Nursing home staffing numbers, explained

If we could only check one thing about a nursing home, it would probably be staffing. The government calculates these numbers from daily payroll records, so they're harder to dress up than a brochure.

Hours per resident per day

This is the total hours nursing staff worked divided by the number of residents, per day. If a home shows 4.0 total nurse hours per resident per day, each resident gets roughly four hours of nursing attention a day, shared across the whole team. It doesn't mean one person sits with them for four hours.

Three kinds of staff make up that number:

• Registered nurses (RNs) assess residents, manage care plans and handle the medically complicated situations.
• Licensed practical or vocational nurses (LPNs/LVNs) give medications and treatments.
• Certified nurse aides (CNAs) do most of the hands-on work: bathing, dressing, helping people eat and get in and out of bed.

A home can look fine on total hours and still be thin on RNs, so check both.

Other numbers worth a look

Weekend staffing is often lower than weekdays. A big drop is worth asking about, since residents don't need less care on Saturday.

Turnover is the share of nursing staff who left over a year. When it's high, residents keep meeting new faces who don't know their routines, their medications or how they like their coffee.

Administrator turnover counts how many administrators left. Several in a short time usually means the home is unsettled.

One note: the staffing star rating adjusts for how sick a home's residents are. The raw hours on our facility pages aren't adjusted, so a home that takes very complex patients may need more hours than average just to keep up.

Minimum staffing rules

Federal rules require a registered nurse on site for at least 8 hours in a row, 7 days a week, and licensed nursing staff around the clock. In 2024 the government finalized a rule setting much higher minimum hours, but it has since been challenged in court and in Congress, so check its current status before relying on it. Many states set their own minimums on top of the federal ones.