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Nursing Home Update: Latest Data Indicate Severe Nurse Understaffing – LTCCC

Empty hallway in a long-term care facility

February 26, 2020 – Sufficient staffing is vital to a nursing home resident’s quality of care and ability to live with dignity. Unfortunately, many nursing homes fail to comply with federal law requiring facilities to provide sufficient care staff and to have a registered nurse on duty eight hours a day, seven days a week. As demonstrated by the newest federal nursing home data (third quarter of 2019), too many facilities are failing to allocate funds to maintain sufficient staffing to meet every resident’s needs.

Today, LTCCC announces the publication of the latest user-friendly data on staffing for every U.S. nursing home (in compliance with mandatory reporting requirements). This information can help the public, news media, and policymakers identify and assess the extent to which nursing homes in their communities are providing sufficient staffing to meet basic clinical and quality of life needs. The data are for the most recent period reported by the federal Centers for Medicare & Medicaid Services (CMS).

Visitors to our website,, can download easy-to-use files for every state that include:

  1. The levels of care staff that a facility has for its residents;
  2. Staffing levels for important non-nursing staff, including administrators and activities staff; and
  3. The extent to which the facility relies on contract workers to provide resident care.

To facilitate ease of use, the individual state files are easily sortable. For example, a state file can be sorted to identify which facilities have the highest and lowest reported levels of registered nurse (RN) care.

Our report also includes data on staffing averages for all states (including Washington, DC), and accompanying maps illustrating state staffing averages and rankings.

  • Based on average total staffing hours per resident day, the top 10 states are: Alaska, North Dakota, Florida, California, Hawaii, DC, Delaware, Oregon, Idaho, and Arizona.
  • The bottom 10 states are: Missouri, Oklahoma, Texas, New Mexico, Illinois, Indiana, South Dakota, Nebraska, Kansas, and Rhode Island.

A few facts about the reported data:

  • A landmark 2001 federal study indicated that 4.10 total care staff hours per resident day (HPRD) and 0.75 RN care staff HPRD are needed to ensure that residents receive necessary clinical care. However, the latest data indicate that US nursing homes provide an average of 3.37 HPRD and 0.42 RN HPRD.
  • Two-thirds of facilities (66.3 percent) provide less than a half-hour of RN care staff HPRD while 7.6 percent of facilities provide close to zero (≤ 0.10 hours) RN care staff HPRD.
  • Two-thirds of facilities (65.8 percent) provide close to zero ( 0.10 hours) social work staff HPRD and 30.0 percent of facilities provide close to zero (≤ 0.10 hours) activities staff HPRD.

* Note: Nursing home facilities are prone to significant fluctuation in staffing and often have very low staffing on specific days such as weekends and holidays. Though our report accounts for staffing fluctuations by averaging all observations, data on staffing for specific days can be found by searching for a nursing home in the CMS dataset,

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John Dalli, Salvatore Marino, and Jeanne RamassoDalli & Marino, LLP has been providing top-tier representation, and we have recovered millions of dollars, for families in cases of nursing home and other skilled care/elder care facility neglect and results of understaffing, in Suffolk and Nassau Counties (Long Island), Manhattan, Brooklyn, the Bronx, Queens, Staten Island, and Westchester County, since 1996.

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