Skilled nursing facilities in states with existing or pending minimum staffing standards should note that higher labor costs in the study were offset by increased net patient revenues, leaving net margins unchanged. SNF advocates argue that payer mix shifts and cuts to non-nursing services enabled that outcome.
The staffing increases documented were driven primarily by CNA and LPN hours, the categories most directly tracked through PBJ reporting and consequential to five-star staffing ratings.
Higher levels of direct care staffing in nursing homes improve resident outcomes, yet concerns persist that minimum staffing mandates could strain facility finances or lead to closures. Using longitudinal data from the period 2010–23 on 6,849 nursing homes operating across twenty-two states, we estimated the effects of state minimum staffing mandates on staffing levels, financial health, and closures. Staffing mandates increased total direct care staff by 0.18 hours per resident day, or roughly 5 percent, on average, driven by increases in licensed practical nurses (0.06 hours per resident day) and certified nursing assistants (0.13 hours per resident day). Facilities’ annual labor expenses rose by about $273,000, but these costs were offset by higher net patient revenues (approximately $546,000), leaving net margins unchanged. Mandates did not increase the likelihood of facility closure.
Werner, Rachel M., et al. “State Nursing Home Minimum Staffing Mandates: Increased Staff Levels, Minimal Impact On Finances And Closures, 2010–23.” Health Affairs, 02 March 2026. https://doi.org/10.1377/hlthaff.2025.01223
Jodi Eyigor, vice president of health policy at LeadingAge, the association of nonprofit providers of aging services, told SNN that the study omits the tradeoffs nursing homes have had to make behind the scenes to accommodate for the state-level staffing mandates. “The study does not tell the full story of what those mandates can mean for nursing home residents,” said Eyigor. “The fact is that care costs money… The authors acknowledge that providers may have to offset the costs of increasing direct care staffing by making other financially motivated operational changes.”
— Skilled Nursing News, March 04, 2026
Providers Tear Into Study Alleging No Financial Harm From Nursing Home Staffing Mandates
“This study raises more questions than answers, and the researchers’ bias is clearly on display. There was no substantial increase in total direct care, and no credible analysis of the various state policies or dynamics that may have led to these results,” American Health Care Association/National Center for Assisted Living spokeswoman Rachel Reeves said. “At the end of the day, staffing mandates are an antiquated approach in today’s healthcare space and in the face of our nation’s growing elderly population.”
— McKnight’s Long-Term Care News, March 03, 2026
‘Excellent Evidence’ Nursing Home Staffing Mandates Don’t Cause Financial Harm: Study
“We know that higher staffing levels save lives and there’s excellent evidence and research showing that. I think now we have excellent evidence that higher staffing levels don’t cause financial harm in nursing homes,” lead researcher Rachel M. Werner, MD, PhD, of the University of Pennsylvania, told McKnight’s Long-Term Care News. “It seems to me those are two of the most important things to nursing homes, and they both support the idea that we should have staffing mandates.”
— McKnight’s Long-Term Care News, March 03, 2026
