Key Findings from 14,751 Facilities
- •5-star facilities have 50% more RN staffing than 1-star facilities (0.77 vs 0.51 hours/resident/day)
- •High turnover kills quality: 1-star facilities average 53% turnover vs 39% for 5-star
- •National average is 0.64 RN hours/resident/day - well below expert recommendations of 0.75-1.0 hours
- •Only 6% of facilities meet the gold standard of 1.0+ RN hours per resident daily
Why Staffing Matters More Than Anything
You can have the newest building, fanciest amenities, and highest star rating - but if there aren't enough nurses to answer call lights, help residents eat, or prevent falls, none of that matters.
Research consistently shows that staffing levels are the single best predictor of nursing home quality. Yet most families don't understand the numbers they're looking at. "0.64 RN hours per resident per day" - what does that even mean?
We analyzed staffing data from all 14,751 Medicare-certified nursing homes to help you understand what adequate staffing looks like and how to spot red flags.
Understanding Staffing Numbers
What "Hours Per Resident Per Day" Means
When you see "0.64 RN hours per resident per day," this means:
For a 100-bed facility:
- 0.64 hours × 100 residents = 64 total RN hours per day
- 64 hours ÷ 24 hours = 2.67 RN nurses on duty at any given time
- That's approximately 1 RN for every 37 residents
Now imagine only 1-2 of those RNs are working nights and weekends. This is why higher numbers are critical.
RN Hours
National average hours per resident per day
Recommended: 0.75-1.0 hours
Total Nurse Hours
National average (RN + LPN + CNA)
Recommended: 4.1+ hours
Turnover Rate
National average annual turnover
Lower is better: <40% is good
Staffing Levels by Star Rating
The correlation between staffing and quality is crystal clear. Here's how average staffing differs by star rating:
| Star Rating | RN Hours | Total Hours | Turnover |
|---|---|---|---|
| ⭐ 1-Star | 0.51 | 3.65 | 53.4% |
| ⭐⭐ 2-Star | 0.58 | 3.61 | 48.4% |
| ⭐⭐⭐ 3-Star | 0.73 | 3.89 | 46.4% |
| ⭐⭐⭐⭐ 4-Star | 0.69 | 3.95 | 43.2% |
| ⭐⭐⭐⭐⭐ 5-Star | 0.77 | 4.30 | 38.6% |
💡 Key Insight
Notice the trend is nearly perfect: every additional star correlates with more RN hours and lower turnover. The jump from 1-star to 5-star represents 50% more RN staffing and 38% less turnover - that's not coincidence.
The Hidden Crisis: Nurse Turnover
High turnover is devastating to quality care. When nurses constantly quit, residents lose familiar faces who understand their needs, routines, and preferences. New staff make more errors and miss subtle changes in condition.
High Turnover (60%+)
Average star rating for facilities with 41-60% turnover
When more than half your nursing staff turns over annually, institutional knowledge is lost and care suffers dramatically.
Low Turnover (20-40%)
Average star rating for facilities with 21-40% turnover
Stable staffing means experienced nurses who know residents' needs, preferences, and baseline health status.
⚠️ Red Flag
If a facility has turnover above 60%, it doesn't matter how nice the building looks. High turnover means constant training of new staff, unfilled shifts, and overworked nurses who are more likely to make mistakes.
What to Look For When Evaluating Staffing
✅ Green Flags (Good Signs)
- ✓RN hours ≥ 0.75 (only 20% of facilities achieve this)
- ✓Total nurse hours ≥ 4.1 (recommended by experts)
- ✓Turnover < 40% (indicates stable, satisfied staff)
- ✓Staff who know residents by name during your tour
- ✓Residents who seem comfortable with staff (not fearful or hesitant)
🚩 Red Flags (Warning Signs)
- ✗RN hours < 0.5 (bottom 40% of facilities)
- ✗Total hours < 3.6 (inadequate for basic care)
- ✗Turnover > 60% (revolving door of staff)
- ✗Call lights going unanswered for 10+ minutes during your tour
- ✗Staff who seem rushed, stressed, or dismissive of residents
- ✗Many residents in bed mid-day (suggests not enough staff to get them up)
Questions to Ask During Your Tour
Don't just look at the numbers - use these questions to assess staffing quality:
1. "What is your current nurse-to-resident ratio on each shift?"
They should answer confidently for day, evening, and night shifts. Vague answers are a red flag.
2. "What's your annual nurse turnover rate?"
If they say "I don't know" or won't answer, that's concerning. Good facilities track and work to reduce turnover.
3. "How do you handle staffing when someone calls in sick?"
Look for: on-call staff, cross-trained employees, or agency nurses. Weak answer: "We make do" or "Staff pick up extra residents."
4. "Can I speak with a nurse or CNA who works here?"
Ask staff directly: How long have you worked here? Do you feel supported? Is there enough help? Their body language tells a lot.
5. "What's your policy on consistent assignment?"
Best practice: same CNAs assigned to same residents daily. This builds relationships and continuity.
Find Facilities with Strong Staffing
Use our search tool to filter by RN hours, total staffing, and turnover rates. See which facilities in your area meet expert recommendations.
Methodology & Data Sources
This guide analyzes staffing data from all 14,751 Medicare-certified nursing homes, current as of October 2024.
Data sources:
- CMS Payroll-Based Journal (PBJ) - actual staffing hours reported by facilities
- CMS Provider Information including overall ratings
- Expert recommendations from CMS, leading researchers, and advocacy groups
Important note: CMS uses 2-week snapshots for ratings, which facilities can game. Our turnover data provides additional context that's harder to manipulate.