NH Staffing Levels

CMS collects data at the facility-level on each nursing home’s average number of nursing care hours per resident, per day. State scores in this indicator derive from the lowest number of nursing care hours per resident, per day provided by race/ethnicity, based on the nursing homes with the most admissions from each group. One state might be scored based on the nursing homes with the most Hispanic resident admissions, while another might be scored based on the nursing homes with the most Asian resident admissions, depending on which group received the lowest amount of care. Nationally, the lowest served groups in each state received about 3.3 hours of nursing care per resident per day. In only three states did these groups receive more than 4 hours of care per person per day, which would be in line with previous CMS recommendations. 

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The number of direct-care staff hours per resident day, including Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nursing Assistant (CNA) hours. This measure was calculated from the Payroll Based Journal (PBJ) Public Use File (PUF), which is based on data submitted by nursing homes to CMS. PBJ PUFs are published quarterly and report information on staffing hours for each day in the quarter, along with resident census information derived from the Minimum Data Set (MDS). The indicator measures weekday staffing (excluding weekends) during the calendar week containing the first Thursday of April 2021.

These data were averaged at the state level following the LTSS State Scorecard approach to measuring equity.

Equity adjustment: Race/ethnicity is indicated in MDS by a 6 category multiple response variable with choices:

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or Other Pacific Islander
  • White 

Residents were classified by race/ethnicity as follows:

  • Hispanic/Latino: “Hispanic or Latino” is selected
  • All Other Races/Ethnicities: exactly one race/ethnicity is selected (a resident is classified as “Asian” if and only if “Asian” is selected and no other races/ethnicity is selected)
  • Multiracial: “Hispanic or Latino” is not selected and two or more other races/ethnicities are selected

Data are presented for all residents and for each race/ethnicity group for the 10% of facilities nationally and within each state that have the most admissions among each group.

For the equity adjusted metric score, residents are divided into 6 groups: White, American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islander, and Multiracial.  The lowest performing group is scored and ranked as a performance metric.

Analysis of 2021 MDS 3.0 state-level care data provided by the Changing Long-Term Care in America Project at Brown University in February-April 2023.

Brown University (2023). Changing Long Term Care in America Project at Brown University funded in part by the National Institute on Aging (1P01AG027296). Providence, RI: Brown University School of Public Health,


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