Nursing Home Staffing Shortages Are Lowering Quality of Care for Residents, Study Finds

Following drastic staffing shortages during the COVID-19 pandemic, new report warns the average U.S. nursing home is understaffed by 25%.

Details from a new report reveal that more than 90% of nursing homes across the United States are understaffed, potentially leading to an insufficient quality care for residents.

According to data published in the Nursing Home Staffing Q3 2024 report, every single state in the country, with the exceptions of Alaska and Oregon, reported not having enough staff to properly care for nursing home residents.

The report was compiled by the Long-Term Care Community Coalition (LTCCC), a non-profit organization that represents the needs of nursing home patients. The group’s researchers used data from the Centers for Medicare and Medicaid (CMS) to calculate resident staffing needs, by using each facility’s own evaluation of its residents’ conditions and medical needs.

Nursing home staffing has been an area of concern since the COVID-19 pandemic, which greatly impacted nursing home care nationwide. Low staffing levels led to high death rates, increases in rates of infections, a greater number of reports involving nursing home abuse, and other types of nursing home neglect, according to various reports by state and federal agencies nationwide.

More than 60% of nursing homes in the U.S. reported losing half of their staff during the initial COVID-19 outbreak. Even after the height of the pandemic, more than 73% said they were at risk of closing due to insufficient staffing.

A report published in 2024 warned less than one-third of nursing homes in the U.S. have enough certified nursing assistants (CNAs) on staff to care for residents. Another report, also published by the LTCCC, indicated one-third of nursing homes had no medical director on staff during 2023.

Nursing Home Staffing Shortages

The Long-Term Care Community Coalition, a nonprofit advocating for nursing home residents, released a new report highlighting severe staffing shortages nationwide. Using data from the Centers for Medicare and Medicaid Services and each facility’s own assessments of residents’ medical needs, the LTCCC found that 90% of nursing homes are understaffed and unable to provide adequate care.

The national average for total nursing staff hours needed per resident per day is 4.94 hours. According to the new report, the average U.S. nursing home provides only 3.73 of those hours.

In addition, the LTCCC noted that the average U.S. nursing home was understaffed by 25%. Understaffing ranged from 10% below adequate levels in Hawaii, up to 38% below adequate levels in Illinois, which was the state with the overall worst staffing levels in the country. Illinois was followed by Texas at 32%, New Mexico and Missouri at 31%, and Georgia and Indiana at 30% below proper staffing levels.

Only nursing homes in two states, Alaska and Oregon, exceeded the required staffing levels on average. Alaska facilities exceeded their levels by 21% overall, and Oregon exceeded expected levels by 2.5%. Every other state fell below their own projected necessary staffing levels.

Most states also failed to meet new nursing home staffing minimums established by CMS in 2024, at 3.48 hours per resident day. However, those standards have been put on hold by the new administration, and many observers anticipate they are likely to be discarded altogether.

The majority of nursing homes across the U.S. are operating with too few staff members to adequately care for residents, the report’s authors concluded, calling for additional changes to be made to state and federal laws to ensure nursing home residents receive the care they need. They called for use of their methodology to help more accurately determine whether facilities were providing adequate nursing home staffing levels.