The following is an alert for LTCCC’s Q4 2025 staffing report. Download national, state, community, and facility-level data at NursingHome411.org.

May 18, 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 1,136,000 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.

“Federal data continue to show widespread understaffing in nursing homes across the country, despite years of promises from the industry and substantial public funding,” said Richard Mollot, LTCCC’s Executive Director. “Far too many facilities prioritize maximizing profits over basic resident care while simultaneously pushing for more taxpayer dollars and even less accountability. Seniors and families deserve safe staffing and meaningful oversight, not a system that rewards facilities with billions in public funding while tolerating chronic understaffing and substandard care.”

Additional Staffing Facts for Q4 2025

  • The average U.S. nursing home provided 3.76 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 5.3% (down from a peak of 10.5% in Q3 2022).
  • 35% report zero medical director time, despite the MD’s responsibilities for overseeing clinical care in every US nursing home.

State Insights

  • High Performers: Only two states – Alaska and Oregon – met or exceeded their expected staffing levels.
  • Low Performers: The ten states with the worst overall staffing were (in order): Illinois, Texas, Missouri, Georgia, West Virginia, New York, Indiana, Virginia, Colorado, and Ohio. [Puerto Rico, though not a state, ranks 9th.]

Note: This report is based on the most recent payroll-based journal (PBJ) data reported by the federal Centers for Medicare & Medicaid Services (CMS).