September 27, 2023 – Every U.S. nursing home is required to provide skilled nursing care and monitoring 24-hours a day, seven days a week. Unfortunately, too many of our nursing homes provide substandard care and conditions that are demeaning and inhumane. As the country has witnessed in the COVID-19 pandemic, too many nursing homes are not even capable of implementing basic infection control protocols.

Good facilities already provide at least 24-hour registered nurses (RNs). The time has come to ensure that all nursing homes provide this level of care and competency. That is why the Biden Administration’s proposal to require that any nursing home that takes public funds have at least one RN in the building 24/7 is so important.

Predictably, the nursing home industry is fighting any safe staffing standard. In respect to 24/7 RNs, industry leaders are claiming that it would cost $610 million a year to meet this standard. In fact, the data that nursing homes themselves report to the government indicate that this claim is false, and that the actual costs would be a small fraction of that number.

Today, LTCCC is releasing a new analysis showing that the actual cost of meeting the 24-hour RN staffing standard is only $71 million per year – just $1.09 per resident per day for facilities with 24-hour RN shortfalls. Our findings are based on government staffing data (reported by facilities) and nursing home staff salary data from the U.S. Department of Labor. The fact is that facilities with less than 24-hour RN staffing do not need to hire a bunch of RNs. They can simply shift from LPNs to RNs to bridge the hours needed to cover the gap. This is precisely what the industry did in 2019, when it fired thousands of therapists when CMS changed its methodology for paying for rehab care.

Key Findings

  • The average cost for a facility to shift to 24-hour RN staffing is $58.69 per day.

  • This comes out to only $1.09 per resident per day for facilities not currently providing 24-hour RNs.

  • If all U.S. nursing home residents are included, the cost is only 16 cents per resident per day.

  • The daily cost to achieve 24-hour RN staffing per day ranges from two cents to $132.80.

  • The actual cost of achieving 24-hour RN staffing nationwide is $71 million per year.

  • Over 75% of facilities already have enough RNs for 24-hour coverage.

Aren’t our residents worth a dollar day?

Costs to Reach 24-Hour RN
NHs with RN Shortfall 3,311 (22.5% of total: 14,699)
Residents at NHs with RN Shortfall 178,827 (15% of total: 1,194,310)
Total Daily Cost Nationwide $194,310
Avg. Daily Cost for Shortfall NH $58.69
Avg. Daily Per Resident Cost – Shortfall NH $1.09
Total Annual Cost Nationwide $70,923,017
Annual Median Wage (2022 Bureau Labor Statistics) Per Hour
RN $75,410 $36.25
LPN/LVN $58,140 $27.95
Difference $17,270 $8.30

Data Sources & Methodology

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

[1] Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Licensed Practical and Licensed Vocational Nurses, at (visited September 25, 2023).

[2] Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, at (visited September 25 2023).