Staffing and MDS census data are derived from the Payroll-Based Journal staffing data reported to CMS for the first quarter of 2023.
Dollar figures are based on the U.S. Bureau of Labor Statistics, Occupational Outlook Handbook average U.S. salaries for Registered Nurses (RNs) and Licensed Practical and Licensed Vocational Nurses (LPNs/LVNs) working in nursing and residential care facilities. Federal data indicate that, as of 2022, median wage for a LPN is $58,140 per year and median wage for a RN is $75,410 per year.
Hourly rates for both RN and LPN were computed based on a standard full-time work year of 2,080 hours. Based on this computation, the median hourly wage is $36.25 for RNs and $27.95 for LPNs. This translates to a differential of $8.30/hour between RNs and LPNs.
The costs to achieve 24 hours of RN staffing per day for each facility were computed by identifying the RN Shortfall at facilities with less than 24 hours of RN staff time per day (RN shortfall = 24 – total RN hours) and multiplying RN Shortfall by $8.30.
The percentage of facilities providing less than 24 hours of Total RN staffing per day (including RN Admin, RN DON) was calculated based on the number of nursing homes with less than an average of 24 or higher hours of RN staff time per day (3,311) and the total number nursing homes (14,699) with reported data for the first quarter of 2023. This means that only 22.5% (3,311 / 14,699 = 22.5%) of U.S. nursing homes would have to shift some of their staffing from LPNs to RNs to achieve 24 hours of RN staffing per day.
Daily Per Resident Costs were determined based on resident census data and average daily costs of meeting 24-RN requirement. Nursing homes with RN shortfalls reported a total of 178,827 residents (15.0% of nationwide census of 1,194,492). Meeting the 24-hour RN requirement would require these nursing homes to collectively pay $1.09 per resident per day (Avg. Daily Per Resident Cost at Shortfall NHs = Total Daily Cost Nationwide / Residents at Shortfall NHs → $1.09 = $194,310 / 178,827). If including all U.S. nursing homes, facilities would need to collectively pay only $0.16 per resident per day to meet the requirement ($0.16 = $194,310 / 1,194,492).
Note: Nursing homes are currently required – and paid – to provide at least eight hours of RN staffing every day. Therefore, our computation of costs for facilities that reported less than eight hours of RN staffing per day do not account for their shortfall below eight hours per day since, as noted above, the facilities are already paid to provide that level of staffing.
For detailed information on actual RN, LPN, and CNA staffing, visit our staffing page at https://nursinghome411.org/data/staffing/.
 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Licensed Practical and Licensed Vocational Nurses, at https://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm (visited September 25, 2023).
 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited September 25 2023).