Washington, D.C. — A day after researchers published a study claiming that state-level nursing home staffing mandates caused little financial harm, the industry hit back hard — and it wasn’t holding back.
The study, published in Health Affairs and led by researchers from the University of Pennsylvania and Lehigh University, concluded that state mandates from 2010 to 2023 raised non-registered nurse staffing by about 5% without driving widespread closures or financial damage. But major industry groups called those findings narrow, incomplete, and shaped by the researchers’ own leanings.
Rachel Reeves, spokeswoman for the American Health Care Association and National Center for Assisted Living, said the study raises questions about methodology and reflects what she described as bias in the analysis.
She said the study showed no substantial increase in total direct care staffing and did not fully analyze the differences in state policies that could have shaped the results.
Reeves added that staffing mandates represent what she described as an outdated policy approach, particularly as the country faces a rapidly aging population and persistent workforce shortages.
What Providers Say the Study Missed
For LeadingAge, the association representing nonprofit aging services providers, the numbers tell only part of the story. Vice president of health policy Jodi Eyigor said the real question isn’t whether mandates cause closures — it’s what operators quietly sacrifice to stay afloat.
Eyigor said that increasing staffing requirements inevitably raises the cost of providing care. She said the study itself acknowledges that providers may offset the costs of increasing direct care staffing through other operational changes. Those changes, she noted, can include cutting dietary and housekeeping staff, shifting admissions toward higher-paying Medicare residents, and scaling back quality-of-life programs — moves that don’t show up neatly in a financial dataset but do affect residents’ daily lives.
Eyigor also pointed out that staffing gains under the studied mandates came mostly from licensed practical nurses and certified nurse aides — not registered nurses, which remain in short supply. She said the nation is already facing significant registered nurse shortages that are expected to persist in the coming years. She said imposing rigid registered nurse staffing requirements under those conditions could create operational risks for providers.
That concern sits at the heart of the ongoing debate over what staffing mandates can realistically deliver when the workforce simply isn’t there to fill the roles.
A Question of Data Quality
Brendan Williams, president and CEO of the New Hampshire Health Care Association, took aim at the study’s methodology. He pointed to inconsistent treatment of different states’ policies and the study team’s own admission that employment data during the pandemic period was unreliable.
Williams said he believes the study overgeneralizes from what he described as incomplete and outdated data. He also said labor costs for nursing home workers have risen sharply since early 2020, creating financial pressure that earlier financial data may not fully capture.
Williams also called out the complete absence of any discussion of Medicaid reimbursement rates. Given that Medicaid is the dominant payer for long-term care, that omission left providers unconvinced. Williams said the study relies on what he described as unreliable financial data, calling it a fundamental flaw in the report.
The researchers, for their part, stand by their conclusions. They say the data reliably showed that mandates raised staffing without triggering the closures the industry had predicted — and they plan to share their findings directly with members of Congress.
As states weigh new minimum staffing rules in the aftermath of the repealed federal mandate, the argument over what the evidence actually shows is only getting louder.
