In mid-June, Senator Elizabeth Warren (D-MA) sent a request to the Leonard Davis Institute of Health Economics at University of Pennsylvania asking for evidentiary support, in advance of an expected Congressional Review Act vote on the staffing mandate, on potential patient outcomes data, particularly the impact on mortality, of the forthcoming implementation of the CMS federal minimum staffing rule.

Warren asked the University of Pennsylvania because of its expertise on the effect of health care policies and delivery systems on the quality of care, citing their extensive research on nursing home reform and staffing levels, as well as their exploration of the impact of Medicare performance measures on mortality rates.

The research resulting directly from her request, released July 22, concludes that the federal minimum staffing  rule, when implemented would save 13,000 resident lives. The analysis calculated the annual number of lives potentially saved with this regulation for three groups of nursing homes: those out of compliance for 6-8 months per year, for 9-11 months, and for 12 months.

UPenn researchers used submitted Payroll Based Journal nursing data from CMS and then estimated monthly staffing levels in 2023 for registered nurses, certified nursing assistants, and overall staffing. Out of compliance nursing homes were identified by calculating the differences between the observed Hours Per Resident Per Day (HPRD) and the HPRD required in the final staffing rule (3.48). The final component of the analysis was calculating the number of nursing home residents in non-compliant nursing homes and their annual mortality rate from Medicare’s Minimum Data Set (MDS) for Nursing Homes.

Finally, using estimates of the relationship between total nurse staffing HPRD and mortality published by researcher Patricia Tong, UPenn estimated what total lives saved would be at each tier: by 6-8 months per year, for 9-11 months, and for 12 months. The final analysis shows approximately 13,000 lives saved.

LeadingAge has responded to Senator Warren and Representative Jan Schakowsky about our advocacy on the federal staffing mandate and stating our position as opposed to the rule.