Ahead of the Centers for Medicare and Medicaid Services’ (CMS) highly anticipated release of its proposed staffing rule for nursing homes, researchers at KFF (formerly Kaiser Family Foundation) on July 14 issued a brief, “What Share of Nursing Facilities Would Meet Possible New Staffing Requirements,” exploring what staffing ratios could be achieved at U.S. providers.

The report examines the implications of requiring from 2.5 hours to 4.0 direct care hours per resident day (HPRD), a measure described by KFF researchers as “relatively simple … that does not account for what type of nursing staff are at the facility or the type of patients the facility services.”

Using data from 14,575 providers that reported staffing levels in June 2023, KFF analysts found that nearly all nursing homes could meet a requirement of 2.5 hours or fewer; 85% could meet 3.0 hours. However, only 55% would be able to meet 3.5 hours and only 29% would meet a requirement of 4.0 hours.

The report notes that “if the proposed rule includes requirements related to the types of nurses facilities must employ (and the hours they must work) or adjusts the number of required nurses based on patient health and frailty, fewer nursing facilities would meet a given requirement than are shown here.”

The analysts found that 83% of nursing home residents nationwide live in a home with staffing levels of at least 3.0 hours. The report’s analysis of ownership status showed that if the level were set higher than 3.0 hours, 94% of nonprofits would be able to meet that level, compared to only 81% of for-profit nursing homes. The difference by tax status changed slightly when adjusted for resident frailty.

CMS’ proposed staffing standards rule is still under review at the Office of Management and Budget (OMB). Visit LeadingAge’s Get Real on Ratios page for our perspectives and a proposed new framework for federal legislation, including our six common-sense conditions that must be met before mandatory nursing home staffing ratios could be implemented.

Read the full KFF report here.