State Nursing Home Minimum Staffing Mandates: Increased Staff Levels, Minimal Impact On Finances And Closures, 2010–23

Higher levels of direct care staffing in nursing homes improve resident outcomes, yet concerns persist that minimum staffing mandates could strain facility finances or lead to closures. Using longitudinal data from the period 2010-23 on 6,849 nursing homes operating across twenty-two states, we estimated the effects of state minimum staffing mandates on staffing levels, financial health, and closures. Staffing mandates increased total direct care staff by 0.18 hours per resident day, or roughly 5 percent, on average, driven by increases in licensed practical nurses (0.06 hours per resident day) and certified nursing assistants (0.13 hours per resident day). Facilities' annual labor expenses rose by about $273,000, but these costs were offset by higher net patient revenues (approximately $546,000), leaving net margins unchanged. Mandates did not increase the likelihood of facility closure. Overall, our findings indicate that minimum staffing mandates can meaningfully raise staffing levels without undermining the financial viability of nursing homes.