With the federal minimum staffing mandate repealed, South Carolina's own state-level requirements are the operative staffing floor for nursing homes and community residential care facilities (CRCFs, South Carolina's term for assisted living) operating in the state. These requirements come from two sources that don't always get reconciled clearly: annual state appropriations provisos and DPH licensing regulations.
Nursing home staffing: the current proviso standard
Under Proviso 31.17 of the 2025-2026 Appropriations Act (DPH memo of August 27, 2025), South Carolina's nursing home staffing standards for fiscal year 2025-26 required:
| Requirement | Standard |
|---|---|
| Direct care hours | At least 1.63 hours of direct care per resident per day from non-licensed nursing staff |
| Licensed nurse coverage | At least one licensed nurse per shift for each staff work area, regardless of how many residents are housed in that work area |
This is a temporary modification set through the annual appropriations process, not a permanent regulatory standard. The 2026-27 fiscal year began July 1, 2026, and we could not confirm the FY 2026-27 proviso text, so check the current Appropriations Act and DPH's latest memo. Administrators should treat this as something to re-verify annually, not a fixed rule to file away. All other staffing and non-staffing standards under DPH Regulation 60-17 (Standards for Licensing Nursing Homes) remain independently enforceable alongside this proviso.
CRCF (assisted living) staffing: the regulatory baseline
Under DPH Regulation 60-84 (Standards for Licensing Community Residential Care Facilities, formerly 61-84; last amended May 23, 2025), CRCF staffing requirements include:
| Requirement | Standard | Section |
|---|---|---|
| Peak hours (7 a.m. to 7 p.m. unless DPH approves otherwise) | At least one staff member/direct care volunteer for each eight residents (or fraction thereof) | §503.B.1 |
| Other times | At least one staff member/volunteer on duty for each thirty residents (or fraction thereof), awake and dressed at all times | §503.B.2 |
| Facilities licensed for more than 10 beds | A staff member available on each floor whenever residents are present | §503.B.3 |
| Administrator | A licensed CRCF administrator in charge of all facility functions, with a designated staff member to act in the administrator's absence | §502 |
| Additional staffing | Determined by resident number and condition, so acuity, not just headcount, factors into what is actually required | §503.B |
A live regulatory development: the memory care staffing study
DPH delivered its legislatively mandated memory care staffing study (Proviso 31.48) on January 1, 2026. It surveyed 137 of 629 licensed facilities and took public comment that raised understaffing, inadequate dementia training and safety risks such as elopement and falls. Among nursing homes that favored a higher standard, suggestions ran from 1.85 to 3.5 direct care hours per resident per day, versus the current 1.63. DPH recommended higher minimum ratios, enhanced memory care training and workforce resources, but set no numeric target and proposed no regulation text. Memory care staffing requirements in South Carolina could still tighten — facilities operating memory care units or considering opening one should watch this closely rather than assuming the current, more general staffing floor will remain adequate. Budget status: In the FY 2026-27 budget process the memory care study proviso appears as Proviso 31.47, and the Ways and Means healthcare subcommittee, the House and the Senate Finance subcommittee each recommended deleting it. We could not confirm the final enacted budget text.
What this means operationally
- Don't confuse "no federal minimum" with "no minimum." SC's state-level requirements are real, independently enforceable, and in the case of the nursing home proviso, subject to annual change.
- Track follow-on action to the memory care study. The report is final but did not set a standard; legislation or rulemaking that does would be the most consequential staffing development for memory care operators.
- CRCF staffing compliance is acuity-driven, not just ratio-driven. "One staff per eight residents" is a floor, not a ceiling — DPH's own framework explicitly ties adequate staffing to resident condition, which means a facility with higher-acuity residents may be out of compliance even while meeting the raw ratio.
This reflects South Carolina requirements as of 2026 — always verify current staffing provisos and DPH regulations directly, since the nursing home standard specifically is subject to annual legislative change.
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