$11.3 Billion Needed to Meet Proposed Federal Minimum Staffing Mandate

Due to increased labor costs and nationwide workforce shortages, 191,000 nurses and nurse aides are needed at the annual cost of $11.3 billion in order for nursing homes to meet a staffing minimum of 4.1 hours per resident day (HPRD).

That’s according to the American Health Care Association (AHCA) and CliftonLarsonAllen, an accounting and consulting firm, which on Thursday released an update to a July 2022 report. That report initially estimated that an additional 187,000 caregivers and an annual cost of $10 billion would be required to fulfill the staffing mandate.

“This report once again highlights how our nation’s policymakers should be investing in our long term caregivers, not mandating quotas,” Mark Parkinson, president & CEO of AHCA, said in a statement. “Nursing homes have been doing everything they can to recruit and retain staff—including increasing wages—but it has not been enough to stem the tide. If Washington wants to increase staffing in nursing homes, then they need to put their money where their mouth is.”


The Biden Administration’s proposed minimum staffing mandate is still pending. Industry professionals have expressed concern over absorbing the costs associated with a mandate while accounting for increased costs due to COVID and inflation, and a scarcity of federal funding. A separate CLA report found that nearly 60%of skilled nursing facilities are currently operating with negative margins.

“The additional burden of meeting minimum staffing requirements with no funding mechanism will potentially increase the number of facilities operating with negative margins,” Deb Emerson, Principal at CLA, said in a statement.

Among other findings in the updated report, researchers concluded that 94% of nursing homes would be unable to comply with a potential 4.1 HPRD staffing minimum, and that nearly 450,000 residents may be at risk of displacement if facilities are unable to increase their workforce and must reduce their census in order to comply with minimums.


“Although there have been improvements in workforce availability in some areas of the country, nationally nursing homes are still challenged to find the appropriate workforce,” Emerson said. “If nursing homes are unable to increase their workforce, hundreds of thousands of residents could be impacted by census reductions.”