Decades of research have established a consistent finding: nursing home staffing levels are the single strongest predictor of care quality. Higher RN hours per resident day correlate with lower rates of pressure ulcers, hospitalizations, infections, and restraint use. Yet many facilities operate near or below the minimums that existed before federal requirements were rolled back.
The Federal Minimum Staffing Landscape (2026)
In December 2025, the federal minimum staffing requirements that CMS had finalized in 2024 were repealed. The previous proposed standards would have required 3.48 total nursing hours per resident day (0.55 RN + 2.45 CNA/aide). Current federal law requires only that an RN be on-site 8+ hours daily, 7 days/week, and a licensed nurse be available 24/7.
State Requirements Vary Dramatically
Some states have stepped in with their own requirements. California requires 3.5 total nursing hours/resident day. New York and several other states have requirements at or above the now-repealed federal standard. Many states (including Alabama and others) operate on assessment-based models with no numeric minimums.
What to Look for in Staffing Data
- RN hours per resident day: the gold standard measure; should be 0.6+ for adequate care
- Total nursing hours per resident day: aim for 3.5+ including CNAs
- Weekend staffing vs. weekday staffing: CMS now collects this separately; the gap often reveals how facilities cut corners
- Agency staff percentage: high use of temporary/agency nurses signals chronic understaffing
- CNA turnover rate: CNAs provide most hands-on care; turnover above 60%/year is a concern
The Research Consensus
A landmark study in Health Affairs found that each additional 20 minutes of RN care per resident day was associated with a 26% reduction in pressure ulcer rates. Staffing research consistently shows that facilities with higher RN hours have lower rates of avoidable hospitalizations, restraint use, and antipsychotic medication prescribing.
CareScope displays CMS staffing data (including RN hours, total nursing hours, and staff turnover rates) for every rated facility. Use the comparison tool to put staffing levels side by side for your shortlisted facilities.