For skilled nursing facilities, this study signals that compliance with a proposed minimum nursing staff expenditure ratio would not be sufficient to satisfy CMS minimum staffing hour requirements, particularly for facilities with a high Medicaid census.
Nationally, the median proportion of revenues spent on nursing staff was 33.9 percent, and median nursing staff levels were 3.67 hours worked and 4.08 hours paid per resident day. Facilities with higher shares of Medicaid residents spent a larger share of revenues on nursing staff but had lower staffing levels. States varied significantly with respect to median spending on nursing staff (26.8–44.0 percent of revenues) and median nursing staff levels (3.2–5.6 hours worked and 3.6–5.7 hours paid per resident day). These findings indicate that raising the proportion of revenues spent by nursing homes on nursing staff to a regulated minimum would not guarantee the achievement of adequate nursing staff levels unless it was paired with other regulatory mechanisms.
Citation: Bowblis, John R., et al. “Understanding Nursing Home Spending and Staff Levels in the Context of Recent Nursing Staff Recommendations.” Health Affairs, vol. 42, no. 2, Feb. 2023, https://doi.org/10.1377/hlthaff.2022.00692.
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. Nursing homes with a high Medicaid payer mix had the lowest staffing levels of 3.32 hours worked but spent a higher share of their revenue on staff compared to other facilities.
— RevCycle Intelligence, February 08, 2023
Spending More Revenue on Labor Not Guaranteed to Achieve ‘Adequate’ Nursing Home Staffing
Pushing nursing homes to allocate more money to increase staffing levels will not necessarily achieve the goals of the proposed minimum staffing standard unless aided by other regulatory interventions, according to a new study. Facilities with higher shares of Medicaid residents spent a larger share of revenues on nursing staff but had lower staffing levels, the data revealed. Median staffing levels in U.S. nursing homes that year amounted to 3.67 hours spent working per patient day.
— Skilled Nursing News, February 08, 2023
Addressing Medicaid Rates Key to Minimum Staffing Mandate: Study
Requiring nursing homes to spend a specific share of revenues on direct care alone won’t guarantee that facilities are “adequately” staffed, a new study finds. Rather, researchers who reviewed spending and staffing data from more than 12,000 nursing homes found that a minimum hourly staffing requirement is more likely to increase direct care. “The only way to do it, if you’re going to try to lift all boats, is to either provide funding or create mechanisms that incentivize some of these lower-staffed states to increase their staffing requirements,” said John R. Bowblis, PhD, professor of economics and research fellow at the Scripps Gerontology Center.
— McKnight’s Long-Term Care News, February 07, 2023
