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Nearly a dozen states have changed their minimum staffing requirements for nursing homes in response to the COVID-19 pandemic, according to a new analysis by the Kaiser Family Foundation. 

Five of those (Arkansas, Connecticut, Massachusetts, New York and Rhode Island) have permanently increased their minimum staffing requirements. Meanwhile, at least two states (Oregon and South Carolina) have temporarily decreased their minimum staffing ratios to compensate for staffing shortages. 

Rhode Island adopted the largest increase. Nursing homes went from a required 0.32 hours of direct care per resident, per-day pre-COVID to 4.1 hours per resident day, data showed. 

for the state jumped from a total of 0.38 hours per resident day pre-pandemic to 3.56 hours after the pandemic started. Providers have said compliance with the new requirements may cost an additional $325 million.

Florida decreased minimum staffing requirements for certified nursing assistants from 2.5 hours per resident day to 2.

The analysis also found that there were attempts in both Arizona and Kentucky to permanently increase minimum staffing requirements post-COVID but they failed to pass in their respective states.

KFF’s analysis comes as the Centers for Medicare & Medicaid Services examines ways to set minimum staffing requirements for nursing homes as part of President Joe Biden’s nursing home reform initiatives.