The following is an alert for LTCCC’s Q3 2024 staffing report. Download national, state, community, and facility-level data at NursingHome411.org and explore our interactive staffing map.

May 2, 2025 – New federal data reveal that the overwhelming majority of U.S. nursing homes are operating with insufficient staffing to meet the basic needs of their residents. According to LTCCC’s report on the latest federal staffing data, 9 in 10 nursing homes fall below their expected staffing levels. These expectations are based on a new, evidence-based methodology that uses each facility’s own assessment of its residents’ needs to determine appropriate nurse staffing levels.

“This new methodology, detailed in a clinical investigation published today in the Journal of the American Geriatrics Society, offers a critical tool for the public to understand what staffing levels a nursing home should actually be providing—based not on arbitrary benchmarks, but on the facility’s own assessment of its residents’ needs,” said Richard Mollot, LTCCC’s Executive Director. “It gives residents, families, operators, and policymakers a clear and meaningful way to gauge whether a nursing home is adequately staffed to ensure safe, appropriate care.”

Staffing Facts for Q3 2024

  • The average U.S. nursing home provided 3.73 total nurse staff hours per resident day (HPRD), including 0.60 RN HPRD.
  • The new staffing expectation model, based on each facility’s case-mix index (CMI), shows that 90.5% of nursing homes reported staffing levels below their expected HPRD.
  • The median nursing home fell 25.1% short of expected staffing levels.
  • Based on resident acuity, the national average expected staffing level was 4.94 HPRD.

Regional and State Insights

  • Region 10 (Pacific Northwest) is the strongest performing region with 4.47 Total Nurse Staff HPRD, falling just 10.7% short of expected staffing.
  • Region 2 (New York and New Jersey) ranks near the bottom on both fronts: 3.59 HPRD (9th of 10) and a -28.5% deviation from expected levels (10th of 10).
  • Only two states—Alaska (+21.1%) and Oregon (+2.5%)—met or exceeded their expected staffing levels while North Dakota (-3.5%) ranked third in staffing adequacy, narrowly missing the expected target.
  • States with the worst overall staffing included:
    • Illinois: Lowest total staffing (3.27 HPRD) and largest deviation from expected staffing levels (-37.7%).
    • Texas (-32.1%), New Mexico (-31.2%), Missouri (-31.1%), Georgia (-30.2%), and Virginia (-30.0%) all ranked near the bottom in both total staffing and percent deviation from expected staffing levels.

Notes: 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 staffing page at NursingHome411.org for more data and insights at the facility, community, state, and regional levels—including both nurse and non-nurse staffing levels.