Understanding Nursing Home Spending And Staff Levels In The Context Of Recent Nursing Staff Recommendations

John R. Bowblis, Christopher S. Brunt, Huiwen Xu, David C. Grabowski

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


To provide context for evaluating proposed nursing home staff regulations, we 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.

Original languageEnglish (US)
Pages (from-to)197-206
Number of pages10
JournalHealth affairs (Project Hope)
Issue number2
StatePublished - Feb 1 2023

ASJC Scopus subject areas

  • Health Policy


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