Long Term Care Community Coalition
November 25, 2024
Federal law mandates that all nursing homes provide sufficient staff to meet the care and quality of life needs of their residents every day. However, new data show that hundreds of thousands of residents live in facilities that are staffed far below the minimum needed to provide basic clinical care, as identified in a landmark 2001 federal study.
According to LTCCC’s latest nursing home staffing report, based on CMS’s Q2 2024 payroll-based journal data, over 70% of U.S. nursing homes are failing to provide the 4.1 hours per resident day (HPRD) of nursing staff identified as necessary in the 2001 study.
In addition to information on nurse staffing levels, LTCCC’s staffing report also provides detailed data on various non-nurse staffing categories, including the presence of medical directors, therapists, and activities staff, and the extent to which facilities are using contract staff. It also includes summary findings at the national level, as well as analyses by CMS Region and by state.
Staffing Facts for Q2 2024
- U.S. nursing homes reported an average of 3.71 total nurse staff hours per resident day (HPRD).
- Nearly three-fourths (72.7%) of nursing homes provide less nursing staff time than the minimum necessary (as determined by the landmark 2001 federal study.)
- Missouri, Illinois, Texas, New Mexico, and West Virginia provided the lowest average staffing ratios.
- Alaska, Oregon, North Dakota, Hawaii, and Washington —mostly smaller states—provided the highest staffing ratios.
- More than a third (36.1%) of nursing homes reported zero medical director time in Q2 2024. Among nursing homes reporting a medical director, the medical director was on payroll for an average of 35 minutes per day or 4.1 hours per week per facility.
- Note: LTCCC’s recent study published in the Journal of the American Geriatrics Society, found alarming gaps in medical director presence in U.S. nursing homes.
- The share of contract staffing hours continues to drop, accounting for 7.0% of all nurse staffing hours in Q2 2024 (compared to 9.7% in Q2 2023).
- Understaffing is especially problematic on holidays and weekends.
- On Mother’s Day this year, nursing homes reported an average of only 3.13 total nurse staff HPRD.
- Last year, nursing homes provided an average of 3.43 nurse staffing HPRD on Thanksgiving, over 10% less than the weekday average for that quarter (3.86 HPRD). Will nursing homes be any safer this Thanksgiving?
Source: CMS Payroll-Based Journal Data (Q2 2024, Q4 2023). Notes: (1) 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. (2) The new federal staffing requirements will not go into effect for several years. For more information, see LTCCC’s brief, The New Federal Nursing Home Staffing Standard: What You Need to Know