Nursing homes that can successfully balance their nurse hours per patient day (HPRD), overtime and agency use consistently see stronger quality outcomes and lower labor costs.
Anywhere between 3.75 to 4.5 nursing HPRD is the range for consistent quality outcomes, according to a report from Covr, a workforce scheduling and data analytics platform, while high-performing operators achieve 4.5 to 5.5 nurse HPRD.
And registered nurse (RN) coverage is a particularly strong indicator of quality; operators should aim for a range between 0.65 and 0.80 RN HPRD. Nursing homes that have RN HPRD below 0.65 consistently see higher rehospitalization rates, Covr found.
The scheduling company used Payroll-Based Journal (PBJ) data pulled from the Centers for Medicare and Medicaid Services (CMS) for the majority of 2025, along with workforce perspective data based on surveys conducted between May and June. Performance data reflects 380 nursing homes using Covr between December 2025 and May 2026.
As for agency use, at or below 5% is a good start, but high performers use less than 1%, according to the report. Most nursing homes now have little to no agency use, but a small group of high agency facilities skews the national average to 5.7%, more than 10 times above the median.
“[Activities of daily living] ADL decline, mobility decline and antipsychotic use show worse outcomes when agency use exceeds 5%,” Covr said in its report. “Star ratings also trend downward as agency use increases.”
Overtime and turnover are linked, Covr reported. The less overtime assigned, the less likelihood of high turnover. Notably, once overtime reaches 7% or lower annually, each percentage point thereafter is associated with av1% to 2% turnover reduction.
The best overtime range for nursing homes is between 3% and 7.5%, and operators should aim for less than 50% total nurse turnover.
Continuing with turnover, Covr reported that falls are driven not by staffing volume but by workforce stability. Nursing homes with the highest turnover average 3.4% falls with major injury between December 2025 and May 2026, compared to 2.85% falls for nursing homes with the lowest turnover.
“Falls are largely prevented through consistent day-to-day care,” researchers said in the Covr report. “[Certified nursing aides] CNAs and [licensed practical nurses] LPNs assist with mobility, toileting, repositioning and resident monitoring. When turnover is high or agency staff rotate frequently, caregivers are less familiar with residents, care plans and early warning signs.”
Similar to RN hours and rehospitalizations, LPN hours are linked to fewer falls, reinforcing the importance of having experienced frontline caregivers instead of just adding more hours.
So how do nursing homes achieve desirable turnover numbers? Start with schedule flexibility, according to the report. About 45% of frontline workers say schedule flexibility, control or advance notice is the main reason they stay at a facility, ranking ahead of pay.
“One of the findings that stood out to us was the importance of schedule quality to retention,” Tanner Thompson, CEO of Covr, said in a statement. “The days and hours nurses work have a significant impact on both their job satisfaction and their lives outside of work.”
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