A study entitled Tort Immunity and Nursing Home Staffing published online on June 1, 2026 investigated the association between nursing home staffing and laws adopted during the COVID-19 pandemic that immunized nursing homes from tort liability for patient harms. “To assess the consequences of immunity from liability, and thus the effectiveness of medical malpractice law, we assembled an original database of state laws immunizing nursing homes and their staff during the COVID-19 pandemic. We then assessed the association between immunity from liability and nursing home staffing patterns.”
The study of 13, 205 nursing homes found that facilities immune from tort liability exhibited a 2.5% reduction (7.9 hours per day) in staff time per patient per day than nursing homes in states that did not grant tort immunity.
During the COVID-19 pandemic, approximately 80% of states implemented some form of tort immunity for nursing homes, some of which included automatic end dates and others that were indefinite. Forty-three states adopted some form of immunity during the study period, with the length of immunity ranging from 6 months after adoption to ongoing immunity. Twenty-three states had some degree of retroactive immunity covering the period before the state enacted immunity with a median of 2.8 months, ranging from less than 1 month (Connecticut and Mississippi) to 27 months (Virginia).
Of the 13, 205 nursing homes studied, 11 ,382 (86.2%) were subject to tort immunity and 1,823 (13.8%) were not.
“The structure of nursing homes requires RN staff to act both as the primary administrators for a facility and to provide some more specialized types of care. That RN staffing rates were largely uncorrelated with immunity is consistent with the need for nursing homes to maintain RN staff in their administrative as well as medical roles. However, CNAs and LPNs provide nearly all the direct care to nursing home residents: it is among the CNAs, who comprise two-thirds of the clinical staff, where we find the association between staffing and tort immunity. The average nursing home immunized from liability is estimated to have 7.9 fewer hours daily. Spread equally across all residents, this amount of time (5.2 minutes) might seem small, but for a patient in need, nearly 8 hours of time could make a substantial difference.”
“Staffing levels are important indirect markers for quality of care. Lower nurse and nursing assistant staffing is associated with worse patient care and outcomes. During the COVID-19 pandemic, residents were isolated, and staffing was compromised; therefore, further reductions in human contact due to immunity may have been particularly harmful. Minimum staffing ratios, which could put a floor to potential reductions, in most states were unrealistically low even when compared to staffing level recommendations by patient severity (as measured by Resource Utilization Groups).”
The study’s authors concluded: “Expecting an overwhelming volume of litigation, many states adopted tort immunity to protect nursing homes and their staff during the COVID-19 pandemic. These laws, some of which are still in effect, appear to have had the unintended consequence of reducing staffing levels, perhaps impairing the deterrent effects of exposure to tort law by lowering incentives for administrators to search for nursing staff during a period when there were extreme shortages, thus, high nursing prices. This cohort study of US nursing home data from 2018 to 2023 suggests that the threat of liability may contribute to quality of care even though some evidence suggests that tort suits themselves do not seem to improve care.”
If you or a loved one may have been injured (or worse) in a nursing home in the United States due to nursing home staff shortage, nursing home understaffing, nursing home pressure ulcer (nursing home bedsore) negligence, a nursing home infection, nursing home fall, nursing home aspiration, nursing home neglect, nursing home negligence, nursing home abuse, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home malpractice lawyer who may investigate your nursing home malpractice claim for you and represent you or your loved one in a nursing home malpractice case, if appropriate.
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