Industry-wide Neglect

Data published in the Nursing Home Staffing Q3 2024 report reveals that more than 90% of nursing homes across the United States are understaffed.  Understaffing within a nursing home results in substandard quality of care and inadequate care levels for residents.

The report shows that every state in the country, except Alaska and Oregon, reported having insufficient staff to care for nursing home residents properly. This report was compiled by the Long-Term Care Community Coalition (LTCCC), a nonprofit organization that represents the needs of nursing home residents.

The research was based on data from the Centers for Medicare and Medicaid (CMS) to calculate the needs of each resident, reflecting the facility’s evaluation of each resident’s condition and medical needs. Low staffing levels lead to high death rates, an increase in rates of infections, a greater number of reports involving nursing home abuse, and other types of nursing home neglect.

Published reports have warned that less than one-third of nursing homes in the U.S. have enough certified nursing assistants (CNAs) to meet the staff-to-resident care ratio.

Another report also indicated that one-third of nursing homes had no medical director on staff during 2023.

The national average for total nursing staff hours needed per resident per day is 4.94 hours, but the average U.S. nursing home provided only 3.73 of those hours.

Additionally, the average U.S. nursing home is understaffed by 25%.

In Hawaii, understaffing ranged from 10% below adequate levels to 38% below in Illinois. Illinois is the state with the overall worst staffing levels in the country, followed by Texas at 32%, New Mexico and Missouri at 31%, and Georgia and Indiana at 30% below the proper mandated staffing levels. As stated previously, the only two states that exceeded expected levels were Alaska and Oregon, with Alaska at 21% and Oregon at 2.5%.

In addition to states failing to meet adequate levels of care, most states were also unable to meet the new nursing home staffing minimums established by CMS in 2024, which were set at 3.48 hours per resident day.  The majority of nursing homes in the United States are understaffed, operating at staffing levels that do not provide adequate care for their residents. Study authors urge changes to be made to state and federal laws and plan to use their staffing evaluation method to assess better whether facilities are providing adequate staffing levels.