A recent study led by researchers at UCLA has uncovered a concerning correlation between legislative protections granted to nursing homes and a decline in staffing levels during the COVID-19 pandemic. States that implemented tort immunity laws shielding nursing facilities from COVID-19-related lawsuits experienced a measurable reduction in staff hours, potentially exacerbating the challenges faced by some of the nation’s most vulnerable healthcare settings.
The research scrutinized comprehensive data from 13,205 skilled nursing facilities across the United States, spanning a period from 2018 to 2023. Facilities located in states that enacted immunity provisions reported a 2.5 percent decrease in staffing relative to counterparts in states without such legal protections. This seemingly modest percentage translates into nearly eight fewer hours of direct clinical care and related duties per day for each nursing home, indicating significant implications for resident care and operational capacity.
Jill Horwitz, Emerita Professor of Law at UCLA School of Law and lead researcher on the project, highlights the gravity of these findings. Throughout the pandemic, nursing homes were already struggling with consistent understaffing, a problem that worsened in jurisdictions where the threat of litigation was diminished by legislative immunity. The study’s disturbing insight points to a potential unintended consequence of such immunity laws: reducing the incentive for nursing homes to maintain or enhance staffing levels during critical times.
What makes this revelation particularly striking is that the immunity measures were not tied to any direct financial incentive or explicit staffing mandates. David S. Zingmond, professor-in-residence and corresponding author from the UCLA David Geffen School of Medicine, remarks on the unexpected magnitude of the staffing decline. The absence of predefined benchmarks or monetary benefits suggests that the legal environment alone might influence staffing decisions, underscoring complex behavioral responses to liability protections in healthcare.
During the pandemic, 86 percent of U.S. states enacted some form of tort immunity defense specifically for nursing homes. These laws varied widely, with some having expiration dates and others being indefinite. Notably, 23 states adopted retroactive immunity, covering periods predating the enactment of the legislation. These legal responses were largely driven by the anticipation of a surge in medical malpractice lawsuits alleging negligence tied to COVID-19 infections and deaths in institutional settings.
However, the protective shield offered by medical malpractice law extends beyond financial liability—it plays a critical role in safeguarding the quality of care by imposing a deterrent against negligence. The relaxation of such legal accountability, as this study suggests, may inadvertently signal a tolerance for reduced diligence, directly compromising patient care standards during the crisis.
The staffing decline was most pronounced among Certified Nursing Assistants (CNAs), the frontline workers delivering essential clinical care. Conversely, staffing levels for Registered Nurses (RNs), who often balance clinical and administrative responsibilities, remained relatively stable. This disparity underscores the impact of policy on the immediate caregivers who most affect day-to-day patient outcomes, potentially widening gaps in care quality.
Researchers duly acknowledge the extraordinary stresses on healthcare staffing during the pandemic, including financial constraints and workforce instability prevalent across the sector. Nonetheless, their analysis indicates that nursing homes safeguarded from litigation appeared less motivated to recruit or retain nursing staff amid persistent shortages, exacerbating risk to patient care.
The study relies on robust data streams managed by the Centers for Medicare and Medicaid Services (CMS), specifically the Nursing Home Compare (NHC) initiative and the Payroll Based Journal (PBJ) Daily Nurse Staffing dataset. These databases provide granular, facility-level insights into staffing patterns and quality indicators, enabling comprehensive longitudinal analysis over the five-year period encompassing pre-pandemic and pandemic conditions.
While the study did not directly evaluate clinical outcomes connected to the observed staffing reductions, the authors emphasize the recognized link between staffing levels and quality of care in nursing homes. Future research efforts may seek to map these staffing shifts to resident health metrics, including rates of infection, hospitalization, morbidity, and mortality, to paint a fuller picture of the pandemic’s clinical toll.
This research sheds light on the nuanced, sometimes counterintuitive impact of pandemic-era healthcare policies. Balancing legal protections for providers with mechanisms that promote adequate staffing and quality care remains a complex policy challenge, especially in settings housing highly vulnerable populations. The findings invite policymakers to reconsider the unintended consequences of sweeping liability shields under public health emergencies.
In sum, the UCLA-led study provides a critical evidence base demonstrating how reduced legal accountability for nursing homes correlates with diminished staffing levels, particularly among frontline nursing assistants, during the COVID-19 pandemic. This outcome poses serious concerns given the centrality of staffing adequacy to patient safety and care quality, suggesting a need for integrated policy approaches that safeguard both providers and residents in long-term care environments.
Subject of Research: Not applicable
Article Title: Nursing home staffing declined in states that protected facilities from COVID-19 malpractice lawsuits
News Publication Date: 1-Jun-2026
Web References:
https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2026.1534
References:
Horwitz, J.R., Zingmond, D.S., et al. (2026). Nursing home staffing declined in states that protected facilities from COVID-19 malpractice lawsuits. JAMA Health Forum.
Keywords: Health care, Nursing homes, Medical malpractice, COVID-19, Staffing levels, Tort immunity, Health policy, Long-term care, Pandemic response
