The New Bedford Light
by Grace Ferguson
July 28, 2026
Five years after the state introduced staffing standards to improve care in nursing homes, 51% of facilities are out of compliance, a New Bedford Light investigation found. Resident advocates say state penalties are too low.
Summary:
The Light’s monthslong investigation uncovered:
- Half of the state’s nursing homes failed to meet one or both of the state’s minimum staffing standards at the end of last year.
- Most for-profit facilities were out of compliance with staffing standards at the end of last year. Most nonprofit facilities were in compliance.
- The state’s penalties aren’t strong enough to deter profit-seeking nursing home owners from failing to provide enough staffing, resident advocates say.
- State officials recently reduced penalties for dozens of understaffed nursing homes at the request of an industry trade group.
- The state’s minimum staffing standard for registered nurses isn’t enforced at all.
- State health inspectors have only issued a few dozen health violations for inadequate staffing since 2024, even though 251 nursing homes have dipped below the state minimums in that time.
A monthslong investigation by The New Bedford Light revealed that five years after Massachusetts introduced minimum staffing requirements in 2021, 51% of the state’s 341 nursing homes remain out of compliance with state standards. Analyzing federal data, the report details how half of all long-term care facilities consistently failed to meet mandated staffing thresholds by the end of last year. The findings underscore widespread operational shortcomings across the sector, with residents frequently facing delayed medical care, unaddressed basic hygiene needs, and heightened risks of falls and pressure ulcers due to a lack of available caregivers.
The state’s regulatory framework establishes two specific Hours Per Patient Day (HPPD) metrics: facilities must deliver at least 3.58 total nursing HPPD and 0.508 registered nurse (RN) HPPD. At the end of last year, 34% of facilities violated the overall nursing threshold, 32% failed the RN requirement, and 14% failed both. Out of 369 nursing homes operating since 2021, 314 dropped below minimum staffing levels for at least one quarter, and 40 failed to meet standards for every single quarter evaluated.
A distinct divide exists between profit-driven models and non-profit facilities across the state. A majority of for-profit nursing homes were out of compliance with state staffing rules, whereas most non-profit facilities successfully met the requirements. Critics and resident advocates argue that certain corporate owners deliberately maintain low staffing levels to trim labor costs and maximize profit margins, accepting minor regulatory scrutiny as a routine cost of doing business.
Legal scrutiny has increasingly targeted major healthcare chains operating in the Commonwealth for systemic understaffing. The Massachusetts Attorney General’s Office recently secured a $4 million settlement with Next Step Healthcare and a $2.75 million settlement with Bear Mountain Healthcare over allegations that chronic understaffing led to resident neglect. Despite these high-profile enforcement actions, federal and state inspectors have issued only a few dozen formal health violations for understaffing since 2024, even as 251 facilities fell below state minimums during the same timeframe.
Advocates argue that existing financial penalties imposed by state regulators fail to serve as an effective deterrent against chronic understaffing. While MassHealth has collected $58 million in staffing penalties over five years—averaging $11.6 million annually—that figure represents just 0.5% of the $2.3 billion in annual Medicaid revenue flowing to Massachusetts nursing homes. Furthermore, the investigation found that state health officials recently reduced fine amounts for dozens of non-compliant facilities following appeals from an industry trade association, while the specific RN staffing standard remains largely unenforced.
In response to the investigation, state regulators maintained that overall staffing compliance has improved since the initial implementation of the 2020 reforms, pointing to penalty collections as evidence of ongoing oversight. However, consumer advocates and policy experts contend that regulatory indifference and modest financial sanctions allow facility operators to ignore statutory mandates. Without stronger enforcement mechanisms, higher baseline penalties, and strict oversight of registered nurse ratios, residents will continue to bear the burden of a systemically understaffed long-term care system.
Read the article: Half of all nursing homes in Massachusetts are understaffed in the The New Bedford Light.