July 15, 2023 - The Biden Administration announced last year that it would issue a new rule in the spring of 2023 to increase required nursing staff levels to help address longstanding concerns about insufficient staffing and the quality of care for residents of nursing facilities.

While the timing for the proposed rule is unknown, it is expected to raise the minimum number of nurse hours per resident day, which is currently set at 0.3 hours.

To consider the possible impact of the proposed rule, a new KFF analysis shows that nearly all nursing facilities would meet a requirement of 2.5 or fewer hours. However, just over half (55%) of nursing facilities would meet a requirement for 3.5 hours and only 29% could comply with 4.0 hours without hiring new staff.

For at least 20 years, various health groups have suggested that federal requirements for nursing staff levels are below the levels that would ensure patient safety and well-being, although some states have higher requirements. Nursing facilities cared for nearly 1.2 million Americans in 2022.

The ability of nursing facilities to meet higher staffing levels would vary across states, based on current staffing levels. For example, if staffing levels are set at 4 hours, the share of facilities meeting this standard would range from just 12% in Texas and 13% in Georgia to 94% in Oregon and 100% in Alaska.

If a higher staffing requirement is issued and finalized, many nursing facilities would need to hire additional staff to comply over the coming years. This increased demand for staff would occur alongside existing workforce shortages in the long-term services and supports (LTSS) sector.

In response to staff shortages and the demanding nature of this work, most states have increased, or are working to increase, Medicaid payment rates for LTSS providers, as Medicaid is the primary payer for both institutional and community based LTSS. These potential increases in nursing home staffing could also increase costs, which may be difficult for some state Medicaid programs to absorb without additional federal funding.

KFF’s analysis includes data from 14,575 nursing facilities (97% of all facilities, serving 1.17 million or 98% of all residents) that reported staffing levels in June 2023.
Source: KFF