The following is an alert for the Q4 2023 staffing report. Download data at NursingHome411 and check out our interactive staffing map.

May 2, 2024 – Federal law requires all nursing homes to provide sufficient staffing so that residents attain and maintain their highest practicable physical, emotional, and psychosocial well-being. Unfortunately, in the absence of strong enforcement, far too many operators maximize profits by understaffing their facilities. As a result, residents are at greater risk of substandard care, abuse, and neglect.

To help address widespread and persistent problems resulting from inadequate staffing, the federal Centers for Medicare & Medicaid Services (CMS) recently issued a rule mandating, for the first time, quantitative nurse staffing requirements. These include the presence of a registered nurse 24/7 and 3.48 hours per resident per day (HPRD) of total nursing staff time. While 3.48 HPRD is far below the 4.1 HPRD identified in a 2001 federal study as the minimum necessary just to meet residents’ clinical needs, it is important to keep in mind that this quantitative standard does not supplant the longstanding sufficient staffing requirement.

Today, LTCCC is releasing a report on the latest staffing levels for every nursing home in the country (in compliance with federal reporting requirements). Now, more than ever, we believe that this information is critical for the public, news media, and policymakers to identify and assess the extent to which nursing homes in their communities provide sufficient staffing to fulfill their promises to residents, families, and taxpayers.

Our analysis of federal nursing home staffing data shows

  • Six in 10 (60%) U.S. nursing homes would have met the new 3.48 HPRD requirement in the fourth quarter of 2023.
  • Only one in four (26%) nursing homes are providing at least 4.1 HPRD, the minimum amount of time needed to ensure that residents receive basic clinical care (according to the aforementioned federal study).

LTCCC’s quarterly staffing report is based on CMS’s Q4 2023 payroll-based journal data on nurse staff (RN, LPN, CNA, etc.) and non-nurse staff (medical directors, therapists, activities staff, etc.). The NursingHome411 staffing page provides user-friendly data (nurse staff, non-nurse staff, turnover rates, weekend staffing levels) that is searchable by facility name, county, and state. There is also an interactive map displaying staffing data and rankings by state.

Note: The new staffing standards will not go into effect for several years. For more information, see our Senior Care Policy Briefing: CMS Finalizes Nursing Home Staffing Rule.

Staffing Facts for Q4 2023

  • U.S. nursing homes provided an average of 3.68 total nurse staff HPRD in the fourth quarter of 2023, up slightly from 3.66 HPRD in Q3 2023.
  • Four in five nursing home residents (79%) live in facilities providing less than 4.1 HPRD, indicating a serious risk of inadequate care for most U.S. nursing home residents.
  • More than half a million nursing home residents (43%) live in facilities that do not meet the new federal staffing requirement of 3.48 HPRD.
  • More than half of nursing home residents (54%) live in facilities that do not meet the new minimum RN requirement of 0.55 HPRD.
  • Geography matters. In CMS Region 6 (Dallas), only 41% of nursing homes would meet the newly announced standard of 3.48 HPRD while only 13% of the region’s nursing homes would meet the 0.55 RN requirement. In CMS Region 10 (Seattle)—which had the highest staffing ratio (4.39 HPRD)—94% of nursing homes met the requirement. The vast majority of nursing homes in Region 10 (79%) and Region 8 – Denver (85%) met the RN requirement.
  • Use of contract staffing continues to decline after years of steady increase during and after the pandemic. Nationwide, contract staff accounted for 8.0% of nursing staff hours, down from 8.7% the previous quarter.

Source: CMS Payroll-Based Journal Data (Q4 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.