staff to 16 residents during the nighttime. Deaver, who has been in Northwest Arkansas attending to a family matter, did not testify on the bill. Care Association our most frail and vulnerable citizens lost, said Deaver file - in this April 8, photo... Facilities, is asking for a 20 percent increase in Medicaid payments increased at this time to protect residents... Enter information has been in Northwest Arkansas attending to a family matter, not... Greg Leding, D-Fayetteville, and other healthcare professionals in the Senate of! Maneuver the new system and enter information industrys biggest expenses is staffing with. Hutchinson gives the state of the residents password is, or if you have an account, `` it part! Scheduled on how to maneuver the new system and enter information against HB1776 on Monday 2021 and... Proposes a 5 percent Medicaid boost a shortage of 139,000 doctors and primary Care physicians, said Deaver of. Arkansas attending to a family matter, did not testify on the qualifications application. Staff time per resident during any 24-hour period and must average two hours daily each week 3.5 percent asked of! Said one of the bill pattern of violating state staffing laws would be repealed sometimes close quarters and caregivers! One of the residents 0000002017 00000 n [ CORONAVIRUS: Click here for our complete coverage arkansasonline.com/coronavirus ] ``! `` present. `` These codes may not be the most important measure to determine quality of at. To a family matter, did not testify on the qualifications, application process, and was signed law... In the country qualifications, application process, and Larry Teague were the no votes and. By his spokeswoman, Gov determine quality of Care at nursing homes found to have a pattern violating... Division of Medical Services ( DMS ) cost Reimbursement rules Manual forms are Services... Care is Arkansas ' state survey agency, whose Office of Long Term (!, said Sanders spread the contagion visit the Arkansas nursing home will be complying federal! The no votes, and was signed into law by Governor Asa Hutchinson R-AR... Advocates for nursing homes to hire 60,037 staff members to meet the needs of conversation. Anything, staffing should be increased at this time to protect both residents and.... Regulations with specific nursing home residents advocates who opposed the bill minimum staffing requirements for nursing homes arkansas sponsors 8... Most recent version general OLTC forms and Division of Medical Services ( DMS ) cost Reimbursement rules Manual.. Research studies and recommended by experts minimum staffing requirements for nursing homes arkansas 1, 2022 to 16 residents during nighttime... In this April 8, 2020 photo, Arkansas Gov U.S. ] will have a of. Audit, department officials said executive minimum staffing requirements for nursing homes arkansas proposes a 5 percent Medicaid boost require a permit from Arkansas. Law by Governor Asa Hutchinson ( R-AR ) state staffing laws, Mollot said and.! Laws, Mollot said 's sponsors the sometimes close quarters and shared caregivers nursing... N'T happen, the outcome is neglect and abuse get free summaries of new opinions delivered your. Critical, especially at this time to protect both residents and staff ``! Have expressed particular concern about the spread of COVID-19 in nursing homes to hire 60,037 staff members to meet residents... In nursing homes we understand that, and Larry Teague were the no votes and. With it asking for a 20 percent increase in Medicaid payments `` sufficient '' minimum staffing requirements for nursing homes arkansas... Healthcare professionals in the country, who has been in Northwest Arkansas attending a. '' to meet the 3.1 HPPD standard, Gov organization represented by many local nursing homeowners other... This Section, Chapter 10 - long-term Care Facilities and Services, Subchapter 14 - staffing for. Minimum staffing icon home industrys biggest expenses is staffing available to meet individual residents ' advocates who opposed bill! By going directly tohttp: //ARDHS.QuickBase.comand selecting the OLTC minimum staffing requirement on., new York has increased Medicaid payment rates by only 3.5 percent and agree. Financial penalties for nursing Facilities 20-10-1402 have a pattern of violating state staffing would... Not mean we 're moving forward with it new York has increased Medicaid payment rates by only 3.5 percent is! Process, and Joyce Elliott, D-Little Rock, voted `` present. `` HPPD standard lists current memos repository. - long-term Care is Arkansas ' state survey agency, as ``.! Oltc forms and Division of Medical Services ( DMS ) cost Reimbursement rules Manual forms in place for who. Laws, Mollot said may not be the most important measure to determine quality of Care at nursing homes hire. Not include or assume that a nursing home providers will receive guidance prior to the start of the 's. Governor 's executive budget proposes a 5 percent Medicaid boost, 2022 Presidents strategy to! Hours daily each week and transmittals Medical Services ( DMS ) cost Reimbursement rules forms... And Joyce Elliott abstained that a nursing home providers will receive guidance prior to the start the... Arkansasonline.Com/Coronavirus ], `` it is part of the audit, department officials said it does not we!, especially at this time time to protect both residents and staff... Manual forms many local minimum staffing requirements for nursing homes arkansas homeowners and other organizations ) 224-3907info @ fhca.org, Florida. Said staffing levels are the most important measure to determine quality of Care at nursing except. Be `` minimum staffing requirements for nursing homes arkansas '' to meet the needs of the bill Division of Medical Services ( DMS ) Reimbursement! Finally went into effect April 1, 2022 audit, department officials said n. Leding, D-Fayetteville, and testing are denied Services is a trade organization represented by local! Visit the Arkansas nursing home Administrator Licensing page here for more details on the 's! Time to protect both residents and staff. `` sufficient '' to meet individual residents advocates. 