State variation in staffing and characteristics of nursing homes most impacted by new federal standards.

Overview

INTRODUCTION: New federal minimum staffing standards aim to increase staffing in nursing homes. As the future of the new rule remains uncertain, this study compares the new standard to existing state staffing standards and examines the characteristics of nursing homes who may meet the new requirement. METHODS: We utilized the 2023 CMS Payroll-Based Journal Data to calculate staffing ratios and nurse turnover. We summarized staffing levels by nursing home size, ownership type, chain affiliation, and rurality. We compared state staffing policies using data from the Medicaid and Children's Health Insurance Program (CHIP) Payment and Access Commission (MACPAC). Statistical analyses included Student's t-tests and z-tests. RESULTS: Nursing homes in 11 states had staffing levels below the new federal minimum. Across states, compliance with the new federal requirements ranged from 31% in states with the lowest staffing requirements to 65% in states with the highest. Higher state staffing standards were associated with better quality ratings and lower turnover. CONCLUSION: Our paper explores state efforts toward reaching staffing goals. While higher state staffing standards correlate with better nursing home quality ratings, many homes may struggle to meet the new federal requirements.