As many skilled nursing facilities are falling short of expected federal requirements for adequate nursing staff, the shortage has led to a failure to promote the well-being of residents and to burnout and low retention for current staff.
According to a recent staffing report by the Long Term Care Community Coalition, data provided by the federal government reveals that U.S. nursing homes had an average of only 3.61 total nurse staff hours per resident day (HPRD) in the fourth quarter of 2022. This falls significantly below the threshold necessary to ensure the proper care and support of residents, according to LTCCC.
The report analyzed the payroll-based journal data from the Centers for Medicare & Medicaid Services (CMS) for every nursing home across the country, as mandated by reporting requirements.
Alaska tops the nation with 6.0 total nurse staff HPRD, with only 8 other states making it above the requirement of 4.1 HPRD proposed by the Biden Administration’s forthcoming minimum staffing mandate. Oregon reported 4.83 HRPD, followed by Maine at 4.37 HRPD, followed by Hawaii and District of Columbia tied at fifth spot for 4.27 HRPD, according to the LTCCC report.
Moreover, staffing levels varied considerably by CMS regions. Arkansas, Louisiana, New Mexico, Oklahoma and Texas had the lowest collective total nurse staff HPRD at 3.41.
The complete list of HRPD data by state is below:
On average, U.S. nursing homes provided a mere 3.61 total nurse staff HPRD, while the median nursing home offered 3.58 total nurse staff HPRD. These figures fall far short of the time required to adequately address the basic care needs of the 1.18 million residents in the nation’s nursing homes, the LTCCC said.
Regarding registered nurse (RN) staffing, the median nursing home provided only 0.55 Total RN HPRD and 0.36 RN Care HPRD – these exclude administrative and director of nursing roles. It is worth noting that a significant federal study conducted in 2001 determined that a minimum of 0.75 RN HPRD is necessary to meet basic clinical needs.
Furthermore, nursing homes experience a high turnover rate, with over half of their staff leaving within a 12-month period. The median total nursing staff turnover stands at 53%, including a 50% RN turnover rate, the LTCCC report stated. Research has consistently shown that higher turnover rates correlate with a decline in the quality of care provided, the report noted.
