More than any other single factor, staffing levels predict the quality of care in a nursing home. Facilities with higher nurse-to-resident ratios have lower rates of pressure injuries, falls, infections, and unnecessary hospitalizations. Knowing how to interpret staffing data — and what questions to ask — can help you make a significantly better placement decision.
How Staffing Is Measured
Nursing home staffing is measured in hours per resident day (HPRD) — the total number of nursing hours worked divided by the number of residents, for a given day. CMS reports these numbers on Medicare Care Compare for every certified facility.
| Staff Category | National Average (2024) | Minimum Recommended |
|---|---|---|
| RN hours per resident day | 0.59 hours | 0.75+ hours |
| Total nurse hours per resident day | 3.77 hours | 4.1+ hours |
| CNA hours per resident day | 2.45 hours | 2.8+ hours |
The New Federal Staffing Minimum (2024)
In 2024, CMS finalized new minimum staffing requirements for nursing homes — the first federal minimum staffing standards in history:
- 0.55 RN hours per resident per day (minimum)
- 2.45 CNA hours per resident per day (minimum)
- A registered nurse must be on-site 24 hours per day, 7 days per week (phased in over 3–5 years)
These are minimums — not targets. Research suggests optimal outcomes occur at considerably higher staffing levels. Use these minimums as a floor, not a ceiling.
Weekend Staffing: The Hidden Quality Gap
Many nursing homes substantially reduce staffing on weekends — when administrators and visitors are less present. CMS now reports weekend staffing separately, and it’s often dramatically lower than weekday numbers. When evaluating a facility, always check the weekend staffing data and consider visiting on a Saturday or Sunday.
Staff Turnover: Another Critical Metric
The nursing home industry average annual staff turnover rate exceeds 50% — meaning more than half of all staff leave each year. High turnover means:
- Frequent use of agency (temporary) staff who don’t know residents
- Breakdown of consistent assignment (same aides caring for same residents)
- Higher training costs that divert resources from care
- Lower resident satisfaction and continuity of care
Ask any facility you’re considering: “What is your annual staff turnover rate?” Facilities below 30% are exceptional. CMS now publishes turnover data on Care Compare.
What to Ask During Your Tour
- What is your RN-to-resident ratio on the day shift? Evening shift? Night shift?
- Is a registered nurse on-site — not just on-call — 24 hours per day?
- What is your staff turnover rate?
- Do you use consistent assignment (same aides assigned to the same residents)?
- What percentage of shifts are covered by agency staff?