April 2022: The Economics of a Hypothetical Nursing Home Staffing Regulation: "Expected" Staffing Levels

The Centers for Medicare and Medicaid Services (CMS) reported a staffing star rating on the Nursing Home Compare website. Between 2011 and March of 2018, this staffing star rating was adjusted for resident acuity using the Staff Time Measurement (STM) studies conducted by CMS in the 1990s. In technical documentation, CMS referred to this adjustment factor as an "expected" staffing level. In 2020, some nursing advocates suggested that CMS should require nursing homes to staff to these "expected" staffing levels. This is despite the fact that the STM  studies conducted by CMS were not designed for and did not assess the adequacy of nursing staff.

In a recently published paper in Innovation in Aging, Dr. Bowblis examined what would happen if CMS considered these "expected" or STM staffing levels as a hypothetical requirement. The key findings were nursing homes and nursing home regulators did not consider "expected" staffing levels a relevant benchmark. Moreover, if CMS adopted the "expected" staffing levels as a requirement, it would be economically infeasible for most nursing homes to staff to this hypothetical benchmark. Without additional funding, the majority of the nursing home industry would become insolvent. 

The reference to the article is: Bowblis JR. The Need for an Economically Feasible Nursing Home Staffing Benchmark: Evaluating an Acuity-Based Nursing Staff Benchmark. Innovation in Aging, in press.

A copy of the article is available at: The Need for an Economically Feasible Nursing Home Staffing Regulation