USA Today: Nearly All Nursing Homes Fail To Meet New Rule’s Minimum Staffing Needs

A vast majority of nursing homes in the U.S. fall short of meeting the staffing requirements in the new rule issued by the federal government, an analysis of the most recent payroll based journal (PBJ) data shows.

According to USA Today’s analysis published Thursday, nearly all nursing homes nationally will have to hire more nurses to be in compliance with the final rule on minimum staffing standards issued by the Centers for Medicare & Medicaid Services (CMS).

The gap is significantly wider in many Southern states, the article said. It includes a map with data for all the federally funded facilities nationwide.


Of the nearly 14,500 nursing homes that receive federal reimbursement, only 160 skilled nursing facilities met the new requirements during the summer quarter of 2023, the publication shared, basing its analysis on PBJ data posted last August.

Moreover, most nursing homes met the requirements of the new rule on only three days out of 92 in the quarter.

The final rule mandates a minimum of 3.48 hours per resident per day (HPRD) of total staffing, with specific allocations for registered nurses (RN) and nurse aides.


This standard encompasses 0.55 HPRD of direct RN care and 2.45 HPRD of direct nurse aide care. CMS said that facilities can use a mix of nurse staff, including RNs, LPNs/LVNs, or nurse aides, to meet the additional 0.48 HPRD.

Rural counties have five years to implement the minimum staffing standards while urban areas are allowed up to three years. Urban counties are defined as those that have a population of 50,000 or more people.

About 50% of the federally funded facilities, on average, were able to provide each resident with at least 0.55 hours of care from an RN daily, according to the analysis. Meanwhile, facilities were able to provide each resident with 2.45 hours of care from a CNA for only one day each week – a service they have to render for every day of the week.

And while many facilities complied partially with some stipulations of the rule, consistently meeting all the minimums was a rare occurrence.

“It was more common for nursing homes to have enough registered nurses, with most meeting the minimum about half the time. It was less common for facilities to have enough aides on duty, with most only having enough CNAs about one-third of the time,” the article noted.

The article shared an interactive map with blue dots indicating the federally funded facilities that usually met the standard.

Southern states performed the worst in meeting the requirements of the new rule.

Louisiana, Oklahoma and Texas had the biggest gap to fill on RN staffing, meeting the new requirement on 6 days, 14 days and 16 days, respectively, out of 92.

As for total staffing, Louisiana led the gap for the lowest levels with nursing homes in the state meeting the standard for just three out of 92 days of the quarter. It was followed by Texas (4), Oklahoma (8), Tennessee (8) and Georgia (9).

For the CNA requirement, many Southern states also led the gap. In Texas, facilities met the CNA requirement only on 11 days, while Tennessee met it on 15 days and Virginia on 16 days.

Meanwhile, states that fared better in meeting the total minimum staffing standard included Alaska (90), Hawaii (88), Utah (79), Maine (76) and Delaware (75).

For the CNA requirement, those that came close to meeting it included Alaska (89) Oregon (81) and North Dakota (72).  

Facilities can avail exemptions to the new rules if they are located in an area with a shortage of health-care workers and meet good faith efforts to hire more nurses and aides have failed.

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