Mandated Staff Expenditure

Safe staffing levels at nursing homes have been associated with better care quality for residents.

A Health Affairs study found that nursing homes with higher proportion of lower paying Medicaid residents directed more revenue toward workers but reported lower staffing levels.

This may be attributed to lower Medicaid reimbursement, which nursing homes argue is below the cost of care. This may be unreliable reporting. Nursing expenditures represent the total amount of money spent on nursing staff. Nursing staff levels measured by hours per resident day. The median staffing levels in nursing homes were 3.67 hours worked but 4.08 hours paid.

Experts and researchers propose a minimum threshold for nursing staff expenditure ratios of 25 to 45 percent of gross revenues. Most nursing homes spend more than 25 percent on nursing staff. Fewer than 20 percent of facilities spent more than 40 percent of revenues on staff.

Higher nursing staff expenditures may result from raising wages or paying benefits and may not lead to safe staffing levels.

For a minimum nursing staff expenditure regulation to increase safe staffing, it would have to be paired with a minimum nursing staff requirement.

Biden’s recent executive order will direct the Department of Health and Human Services (HHS) to “build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers,” according to a White House fact sheet.