The following is an alert for the Q3 2023 staffing report. Download data at NursingHome411 and check out our interactive staffing map.

February 28, 2024 – Federal law requires all nursing homes to provide a sufficient level of staffing so that residents attain and maintain their highest practicable physical, emotional, and psychosocial well-being. Unfortunately, far too many nursing home operators are understaffing their facilities and leaving residents at greater risk of substandard care, abuse, and neglect.

LTCCC’s analysis of federal nursing home staffing data for Q3 2023 shows that the typical (median) nursing home is providing 3.62 hours per resident day (HPRD), including only 0.55 total RN HPRD. These marks fall short of the amount of time needed to ensure that residents receive clinical care (4.10 hours total care staff HPRD and 0.75 RN HPRD), according to a landmark 2001 federal study.

LTCCC’s quarterly staffing report is based on CMS’s Q3 2023 payroll-based journal data on nurse staff (RN, LPN, CNA, etc.) and non-nurse staff (Admin, OT, PT, Activities, etc.) caring for 1.2 million residents in the 14,611 U.S. nursing homes in compliance with mandatory reporting requirements. The NursingHome411 staffing page provides user-friendly data (nurse staff, non-nurse staff, turnover rates, weekend staffing levels) on nursing homes in your community along with an interactive map displaying staffing data and rankings by state.

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 Q3 2023

  • U.S. nursing homes collectively provided an average of 3.66 total nurse staff HPRD in the third quarter of 2023, the same level as the previous quarter.
  • Only one in five residents (21%) live in nursing homes providing at least 4.1 HPRD, indicating that most residents are living in understaffed facilities.
  • CMS Region 6 – Dallas reported the lowest total nurse staffing ratio (3.43 HPRD) followed by Region 7 – Kansas City (3.54 HPRD) and Region 2 – New York (3.54 HPRD). Region 10 – Seattle (4.28 HPRD) and Region 9 – San Francisco (4.15 HPRD) reported the highest total nurse staffing ratios.
  • Nearly half (47%) of nursing homes experienced administrator turnover in the past year among the 11,000+ nursing homes meeting the criteria required to calculate administrator turnover.
  • US nursing homes provided a ratio of 45 minutes per resident day (MPRD) of non-nurse staff, including 9.4 MPRD of Activities staff, 9.4 MPRD of Physical Therapy staff (incl. asst & aide), 8.4 of Occupational Therapy staff (incl. asst & aide), and 5.3 MPRD of Social Work staff.
  • Roughly two-thirds (64%) of nursing homes reported using contract nurse staff. Nationwide, contract staff accounted for 8.7% of nursing staff hours, down from 9.7% the previous quarter.

Source: CMS Payroll-Based Journal Data (Q3 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.