Per CMS and the Office of Long-term Care regulations, the elderly population in nursing homes and/or long-term care facilities are to receive 3.36 hours daily of direct care from staff. Direct care staff includes RN, LPN, CNA, APN, MD, PT,OT,ST and PA-Cs.  This is an issue because the regulation does not specify how that time is divided up, and is really just not a clear regulation. Keep in mind that there is 24 hours in a day and residents living in long-term care facilities in the state of Arkansas pay anywhere from $69,350-$88,513 for private pay annually, meaning they generally have a private room and pay out of pocket, and semi-private rooms cost approximately $63,988-$73,000 annually. Can you imagine paying this much money and only having a minimum of 3.36 hours of direct care promised to you by regulations? Think of all of your activities of daily living that you perform each day such as: bathing, brushing your teeth, going to the bathroom, cutting your nails or toenails, eating 3 meals, walking, taking your medications and just enjoying socialization in general. Now, imagine not being able to do all of those things for yourself. Do you think that 3.36 hours would wrap up your daily routine, especially for the elderly that typically move slower and have a slower thought process? Now, imagine paying that much money annually and being told that by regulation, direct care staff really only has to give a minimum of 3.36 hours of direct care. 3.36 hours to meet all of your needs in a 24 hour period. Do you think it can be done? Well, I don't. In fact, I know it can't be done because I have worked in several long-term care facilities and there is no worse feeling in the world than for a nurse to go home and feel like he/she has given subpar care due to time constrictions. The elderly population deserves better care for the amount of money they pay, and nurses deserve to have the time to give that better care without feeling so short staffed and run ragged. I propose that the Office of Long-term care increase the minimum 3.36 direct care hours to at least 5 hours and increase direct care staffing ratios. I have worked in long-term care facilities for the last 13 years, and at times, I have taken care of 35 residents at a time doing multiple med-passes, which are allotted a two hour window, which means if a medication is due to be given at 8am, you are able to give it an hour before or an hour after, so you have from 7am-9am to give that medication. On top of administering these medications several times in one shift, the nurse is also responsible for wound care, checking blood glucose levels, administering insulin at an acceptable time, addressing emergent issues such as falls and also completing monthly summaries and charting. How does a nurse have enough time to care for the elderly the way they deserve if they have this many responsibilities? I am just wanting what is right to be done to better the quality of life for residents and lighten the workload for the nurse, so he/she is able to give good quality care. I think of my grandparents and their hard earned money and wonder what their care will look like if that day comes that they must go to a long-term care facility. Not only do I think about their care, but also my own. We must advocate for the elderly population as well as the nursing population. If nurses continue to leave the bedside, there will be a big piece missing from the healthcare puzzle.