Ohio is listed as one of the worst for nursing home care. A major part of this  problem is staffing. Current guidelines in the state of Ohio endanger not just the patients but also the staff, one nurse or nurse aide should not have up to 25-50 patients to care for depending on the unit. Safe patient to nurse ratio needs to be addressed. The acuity of care has changed, Nurses and aides are taking care of not only the elderly, but a younger generation that requires a higher level of care than ever before.