Inadequate and Dangerously Low Staffing Issues in Nursing Homes

December 11, 2018 – Staffing is perhaps the most important factor in a nursing home resident’s quality of care and ability to live with dignity. Unfortunately, inadequate staffing is a widespread and persistent problem. In fact, the federal government has recently indicated serious concerns about inadequate staffing, especially on nights and weekends, and ordered states to conduct more inspections on weekends to crackdown on this problem. While some nursing homes provide sufficient levels of qualified care staff, in the absence of limits on profits or administrative expenses, too many nursing homes fail to allocate funds to maintain sufficient staffing.  Thus, the ability to find out about the staffing levels in individual nursing homes is critical.Today, LTCCC announces the publication of the latest, user-friendly data on the staff assigned to provide resident care, select non-nursing staff, and facilities’ use of contract staff to provide resident care. This information can help the public, news media, and policymakers identify and assess the extent to which nursing homes in their communities are providing sufficient staffing to meet basic clinical and quality of life needs. The data are for the 2nd quarter of 2018, the most recent period reported by the federal Centers for Medicare & Medicaid Services (CMS). Visitors to our website,, can download easy-to-use charts for every state that include (for each facility in the state in compliance with the reporting requirement):

  1. The facility’s direct care RN, LPN, and CNA staffing;
  2. The ratios of care staff to residents;
  3. Select non-nursing staff hours per day, including administrators, social workers, and activities staff;
  4. The extent to which the facility relies on contract staff to provide resident care.

To facilitate ease of use, the individual state files are easily sortable. For example, a state file can be sorted to identify which facilities have the highest reported levels of RN care and which have the lowest. A few facts about the reported data:

  • US nursing homes provide an average of 3.5 total care staff hours per resident per day. A 2001 landmark federal study indicated that at least 4.1 hours is needed to meet a typical resident’s needs.
  • US nursing homes provide an average of .5 RN care staff hours per resident per day. The 2001 federal study indicated that a minimum of 10 – 50% more is needed to meet a typical resident’s clinical needs.
  • US nursing homes provide an average of .2 hours activities staff time and .1 hours of social work staff time per resident per day. LTCCC believes that lower activities staff time may contribute to social isolation and impact a resident’s psychosocial well-being.

On December 18, LTCCC will be hosting a free webinar, Staffing: How to Find Out About Staffing in Your Facility & What it Means for Your Resident’s Care & Quality of Life. The invitation is available at

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