Nursing home staffing standards: Their relationship to nurse staffing levels

Christine A Mueller, Greg Arling, Robert L Kane, Julie Bershadsky, Diane Holland, Annika Joy

Research output: Contribution to journalReview articlepeer-review

78 Scopus citations


Purpose: This study reviews staffing standards from the 50 states and the District of Columbia to determine if these standards are related to nursing home staffing levels. Design and Methods: Rules and regulations for states' nursing home staffing standards were obtained for the 50 states and the District of Columbia. Nurse staffing data were obtained from the Centers for Medicare and Medicaid Services On-Line Survey, Certification, and Reporting (known as OSCAR) database. The minimum hours per resident day (HPRD) staffing standards for each state were categorized according to the following: no state-specific HPRD standard (adheres only to federal staffing guidelines); low HPRD standard (≤ 2.5 HPRD); and high HPRD standard (> 2.5 HPRD). A series of hierarchical linear models examined the relationships between state staffing standards and actual facility staffing (total, licensed, and certified nurse aide HPRD), using a number of covariates. Results: The variance in facility staffing was much greater within than between states. Facilities in states with high staffing standards had somewhat higher staffing than states with no standards or low standards, whereas facility staffing in states with low standards was not significantly different from that in states with no standards. Other factors, such as resident acuity and average state Medicaid rate, also were related to staffing. Implications: State staffing standards may not be effective policy tools because they are only one of many factors that affect facility staffing levels. Setting a low minimum HPRD standard may fail to raise staffing, or it may even have a dampening effect on staffing rates in facilities.

Original languageEnglish (US)
Pages (from-to)74-80
Number of pages7
Issue number1
StatePublished - Feb 2006

Bibliographical note

Funding Information:
This research was supported by grants from the National Alzheimer’s Association. The authors express appreciation for the cooperation of the staff, residents, and families participating in the Collaborative Studies of Long-Term Care. We also wish to thank Ms. Jane Darter for expert data management and Karminder Gill for his valuable analytical assistance. Address correspondence to Peter S. Reed, PhD, MPH, Director, Care Services, Alzheimer’s Association, National Office, 225 N. Michigan Ave, FL. 17, Chicago, IL 60601. E-mail: 1Alzheimer’s Association, National Office, Chicago, IL. 2Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill. 3School of Social Work, The University of North Carolina at Chapel Hill. 4Department of Family Medicine, The University of North Carolina at Chapel Hill. 5Department of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill. 6Regenstrief Institute, Inc. and Indiana University Center for Aging Research, Indianapolis, IN.


  • Nursing home
  • Policy
  • Quality of care
  • Staffing levels
  • State standards


Dive into the research topics of 'Nursing home staffing standards: Their relationship to nurse staffing levels'. Together they form a unique fingerprint.

Cite this