The following is an alert for LTCCC’s Q3 2025 staffing report. Download national, state, community, and facility-level data at NursingHome411.org.
March 5, 2026 – 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, close to 9 in 10 nursing homes fall below their expected staffing levels and the average facility is under-staffed by 24% on a daily basis. As a result, approximately 1,140,000 Americans reside in facilities that fail to provide the staffing levels expected to meet their residents’ basic clinical needs. These expectations are based on an evidence-based methodology that uses each facility’s own assessment of its residents’ needs to determine appropriate nurse staffing levels.
Additional Staffing Facts for Q3 2025
- The average U.S. nursing home provided 3.77 total nurse staff hours per resident day (HPRD), including 0.62 RN HPRD.
- Contract staff usage continues to decline since the COVID pandemic, to a rate of 5.5% (down from a peak of 10.5% in Q3 2022).
- 36% report zero medical director (MD) time, despite the MD’s responsibilities for overseeing clinical care in every US nursing home.
State Insights
- Only two states – Alaska (+21.1%) and Oregon (+0.9%) – met or exceeded their expected staffing levels while North Dakota (-4.5%) ranked third in staffing adequacy.
- States with the worst overall staffing included:
- Puerto Rico had the largest deviation from expected staffing levels to meet resident needs (-39.9%).
- Illinois had the largest negative deviation of any state (-37.9%), followed by Texas (-31%), Missouri (-30%), and Georgia (-30%).
Note: This report is based on the most recent payroll-based journal (PBJ) data reported by the federal Centers for Medicare & Medicaid Services (CMS).