While staffing shortages in nursing homes have existed for decades, the COVID-19 pandemic has highlighted and intensified the need for sufficient, consistent, trained staff to care for residents. Numerous studies have found that high staffing levels are associated with higher care quality. Yet, a recent report concluded that “staffing standards in almost every state remain severely low.” In April 2022, the National Academies of Science, Engineering, and Medicine recommended minimum staffing levels, policies to ensure competitive wages and benefits, and improvements to staff training and opportunities for career advancement, among other reforms, as part of its comprehensive report to improve nursing home quality. The Biden Administration has announced plans to propose new federal minimum staffing adequacy regulations in the next year.
This issue brief summarizes federal and state standards related to nursing home staffing prior to COVID-19 and builds on existing information by identifying changes to state minimum staffing requirements adopted since the onset of the COVID-19 pandemic. We also examine state legislative and regulatory actions since the onset of the pandemic that directly affect worker wages and training requirements. Key findings include the following:
Staffing Requirements: At least five states (AR, CT, MA, NY, RI) adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least...
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