The following is an alert for LTCCC’s Q1 2026 staffing report. Download national, state, community, and facility-level data at NursingHome411.org.

August 31, 2026 – New federal data show that chronic understaffing continues to affect the overwhelming majority of U.S. nursing homes. According to LTCCC’s analysis of Q1 2026 federal staffing data, 88% of nursing homes provided less staffing than expected to meet their residents’ clinical needs, virtually unchanged from the previous quarter. On average, nursing homes provided 24.6% less nurse staffing than expected based on their resident populations’ clinical needs.

As a result, approximately 1.15 million nursing home residents lived in facilities with staffing below expected levels during the quarter. These expectations are based on the CASE (Casemix Adjusted Staffing Expectations) methodology, an evidence-based, peer-reviewed methodology for identifying the expected nurse staffing levels necessary to meet the clinical needs of a nursing home’s residents.

“Quarter after quarter, federal data tell the same troubling story: nearly nine in ten nursing homes are failing to provide the staffing expected to meet their residents’ needs,” said Richard Mollot, LTCCC’s Executive Director. “Despite billions of dollars in public funding flowing to the nursing home industry every year, too many residents are still being left without sufficient staff to provide the care and attention they need. Residents and families deserve better. Public funding must be tied to meaningful accountability so that taxpayer dollars support safe staffing and quality care, rather than chronic understaffing to maximize profits.”

Additional Staffing Facts for Q1 2026

  • The average U.S. nursing home provided 3.75 total nurse staff hours per resident day (HPRD), down slightly from 3.76 HPRD in Q4 2025.
  • Nursing homes were expected to provide an average of 4.97 HPRD based on resident needs, resulting in an average staffing shortfall of 24.6%, compared with 24.2% in the previous quarter.
  • Average RN staffing was 0.62 HPRD.
  • Only 28% of nursing homes provided at least 4.1 total nurse staff HPRD, while just 30% provided at least 0.75 RN HPRD (the two nurse staffing benchmarks established in a landmark 2001 federal study).
  • Contract staffing accounted for approximately 5.3% of total nurse staffing hours, remaining essentially unchanged from the previous quarter.
  • Nearly one-third of nursing homes (4,753 facilities) reported zero medical director time during the quarter.

State Insights

  • High Performers: Only two states – Alaska and Oregon – met or exceeded their expected staffing levels, the same two states as in Q4 2025.
  • Low Performers: The ten states with the greatest staffing shortfalls were Illinois, Texas, Missouri, Georgia, New Mexico, New York, West Virginia, Virginia, Colorado, and Wyoming.
    • Illinois continued to have the largest staffing shortfall in the country, providing approximately 39% less staffing than expected based on resident needs.

Note: This report is based on the most recent payroll-based journal (PBJ) data reported by the federal Centers for Medicare & Medicaid Services (CMS).