New Nursing Home Minimum Staffing Requirements

On September 1, 2023 the US Department for Health and Human Services announced new minimum staffing standards for US nursing homes (see press release from CMS). The proposals comes more than a year after President Biden mentioned them in the 2022 State of the Union address and despite significant concerns from industry.

According to the press release, the nursing homes would be expected to have:

  • .55 hours of care from registered nurse per resident per day (This is direct time with a resident. It does not include time spent on other matters)
  • 2.45 hours of care from a certified nurse aid per resident per day
  • a least one registered nurse on site 24/7

See our report on nursing home staffing for a comparison to current staffing levels. According to CMS data from August 2023, 49% of US nursing homes currently meet the time requirement for registered nurse care and 27% of US nursing homes meet the time requirement for certified nurse aids. No data is provided on the 24/7 staffing of registered nurses.

According to various news articles, these proposals have not been well received by industry. Foremost among the complaints is the fact the proposals are too simple and do not account for the complexity of delivering nursing home care. Since nursing homes deal with a wide range of needs which are not easily addresses by a minimum care requirement, some residents are recovering from surgery and don’t need much care while others have chronic conditions that required significantly more oversight and assistance. Nursing homes in the United States are already subject to a very complicated system of inspections and reviews in the form of the Centers for Medicare and Medicaid’s 5-Star Quality Rating System. Then there is the fact that there is a national shortage of trained medical professionals. And, what is somewhat ironic is that the fact that how much a nursing home spends on staff is directly related to how much Medicare and Medicaid reimburse the homes to begin with.

At the moment, these new minimum levels are still just a proposal. It is not clear when or whether they will become required.

To help shed light on the issue, we have put together a page that will update every time CMS provides new data. We will be adding to page from time to time and would appreciate any feedback on what data and analysis would be helpful.