Nursing homes report their staffing from payroll records rather than by self-description, which makes long-term care the one part of American nursing where actual staffing levels are public, facility by facility, every quarter.
This page summarises the current federal file. It covers 14,690 certified nursing homes, of which 14,271 have staffing measures reported, and comes from the provider information dataset published in August 2026.
What the measures mean
Hours per resident per day is total nursing hours divided by resident days. It is not a ratio: 3.5 hours per resident day describes the whole day across all shifts and all nursing staff, not how many patients one nurse carries at a time. See patient acuity and staffing systems.
Case-mix adjusted means the figure is corrected for how sick the residents are, using the assessment data each facility already submits, so a facility with heavier residents is not credited for staffing that merely matches its workload. The adjusted numbers are the ones used below.
Turnover is the share of nursing staff who left over twelve months, again computed from payroll data rather than reported by the facility.
The national picture
- Median total nurse staffing: 3.77 hours per resident per day.
- Median registered nurse staffing: 0.59 hours per resident per day, about 35 minutes of registered nurse time per resident per day.
- Median weekend total staffing: 3.35 hours, which is 0.41 hours below the all-week median at the typical facility. Weekends are thinner almost everywhere.
- Median total nursing staff turnover: 44.9 percent. Median registered nurse turnover: 41.7 percent.
That turnover figure deserves a second look next to hospitals, where registered nurse turnover runs at 17.6 percent. Long-term care replaces nearly half its nursing staff every year. See nurse turnover and retention.
How many would have met the repealed rule
The 2024 federal minimum staffing rule required 3.48 total nurse hours per resident day, including at least 0.55 hours of registered nurse care and 2.45 hours of nurse aide care, plus a registered nurse on site around the clock. A court vacated it in April 2025, Congress barred any similar requirement until 2034, and a repeal rule published in December 2025 removed the text, taking effect in early February 2026. See nursing home staffing requirements.
Against today's data, the rule would have bitten hard:
- 45 percent of facilities fall below the 0.55 registered nurse hours the rule would have required.
- 36 percent fall below the 3.48 total nurse hours.
So the sector's objection that it could not comply was not rhetorical. Nearly half of nursing homes are staffed below a standard that no longer exists, and the current federal floor asks only for a registered nurse eight hours a day.
Ownership makes a visible difference
| Ownership | Facilities | Median total nurse hours | Median nursing turnover |
|---|---|---|---|
| For profit | 10,630 | 3.60 | 46% |
| Non profit | 2,750 | 4.58 | 40% |
| Government | 891 | 4.40 | 42% |
The gap between for-profit and non-profit facilities is almost a full hour of nursing care per resident per day, and it shows up again in turnover. Ownership type is published for every facility in the same file, so this is checkable rather than inferred.
By state
Median values across facilities in each state. The fourth column is the share of that state's facilities below the registered nurse threshold the repealed rule would have set.
| State | Facilities | Total nurse hours | RN hours | Below 0.55 RN hours | Nursing turnover |
|---|---|---|---|---|---|
| Alabama | 224 | 4.42 | 0.71 | 22% | 47% |
| Alaska | 20 | 7.19 | 2.02 | 0% | 46% |
| Arizona | 140 | 3.72 | 0.59 | 39% | 46% |
| Arkansas | 221 | 4.58 | 0.45 | 73% | 48% |
| California | 1165 | 4.13 | 0.48 | 61% | 36% |
| Colorado | 210 | 3.75 | 0.78 | 18% | 47% |
| Connecticut | 191 | 3.69 | 0.61 | 40% | 36% |
| Delaware | 44 | 4.18 | 0.88 | 14% | 42% |
| District of Columbia | 17 | 4.59 | 1.34 | 0% | 32% |
| Florida | 694 | 3.88 | 0.67 | 30% | 42% |
| Georgia | 356 | 3.42 | 0.45 | 64% | 46% |
| Hawaii | 43 | 4.43 | 1.52 | 0% | 32% |
| Idaho | 80 | 3.70 | 0.71 | 19% | 50% |
| Illinois | 666 | 2.66 | 0.50 | 57% | 43% |
| Indiana | 507 | 3.27 | 0.56 | 48% | 45% |
| Iowa | 387 | 4.22 | 0.79 | 16% | 42% |
| Kansas | 296 | 4.48 | 0.72 | 24% | 47% |
| Kentucky | 267 | 3.36 | 0.64 | 40% | 45% |
| Louisiana | 265 | 3.98 | 0.27 | 95% | 47% |
| Maine | 78 | 4.45 | 1.06 | 1% | 47% |
