Higher Spending on Nursing Home Staff is Not Tied to Better Staffing Levels

Nursing homes with higher shares of Medicaid residents directed more revenue toward workers but had lower staffing levels, indicating that a minimum nursing staff expenditure regulation would not guarantee better staff levels, a Health Affairs study found.

Adequate staffing levels at nursing homes have been associated with better care quality for residents. However, federal regulations do not currently define minimum nursing staff ratios.

A National Academies of Sciences, Engineering, and Medicine report recommended that nursing homes designate a specific share of Medicare and Medicaid payments for direct-care services for residents, including nursing home staff.

“Our findings suggest that any specific threshold for nursing staff expenditures that regulators might consider would have a varying degree of effectiveness in ensuring that any given nursing home was adequately staffed,” researchers wrote.

For a minimum nursing staff expenditure regulation to positively impact staffing, it would have to be paired with a minimum nursing staff requirement. Additionally, any potential regulation should consider the resource constraints that nursing homes face based on their payer mix, reimbursement rates, and workforce.