Analysis: Final Nursing Home Staffing Rule Would Require 102,000 Additional Caregivers, Cost $6.5 Billion Per Year

Advocacy; Legislative; Workforce

​WASHINGTON, D.C. – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and long term care facilities across the country that provide care to approximately five million people each year, released an analysis today on the impact of the Centers for Medicare and Medicaid Services' (CMS) federal staffing mandate on nursing homes. The final rule requires every nursing home to deliver a minimum of 3.48 total nursing staff hours per resident per day (HPRD), including 2.45 hours from nurse aides and 0.55 hours from registered nurses (RN). Additionally, nursing homes will be required to have an RN on site 24 hours per day.​

AHCA/NCAL's findings include:

  • Only six percent of nursing homes currently meet all four requirements.
  • Eighty percent of nursing homes will have to hire more RNs to meet the 24/7 RN requirement, including 92 percent of rural facilities.
  • Nursing homes will have to hire an additional 102,000 nurses and nurse aides to comply with the mandate.
  • It will cost nursing homes an estimated $6.5 billion annually to hire these additional caregivers.
  • There is a strong correlation between Medicaid census and compliance; facilities that predominantly serve residents on Medicaid are less likely to meet each of the four requirements.
  • Nearly one-quarter of nursing home residents (more than 290,000) may be at risk of displacement, as facilities are forced to reduce their census in order to comply with the mandate, or ultimately close altogether.

“What our new analysis confirms is what we've been saying for years: An unfunded, one-size-fits-all minimum staffing mandate for nursing homes would be impossible to meet and only threatens to limit access to care for our seniors," said AHCA/NCAL President and CEO Mark Parkinson. “When nearly every nursing home in the country would be considered out of compliance and an exemption is basically impossible to obtain, it demonstrates how out of touch Washington bureaucrats are with reality. Nursing homes have been doing everything they can to recruit and retain more caregivers, but the available labor force is not there."

“There is growing bipartisan consensus in Congress that this federal staffing mandate is not the answer, yet the Biden Administration ignored concerns and finalized this rule," continued Parkinson. “We will continue to work with Congress to find more productive solutions to address workforce shortages and safeguard access to care for our nation's seniors."

The AHCA/NCAL analysis of the final rule uses staffing, cost, and facility data from the federal government: CMS' Payroll Based Journal, Medicare Cost Reports, and Care Compare.

See the full analysis HERE.