Adequate staffing in nursing homes (NHs) is one of the primary drivers of better quality of care and reduced incidence of abuse and neglect of residents. NH staffing issues have gained national attention especially during the height of the COVID-19 pandemic, which caused more than 169,000 deaths in NHs to date. COVID prompted an exodus of many nurses out of the NH industry due to infection risk, low wages, and difficult working conditions.

The federal government and states both have a role in overseeing NH quality and staffing. The Centers for Medicare & Medicaid Services creates the requirements that NHs must meet if they receive any Medicare or Medicaid funding. States can also add their own regulations to supplement federal rules and are tasked with licensing, oversight surveys, and complaint investigations to ensure NHs meet both state and federal standards.

This Better Care Playbook blog post, coauthored by CHCS’ Emma Rauscher and Carrie Graham, outlines some of the current rules on NH staffing, research findings that are important for policymakers to understand when setting NH staffing rules, and implications of new proposed federal staffing rules.