| Maryland | 221 | 3.55 | 0.69 | 26% | 42% |
| Massachusetts | 341 | 3.75 | 0.58 | 43% | 38% |
| Michigan | 422 | 4.09 | 0.76 | 24% | 45% |
| Minnesota | 338 | 4.75 | 1.13 | 2% | 40% |
| Mississippi | 202 | 4.62 | 0.65 | 33% | 44% |
| Missouri | 487 | 3.58 | 0.42 | 70% | 56% |
| Montana | 61 | 4.57 | 1.03 | 7% | 53% |
| Nebraska | 180 | 4.31 | 0.67 | 27% | 47% |
| Nevada | 66 | 3.77 | 0.84 | 21% | 45% |
| New Hampshire | 73 | 3.74 | 0.76 | 21% | 44% |
| New Jersey | 348 | 3.66 | 0.56 | 48% | 39% |
| New Mexico | 68 | 3.82 | 0.66 | 32% | 53% |
| New York | 593 | 3.42 | 0.57 | 46% | 38% |
| North Carolina | 419 | 3.67 | 0.53 | 53% | 49% |
| North Dakota | 72 | 5.14 | 1.05 | 1% | 50% |
| Ohio | 922 | 3.32 | 0.54 | 51% | 48% |
| Oklahoma | 283 | 4.53 | 0.38 | 81% | 55% |
| Oregon | 128 | 5.31 | 0.68 | 30% | 46% |
| Pennsylvania | 656 | 3.66 | 0.65 | 36% | 44% |
| Rhode Island | 72 | 3.64 | 0.74 | 22% | 39% |
| South Carolina | 187 | 3.87 | 0.56 | 50% | 45% |
| South Dakota | 96 | 4.09 | 0.87 | 7% | 47% |
| Tennessee | 303 | 3.48 | 0.51 | 58% | 50% |
| Texas | 1177 | 3.31 | 0.39 | 79% | 52% |
| Utah | 97 | 3.56 | 0.99 | 3% | 50% |
| Vermont | 33 | 4.07 | 0.77 | 13% | 58% |
| Virginia | 289 | 3.36 | 0.51 | 57% | 48% |
| Washington | 193 | 3.96 | 0.84 | 8% | 43% |
| West Virginia | 123 | 3.32 | 0.63 | 31% | 43% |
| Wisconsin | 323 | 4.10 | 0.93 | 9% | 46% |
| Wyoming | 36 | 4.28 | 0.86 | 6% | 48% |
What stands out
Total hours and registered nurse hours are different questions. Arkansas and Oklahoma staff well above the national median in total hours while sitting near the bottom on registered nurse coverage, with 73 and 81 percent of facilities below the repealed threshold. Louisiana is the extreme case: 95 percent of its facilities fall below it, on a median of 0.27 registered nurse hours per resident day. A resident there gets plenty of hands and very little registered nurse time.
The states with the most registered nurse coverage are small or remote. Alaska, Hawaii, the District of Columbia, Minnesota, North Dakota and Maine all sit at or near universal compliance with the threshold that no longer applies.
Illinois has the lowest total staffing in the country at a median of 2.66 hours per resident day, more than an hour below the national median and well under the repealed rule.
Turnover is worst where staffing is thinnest, but not neatly. Vermont, Missouri, Oklahoma, Montana and New Mexico all exceed 50 percent annual nursing turnover. California and Hawaii, at 36 and 32 percent, are the most stable, and California achieves that while sitting at 61 percent below the registered nurse threshold, which shows that stability and registered nurse coverage are separate problems.
Caveats
The data are submitted by facilities from their own payroll systems and audited by the regulator, which makes them far better than self-report and not beyond challenge. Facilities with insufficient or unreliable submissions are footnoted or excluded, which is why 419 of the 14,690 have no staffing values here. Medians describe the middle facility in a state and hide the spread inside it. And staffing hours say nothing about how those hours were distributed across shifts, beyond the weekend measure.
For an individual facility, the same dataset carries its own values, its ownership, its inspection findings and its ratings, which is the practical use for anyone choosing a workplace or a home for a relative.
Related
- Nursing home staffing requirements
- Nurse staffing and patient outcomes
- Nurse turnover and retention
- Long-term and post-acute care nursing
- Where the nursing numbers come from
Sources
- Nursing home provider information dataset, August 2026 release. Centers for Medicare and Medicaid Services. Figures on this page were computed from the full file of 14,690 facilities on 9 September 2026.
- Staffing data submission: Payroll-Based Journal. Centers for Medicare and Medicaid Services, on quarterly payroll reporting. Accessed September 9, 2026.
- Payroll-Based Journal methodology. Centers for Medicare and Medicaid Services, on case-mix adjustment. Accessed September 9, 2026.
- Minimum staffing standards for long-term care facilities final rule. Centers for Medicare and Medicaid Services, 2024, for the 3.48, 0.55 and 2.45 thresholds. Accessed September 9, 2026.
- Repeal of minimum staffing standards for long-term care facilities. Federal Register, December 2025. Accessed September 9, 2026.