These developments underscore the compliance uncertainty SNFs face as federal minimum staffing are considered. Accurate Payroll Based Journal reporting remains the central metric by which staffing compliance is measured at both the state and federal level, regardless of whether penalties are actively enforced.
State initiatives painted as ‘building blocks’ that may transform nursing home staffing
Nine states have already enacted an incentive-based approach central to enhancing resident care in nursing homes. But four states are using incentives in Medicaid as a direct way of bolstering staffing levels… States are using VBP metrics obtained through the Centers for Medicare and Medicaid Services’ Five-Star Quality Rating System, as well as its Staff Time and Resource Intensity Verification (STRIVE) ratios.
— McKnight’s Long-Term Care News, April 24, 2025
California, Florida, Massachusetts, New York, and Rhode Island have sought to improve nursing home quality by mandating the highest minimum hours of care per resident among states. But an examination of records in those states revealed that putting a law on the books was no guarantee of better staffing. Instead, many nursing homes operated with fewer workers than required, often with the permission of regulators or with no consequences at all.
— KFF Health News, July 12, 2024
KFF: Five States with Toughest Nursing Home Staffing Rules Fail to Improve Care Quality
The analysis used daily payroll-based journal data (PBJ) from nursing homes, covering the final three months of 2023 and totaling 1.3 million records. According to KFF, there is widespread non-compliance with the rules, with many nursing homes in these states operating below the state mandated staffing levels, often with tacit approval from regulatory bodies or without facing penalties.
— Skilled Nursing News, July 12, 2024
Policy Moves That Are Yielding State Winners on Nursing Home Staffing Front
North Dakota has some of the highest staffing levels in the country… The state’s 5-star direct care staffing rating was 4.25 stars out of 5, while the average for the rest of the country was 2.69. Total nursing hours per resident per day (HPRD) was 4.78 during the most recent quarter compared to 3.8 for the country, according to data collected from the Five-Star Payroll Based Journal (PBJ).
— Skilled Nursing News, April 4, 2024
Illinois, Rhode Island and New York paused penalties for nursing homes that violate state staffing mandates as the governors feared the cost of compliance could force nursing homes to limit patient access or close their doors. Their experiences point to problems [Centers for Medicare and Medicaid Services (CMS)] could encounter carrying out a federal staffing mandate, but the agency is adamant its final rule will be workable for nursing homes.
— American Health Care Association / NCAL, March 20, 2024
Nursing home staffing mandates face uneasy rollout in states
Nursing home staffing mandates in three states could be a harbinger of the difficulties ahead for the Centers for Medicare and Medicaid Services when it implements a federal staffing mandate.
— Modern Healthcare, March 20, 2024
