We cannot allow the safety of vulnerable residents to be hijacked by cynical soundbites from powerful & wealthy industry lobbyists.

By definition, every licensed U.S. nursing home is required to provide skilled nursing care, supervision, and services 24-hours a day, seven days a week. Unfortunately, too many of our nursing homes provide substandard care and conditions that are demeaning and inhumane. As the country has witnessed in the COVID-19 pandemic, too many nursing homes are not even capable of implementing basic infection control protocols.

Research showed that nursing homes with higher registered nurse (RN) staffing had fewer COVID-19 infections and better quality outcomes.  RNs are specifically trained in infection control planning and management, resident assessment and care planning, and the identification and treatment of chronic and acute conditions. This is why RNs are essential.  Yet too many nursing homes maximize profits by hiring LPNs to substitute for RNs.

Good facilities provide at least 24-hour RN nursing. The time has come to ensure that all nursing homes provide this level of care and competency. That is why the provision in the Build Back Better bill that every nursing home provides, at a minimum, one RN in the building 24-hours a day is so important.

The pandemic was a wake-up call to the nation that nursing homes must be held accountable for following through on the promises they make to residents and families. The Build Back Better bill will help to ensure that promises made are promises kept. It passed in the House of Representatives last week. Now it is time for our U.S. Senators to stand up for the seniors and families in their states.

Sadly, powerful and wealthy industry lobbyists are pushing a false narrative that 24-hour RNs are just too expensive. They are claiming that it will cost over $10 billion a year, and that it would require hiring not only RNs, but also LPNs and CNAs. They are maintaining it is an “unfunded mandate.” These claims are false, false, false.

Facilities with less than 24-hour RN staffing do not need to hire a bunch of RNs. They can simply shift from LPNs to RNs to bridge the hours needed to cover the gap. To find out the true costs of 24-hour RN staffing, LTCCC conducted an analysis of facility staffing levels and computed the cost for every nursing home to provide 24-hours of RN care per day. The results of our analysis, available at www.nursinghome411.org/24-HOUR-RN, indicate that 24-hour RN staffing is possible at a fraction of the price that industry lobbyists claim.

Key Findings

  • The average cost for a facility to shift to 24-hour RN staffing is $61.82 per day.

  • The cost range for a facility to achieve 24-hour RN staffing per day ranges from three cents to $141.15 per day.

  • The actual costs of achieving 24-hour RN staffing nationwide is only $75 million per year.

  • Over 75% of facilities already have enough RNs for 24-hour coverage.

Annual Median Wage (2020 Bureau Labor Statistics) Per Hour
RN $68,450 $32.91
LPN/LVN $50,100 $24.09
Difference $18,350 $8.82


Costs to Reach 24-Hour RN
NHs with RN Shortfall 3,327 (22.46% of total)
Avg. Daily Cost Per Facility $61.82
Total Daily Cost Nationwide $205,691
Total Annual Cost Nationwide $75,077,382

Data Sources & Methodology

Staffing and MDS census data are derived from the Payroll Based Journal staffing data reported to CMS for the second quarter of 2021.

Dollar figures are based on the U.S. Bureau of Labor Statistics, Occupational Outlook Handbook average U.S. salaries for Registered Nurses (RNs) and Licensed Practical and Licensed Vocational Nurses (LPNs/LVNs) working in nursing and residential care facilities. The most recent federal data on the median wage for a LPN is $50,100 per year [1] and on the median wage for a RN is $68,450 per year. [2]

Hourly rates for both RN and LPN were computed based on a standard full-time work year of 2,080 hours. Based on this computation, RNs are paid an average of $32.91/hour and LPNs an average of $24.09/hour. This translates to a differential of $8.82/hour between RNs and LPNs.

The costs to achieve 24 hours of RN staffing per day for each facility was computed by identifying facilities with less than 24-hours of RN staff time per day, subtracting 24 from that number (to identify the shortfall), and multiplying that amount by $8.82.

For detailed information on actual RN, LPN, and CNA staffing, visit our staffing page at https://nursinghome411.org/data/staffing/.

[1] Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Licensed Practical and Licensed Vocational Nurses, at https://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm (visited November 19, 2021).

[2] Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited November 19, 2021).