How to read nursing home staffing numbers

Almost every staffing number you will see for a nursing home — on this site, on Medicare's Care Compare, or in a news story — is expressed as hours per resident per day, often abbreviated HPRD. It answers a simple question: on an average day, how many hours of nursing staff time does this facility provide for each resident?

The math is straightforward. Take all the hours that nursing staff worked over a period, divide by the number of days, then divide by the average number of residents. If a 100-resident facility's nursing staff worked 350 hours on a given day, that is 3.5 hours per resident per day.

Two things to keep in mind when reading these numbers:

• It is an average, not a schedule. A resident does not receive 3.5 uninterrupted hours of one-on-one care. The figure spreads all staff time — direct care, charting, medication rounds — across all residents and all shifts, including overnight.
• Small differences add up. Half an hour per resident per day may sound minor, but across 100 residents it is 50 additional staff-hours every day — roughly six more full-time caregivers in the building.

Staffing figures are not a facility's own estimate. Since 2016, federal law has required every Medicare- or Medicaid-certified nursing home to submit staffing data to CMS through the Payroll-Based Journal (PBJ) system. Facilities must report, for every calendar quarter, the hours each nursing employee and contract worker was paid to work, tied to payroll and other auditable records.

This matters because of what came before. Under the old system, facilities simply wrote down their own staffing levels around inspection time, with little verification. PBJ data, by contrast, can be audited against payroll records, and CMS runs checks and audits on the submissions. Facilities that fail to submit usable data can have their staffing rating suppressed.

PBJ is not perfect — it measures paid hours, not the quality of the care delivered in those hours — but it is the most reliable staffing evidence available, and it is the source for everything on this page of the site.

Total nursing hours combine three very different roles, and it helps to know what each one does.

Registered nurses (RNs) have the most training — typically a two- to four-year degree plus a national licensing exam. RNs assess residents' conditions, develop and adjust care plans, handle complex clinical tasks like IVs and wound care decisions, and are usually the ones who catch a developing problem — an infection, a medication reaction — before it becomes an emergency. Research on nursing home quality most consistently links RN time, specifically, with better resident outcomes.

Licensed practical nurses (LPNs) — called licensed vocational nurses (LVNs) in some states — complete a roughly one-year practical nursing program. They handle much of the day-to-day clinical routine: giving medications, changing dressings, monitoring vital signs, and reporting changes to the RN. LPNs work under the direction of an RN or physician.

Certified nurse aides (CNAs) provide most of the hands-on daily care: helping residents bathe, dress, eat, use the bathroom, and move safely. Aides typically complete a state-approved training course of a few weeks plus a competency exam. They spend more time with residents than anyone else in the building, which is why aide staffing levels and aide turnover matter so much for daily quality of life.

Raw staffing hours are not fair to compare directly, because nursing homes serve very different populations. A facility full of short-stay rehabilitation patients recovering from surgery needs more nursing time per resident than one serving mostly stable long-term residents. Sicker, more dependent residents simply need more hours.

CMS handles this with case-mix adjustment. Using each facility's resident assessment data, CMS estimates how many staffing hours that particular mix of residents would be expected to need, then adjusts the facility's reported hours up or down relative to that expectation. The result: a facility with a sicker population is not penalized for looking "average" on raw hours, and a facility with an unusually healthy population cannot look generous just because its residents need less care.

On this site, the staffing percentiles you see are computed from case-mix adjusted hours — the same basis CMS uses for the staffing star rating. When we say a facility is in the top 20% of its state for RN staffing, that comparison already accounts for how sick each facility's residents are. The one exception is weekend RN hours: CMS does not publish an adjusted version of that measure, so we display it as reported and label it "not acuity-adjusted" wherever it appears.

Two numbers reveal what an overall average can hide.

Weekend staffing. Staffing at most facilities drops on Saturdays and Sundays — fewer administrators, fewer therapists, and often noticeably fewer nurses. But residents' needs do not take weekends off, and families visiting on a Saturday are seeing the facility at its thinnest. A facility whose weekend RN hours fall far below its weekday levels may leave a single RN — or, historically at some facilities, none at all for stretches — covering the entire building. When comparing facilities, look at weekend figures separately rather than assuming the overall average holds seven days a week. Remember that on this site the weekend RN figure is shown as reported and is not acuity-adjusted.

Turnover. CMS also publishes the percentage of a facility's nursing staff that left over a twelve-month period. A total nursing staff turnover of 50% means half the nursing employees working at the start of the year were gone by the end. High turnover hurts residents in concrete ways: new staff do not know that a particular resident refuses medication unless it comes with juice, or which resident is a fall risk when getting up at night. Continuity of care — being cared for by people who know you — depends on staff staying. Persistent high turnover can also signal deeper problems with management, pay, or working conditions. Turnover varies by region and by role, so the most useful comparison is against the state average shown next to each facility's number.

In 2024, CMS finalized the first-ever federal minimum staffing rule for nursing homes. As finalized, it required facilities to provide at least 3.48 total nurse staffing hours per resident per day, including at least 0.55 RN hours and 2.45 nurse aide hours, along with an RN on site 24 hours a day, 7 days a week — phased in over several years, with longer timelines and possible hardship exemptions for rural facilities. The rule's future has been contested since it was issued: it faced litigation in federal court and congressional action affecting its implementation, and its requirements and timeline have been in flux as a result. Rather than assume any particular requirement is currently in force, treat the finalized numbers as a reference point and check CMS directly for the rule's current status. Whatever its legal fate, the rule is useful to families as a marker of what federal regulators concluded a minimally adequate staffing floor looks like — and many facilities today report staffing below those levels.

Each facility page on this site shows staffing in a three-column table:

Read it in this order:

1. Compare the facility to its state average first. Labor markets, Medicaid payment rates, and regulations differ by state, so in-state comparison is the most meaningful.
2. Use the national average as a second reference point, especially if you are comparing facilities across state lines.
3. Check the RN line separately from the total. Two facilities can have identical total hours while one delivers far more of them through RNs.
4. Look at the weekend and turnover rows for the average-versus-reality check described above.

Where you see phrasing like "top 20% in the state" or "bottom 10% nationally," that is a percentile: the share of facilities this one outperforms or trails on that measure. Percentiles are computed from case-mix adjusted hours (except weekend RN hours, which are not acuity-adjusted), so they are fair comparisons across facilities with different resident populations. As always on this site, these numbers describe official records — they are a starting point for your own questions and visits, not a recommendation for or against any facility.