PUBLISHED: February 2023
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This study examined the proportion of facility revenues spent on nursing staff, as well as nursing staff levels in hours worked and paid per resident day, in 2019.

Nationally, the median proportion of revenues spent on nursing staff was 33.9 percent, and median nursing staff levels were 3.67 hours worked and 4.08 hours paid per resident day. Facilities with higher shares of Medicaid residents spent a larger share of revenues on nursing staff but had lower staffing levels. States varied significantly with respect to median spending on nursing staff (26.8–44.0 percent of revenues) and median nursing staff levels (3.2–5.6 hours worked and 3.6–5.7 hours paid per resident day).

These findings indicate that raising the proportion of revenues spent by nursing homes on nursing staff to a regulated minimum would not guarantee the achievement of adequate nursing staff levels unless it was paired with other regulatory mechanisms.

Bowblis, John R., et al. “Understanding Nursing Home Spending and Staff Levels in the Context of Recent Nursing Staff Recommendations.” Health Affairs, vol. 42, no. 2, Health Affairs (Project Hope), Feb. 2023, pp. 197–206. https://doi.org/10.1377/hlthaff.2022.00692.