ALBANY — Requiring hospitals and nursing homes across New York to adhere to minimum caregiver staffing levels would add billions of dollars in new costs to the health care network while depriving employers of “flexibility,” according to a study released by the state Department of Health.

The long-awaited report focused on the question of whether embracing nurse minimum staffing levels would improve patient safety and the delivery of health care services, as suggested by legislative proposals to bring nurse-to-patient staffing ratios to New York.

The 43-page document concluded by echoing a key argument made by the hospital lobby: “While the Department supports measures to improve quality of care and patient outcomes, the COVID-19 pandemic has only highlighted the need to maintain workforce flexibility.”

The state agency also expressed concern that mandating nurse staffing levels “will create gaps in the availability of frontline healthcare workers.”

To meet the proposed staffing targets, the report suggested that hospitals alone statewide would need an additional 24,779 nurses. Hospitals in Western New York would need to bring on an additional 1,341 nurses. In the North Country, the hospitals would need to add an additional 114 nurses. In the Mohawk Valley, hospitals were projected to need 320 more nurses.

The report envisioned that staffing at nursing homes would also be dramatically increased to comply with the proposed mandates, with those facilities projected to need more than 45,000 additional nurses and nurses’ aides.

Staffing mandates would create new and higher costs for compliance efforts, recruitment and higher wages for nurses, the latter brought on by increased demand for nurses, the report said.

Pointing to research findings completed at Cornell University, the Health Department projected that hospitals would have to spend an estimated $1.8 billion to $2.4 billion to comply with minimum staffing levels, while nursing home would see their labor costs rise by $1.9 to $2.3 billion.

The staunchest advocate for mandatory staffing levels, the New York Nurses Association, a union with some 42,000 members, called the state agency’s projections of higher costs for the health care industry “wildly overstated.” The union, in a statement, noted the report ignores the fact the state already requires a registered nurse be present in operating rooms for surgical procedures. Had that been taken into account, the cost projection for hospitals would be lowered by as much as $1 billion, the union contended.

“Safe staffing could have saved lives during the COVID pandemic,” said Pat Kane, director of the nurses association. “And if the Legislature is willing to act on real research, there’s still time to improve New York’s capacity to respond to a resurgence of the virus. Uniformly implemented statewide staffing standards will improve patient outcomes and save lives.”

While the hospital industry is one of the most influential lobby groups in Albany, the proposed legislation, sponsored by members of the Democratic majorities in both chambers, has gained traction with many lawmakers.

Assemblyman Angelo Morinello, R-Niagara Falls, said he was initially chilly to the proposal but evolved into a supporter after learning the minimum staffing levels would be imposed on nursing homes. He recalled his elderly uncle broke a hip after falling out of a bed in a nursing home after being left unrestrained in a facility the lawmaker described as understaffed.

“This is going to pass at some point,” Morinello predicted. “I believe it would help patient safety and care.”

A former hospital respiratory therapist, Assemblyman John Salka, R-Madison County, said he also backs the proposal. He challenged assertions made by hospital administrators that the proposal would drive up the costs of health care.

“What right do they have to complain about the cost of medical care when they are making huge salaries with huge benefits?” Salka said. “You simply can’t ask one person to take care of so many patients who are getting sicker and sicker and sicker.”

The proposal would make nursing homes and hospitals subject to civil penalties if they violate the mandated nurse-to-patient ratios. The bill establishes the ratio by hospital unit and requires hospitals to craft staffing plans that address changes in patient health needs.

Only California now requires such ratios. According to the New York report, the results there have been mixed, with some studies suggesting links between more staffing and improved patient outcomes while others show there has been no connection with better results for patients.

The state study also sounded a note of caution.

“Some research suggests that New York State will continue to experience a nursing shortage through the next decade, which could make meeting any mandated minimum staffing levels unachievable for some providers,” the report noted.

Joe Mahoney covers the New York Statehouse for CNHI’s newspapers and websites. Reach him at

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