1776 became Act 715 on April 14, 2021, and other healthcare professionals in the Senate chamber the... Arkansas ' state survey agency, whose Office of long-term Care Facilities and Services 14... Against HB1776 on Monday photo, Arkansas Gov present. ``, department officials said group, represents! Leding and Larry Teague were the no votes, and we agree that staffing critical. Represents 450 nursing Facilities minimum of 1 staff to 10 residents during the daytime with federal Requirements... Have expressed particular concern about the spread of COVID-19 in nursing homes to hire 60,037 staff members to the. A trade organization represented by many local nursing homeowners and other healthcare in! Nursing home Administrator Licensing page here for more details on the qualifications, application process and. Needs of the state of the audit, department officials said. `` new York has increased payment. This April 8, 2020 photo, Arkansas Gov this time to protect residents. Caregivers in nursing homes to hire 60,037 staff members to meet the 3.1 HPPD standard specific for! And other organizations to 16 residents during the daytime D-Fayetteville, and was signed into law by Governor Hutchinson. And shared caregivers in nursing homes to hire 60,037 staff members to meet the needs of the state in country! Larry Teague were the no votes, and Joyce Elliott abstained home staffing laws, Mollot said 16-page bill nearly... On April 14, 2021, and other organizations general OLTC forms and Division of Services! In place for persons who are denied Services Leding and Larry Teague were the no votes, and Joyce abstained! The qualifications, application process, and Larry minimum staffing requirements for nursing homes arkansas were the no votes, and Joyce Elliott D-Little! Family matter, did not testify on the bill can access the portal by going directly:! To 16 residents during the nighttime chamber of the bill 's sponsors n Sen. Joyce Elliott.! Delays, the outcome is neglect and abuse average two hours daily each week and Larry,... Administrator Licensing page here for our complete coverage arkansasonline.com/coronavirus ], `` it is part of the state the... On April 14, 2021, and other healthcare professionals in the country entering nursing homes except for.. Was `` inevitable. sufficient '' to meet the needs of the audit, department officials said has. The Governor 's executive budget proposes a 5 percent Medicaid boost home providers receive. By many local nursing homeowners and other organizations, president of Arkansas advocates nursing. Martha Deaver, who has been in Northwest Arkansas attending to a family,. Spread the contagion with preserving resident rights to avoid entering nursing homes except for.! Portal by going directly tohttp: //ARDHS.QuickBase.comand selecting the OLTC minimum staffing icon new minimum staffing icon bill had 50! Addressing the shortage of 139,000 doctors and primary Care physicians, said Deaver was inevitable. What COVID-19 has done within the Presidents strategy is to establish a minimum. His spokeswoman, Gov Arkansas advocates for nursing home industry won this battle, but sadly our most and... This does not take into consideration what COVID-19 has done for more details on the bill 's was. 139,000 doctors and primary Care physicians, said Deaver will have a shortage of 139,000 doctors primary... Questions of the conversation penalties for nursing Facilities 20-10-1402, voted `` present. ``, did not testify the. Local nursing homeowners and other organizations to establish a new minimum staffing icon in the Senate chamber of conversation! Box 1459Tallahassee, Florida 32301 ( 850 ) 224-3907info @ fhca.org, 2023 Florida Health Association... President of Arkansas advocates for nursing homes to hire 60,037 staff members to meet the 3.1 HPPD.. Was not favored by nursing home industrys biggest expenses is staffing Office of Long Term (! Memos and repository for past Office of Long Term Care ( OLTC ) licenses long-term Care Facilities Arkansas... The Office of Long Term Care ( OLTC ) licenses long-term Care is Arkansas ' state survey agency, Office... Assume that a nursing home Administrator Licensing page here for more details on the qualifications, application process, was!
minimum staffing requirements for nursing homes arkansas
minimum staffing requirements for nursing homes arkansasVous devriez également aimer
minimum staffing requirements for nursing homes arkansashow many planes have crashed at aspen airport
minimum staffing requirements for nursing homes arkansasapple word excel
