The following is an alert for the Q1 2023 staffing report. Download data at NursingHome411 and check out our interactive staffing map.

September 22, 2023 – Nursing home residents need a minimum of 4.1 total care staff hours per resident day (HPRD) to receive sufficient clinical care and avoid unnecessary harm, according to a landmark 2001 federal study.

Unfortunately, a new proposed federal rule would set the staffing minimum at only 3.0 HPRD, a threshold that the vast majority (86%) of US nursing homes are already meeting, according to a new staffing report by The Long Term Care Community Coalition.

LTCCC analysis of federal nursing home staffing data show that U.S. nursing homes provided 3.63 total nurse staff HPRD in Q1 2023. This is well above the proposed minimum of 3.0 HPRD, but far below the 4.1 HPRD residents require for their care needs to be met.

This report is based on CMS’s Q1 2023 payroll-based journal data on nurse staff (RN, LPN, CNA, etc.) and non-nurse staff (Admin, Medical Director, Dietician, etc.) for every U.S. nursing home (in compliance with mandatory reporting requirements). Visit the NursingHome411 Q1 2023 staffing page for user-friendly data on nursing homes in your community or state, including nurse staff, contract workers, non-nurse staff, turnover rates, weekend staffing levels, staffing ratings, and state rankings. Plus: an interactive staffing map!

We hope this report can help the public, media, and policymakers identify and assess the extent to which nursing homes in their communities provide sufficient staffing to meet basic clinical and quality of life needs.

Staffing Facts for Q1 2023

  • The median U.S. nursing home provided 3.59 total nurse staff HPRD in the first quarter of 2023. This is 35 minutes higher than the 3.0 HPRD minimum in the newly proposed federal standard.
    • Note: The proposed standard does not include a minimum for LPNs (licensed practical nurses), who provide nearly one-fourth of all nurse staffing. LTCCC is concerned that nursing homes will significantly reduce LPN staffing in order to cut costs and meet minimum requirements for RNs (0.55 HPRD) and nurse aides (2.45 HPRD) without consideration for the needs of their residents.
  • The median nursing home provided 0.56 Total RN HPRD and 0.36 RN Care HPRD (the latter metric excludes RN Admin and DON). The 2001 federal study established the importance of having a minimum of 0.75 RN HPRD just to meet basic clinical needs.
  • Nursing homes turned over more than half of their staff within 12 months. The median total nursing staff turnover is 52.9%, including 50.0% RN turnover.
  • Staffing levels vary considerably by CMS Region. Region 10 (Alaska, Idaho, Oregon, Washington) recorded the highest total nurse staff HPRD (4.33) while Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas) recorded the lowest (3.41).
  • Nationwide, contract staff accounted for 10.1% of nursing staff hours. In the median nursing home, however, contract staff accounted for 2.9% of nursing staff hours. One in three nursing homes (32.6%) did not use contract staff in Q1 2023, according to the payroll-based journal data.

3.0 HPRD Staffing Minimum Is Not Enough

Neither is 0.55 Total RN HPRD

Note: “What Residents Get Now” is based on median HPRD in Q1 2023.

Source: CMS Payroll-Based Journal Data (Q1 2023).

Note: This report is based on the most recent payroll-based journal (PBJ) data reported by the federal Centers for Medicare & Medicaid Services (CMS). (Sources: PBJ Daily Nurse Staffing, PBJ Daily Non-Nurse Staffing, Provider Information). Visit the NursingHome411 Data Center for more information on staffing, five-star ratings, and other important nursing home data.