The following is an alert for LTCCC’s Q4 2024 staffing report. Download national, state, community, and facility-level data at NursingHome411.org and explore our interactive staffing map.

June 4, 2025 – Today LTCCC is releasing its latest quarterly report on the staffing levels for every U.S. nursing home (in compliance with federal reporting requirements). These data, accessible to the public at www.nursinghome411.org/data/staffing/, reveal that U.S. nursing homes, on average, delivered just 3.75 hours of nursing care per resident per day, well below the 4.95 hours expected based on resident acuity. Expected staffing levels provided in the report are determined using a new, evidence-based case-mix adjustment methodology that accounts for the specific care needs of residents as identified by the facilities themselves.

“The significant staffing shortfall is more than just a statistic,” said Richard Mollot, LTCCC’s Executive Director, “it reflects the daily reality of thousands of vulnerable residents enduring avoidable pain and neglect simply because too many nursing homes are not being held accountable for meeting even basic care standards. Caring for our elders is a privilege and should not be treated as a business opportunity to bankroll mega-mansions and yachts.”

Select Staffing Facts for Q4 2024

  • The average U.S. nursing home provided 3.75 total nurse staff hours per resident day (HPRD), including 0.61 RN HPRD.
  • The staffing expectation model, based on each facility’s case-mix index (CMI), shows that 90.2% of nursing homes reported staffing levels below their expected HPRD.
  • The median nursing home fell 24.9% short of expected total staffing levels and 42.3% short of expected RN staffing levels.
  • 36% of facilities reported zero (0) presence of a medical director, despite federal requirements that a medical director oversee the quality of clinical care provided in every facility.
  • The average facility provided less than ½ minute per resident day of a mental health service worker’s time.

Regional and State Insights

  • Region 10 (Pacific Northwest) is the strongest performing region with 4.47 Total Nurse Staff HPRD, falling just 10.8% short of expected staffing.
  • Region 2 (New York and New Jersey) ranks near the bottom on both fronts: 3.62 HPRD (9th of 10) and a -27.9% deviation from expected levels (10th of 10).
  • Only three states—Alaska (+24.1%), Oregon (+2.7%) and Puerto Rico (1.6%)—met or exceeded their expected staffing levels while North Dakota (-4.1%) ranked fourth 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 (-38.1%).
    • Texas (-31.4%), Missouri (-31.3%), Georgia (-30.4%), New Mexico (-29.7%), Indiana (-29.6%), Virginia (-29.2%), and New York (-29.0%) 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). Visit the staffing page at NursingHome411.org for more data and insights at the facility, community, state, and regional levels – including for both nurse and key non-nurse staffing positions.