Registered Nurse Staffing Falls Short in Most Nursing Homes

Most nursing homes report registered nurse (RN) staffing levels at half an hour per resident day or less, highlighting the labor shortage that’s affecting most of the senior care industry.

Seventy percent of nursing homes reported RN care at or below 30 minutes per day, while 82% of nursing homes reported total direct care staffing at four hours per resident day or less. In addition, 30% of nursing homes reported three hours per resident day or less of total direct care staffing.

Those numbers come from a new analysis by the Long Term Care Community Coalition (LTCCC), a New York City-based non-profit that looked at third-quarter data from the Centers for Medicare & Medicaid Services (CMS).


A 2001 federal study found that anywhere from 0.55 to to 0.75 hours of RN care staffing per resident day is generally needed to meet the clinical needs of residents, LTCCC noted in a press release. The same study put the appropriate amount of direct care staff time at 4.1 hours.

The data separates those who provide direct care and those who work in administrative roles in nursing homes. This distinction could explain the fact that some nursing homes have zero hours of RN care time per resident per day, Richard Mollot, executive director of LTCCC, told Skilled Nursing News.

“For a lot of facilities, what I suspect is they have an RN in the building, but maybe the RN is [assigned] in an administrative capacity and may not be providing direct care,” he said.


CMS in November 2017 released information on nursing home staffing based on payroll and other auditable data sources, rather than data that was self-reported by facilities. It marked the first time the information was publicly available, even though nursing homes have been required to report verifiable staffing data since 2016. The LTCCC wanted to present the data while it is as fresh as possible, but there are some limitations, Mollot noted.

For one thing, approximately 13,000 facilities reported data out of about 15,000 in the U.S. There were also some units associated with hospitals or with a pediatric focus that would have higher staffing levels — all of which would need to be considered in a more thorough analysis, Mollot said.

Still, the data represents an important peek into the skilled nursing industry, Mollot said.

“For the first time we’re seeing what facilities are providing in terms of direct care staff as opposed to administrative staff,” he explained. “With Nursing Home Compare, the data has historically lumped everyone together.”

Written by Maggie Flynn

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