Minimum Staffing Levels for Nursing Homes: Current Levels State by State

New Standards for Nursing Home Staffing

Updated on September 2, 2023

On September 1, 2023 the US Department for Health and Human Services announced new minimum staffing standards for US nursing homes (see press release from CMS). The proposals comes more than a year after President Biden mentioned them in the 2022 State of the Union address and despite significant concerns from industry. Also see news coverage and detailed analysis).

While proponents argue that studies and personal experiences suggest that positive outcomes for nursing home residents are highly correlated with the amount of care they receive, opponents point out that the industry is already facing tremendous challenges in hiring staff. (Ironically, the CMS’ reimbursement caps are the single most important factor limiting nursing home’s hiring.)

Despite the challenges in staffing, the proposed legislation would require nursing homes to provide:

• .55 hours of care from registered nurse per resident per day. (The current average nationwide is 0.67 hours and 51.00% of US nursing homes meet or exceed this standard.)
• 2.45 hours of care from a certified nurse aid per resident per day. (The current average nationwide is 2.29 hours and 30.78% of US nursing homes meet or exceed this standard.)
• a least one registered nurse on site 24/7

Hours of RN Care per Day: State Averages

The table below shows the current (as of October 1, 2024) hours of direct care per day provided by Registered Nurses (RNs) in each state and nationwide as well as the monthly and annual trends. The data is updated monthly.

State	Current / Last Month / Last Year	Perc. Chg. Monthly / Yearly
AK	2.15 / 2.10 / 2.29	-6%
AL	0.60 / 0.60 / 0.57	5%
AR	0.41 / 0.41 / 0.38	7%
AZ	0.72 / 0.72 / 0.72	-1%
CA	0.60 / 0.58 / 0.57	5%
CO	0.85 / 0.84 / 0.85	0%
CT	0.71 / 0.72 / 0.71	0%
DC	1.73 / 1.60 / 1.48	17%
DE	1.06 / 1.04 / 1.05	1%
FL	0.74 / 0.71 / 0.68	8%
GA	0.48 / 0.47 / 0.45	6%
HI	1.57 / 1.56 / 1.61	-2%
IA	0.75 / 0.75 / 0.74	2%
ID	0.83 / 0.88 / 0.92	-10%
IL	0.71 / 0.71 / 0.72	-1%
IN	0.63 / 0.63 / 0.63	1%
KS	0.73 / 0.70 / 0.71	2%
KY	0.74 / 0.75 / 0.74	0%
LA	0.31 / 0.30 / 0.30	2%
MA	0.65 / 0.64 / 0.68	-5%
MD	0.84 / 0.83 / 0.85	-1%
ME	0.98 / 1.00 / 1.03	-5%
MI	0.75 / 0.74 / 0.76	-1%
MN	1.03 / 1.03 / 1.03	0%
MO	0.44 / 0.44 / 0.45	-3%
MS	0.60 / 0.61 / 0.59	2%
MT	0.86 / 0.89 / 0.78	10%
NC	0.57 / 0.58 / 0.59	-3%
ND	0.92 / 0.91 / 0.86	7%
NE	0.72 / 0.71 / 0.73	-2%
NH	0.73 / 0.73 / 0.78	-7%
NJ	0.72 / 0.73 / 0.73	-2%
NM	0.65 / 0.63 / 0.64	2%
NV	0.98 / 0.97 / 0.88	11%
NY	0.71 / 0.69 / 0.68	5%
OH	0.62 / 0.61 / 0.60	3%
OK	0.34 / 0.34 / 0.34	0%
OR	0.67 / 0.71 / 0.73	-8%
PA	0.79 / 0.80 / 0.78	2%
PR	3.89 / 4.86 / 3.56	9%
RI	0.78 / 0.78 / 0.81	-3%
SC	0.66 / 0.66 / 0.68	-3%
SD	0.80 / 0.79 / 0.78	2%
TN	0.60 / 0.59 / 0.58	3%
TX	0.41 / 0.40 / 0.38	8%
UT	1.15 / 1.18 / 1.17	-2%
VA	0.67 / 0.67 / 0.62	8%
VT	0.80 / 0.84 / 0.81	-2%
WA	0.90 / 0.90 / 0.87	4%
WI	0.95 / 0.95 / 0.96	-1%
WV	0.72 / 0.71 / 0.71	1%
WY	0.93 / 0.99 / 0.87	7%
US Totals	0.67 / 0.66 / 0.66	1% / 1%

Hours of CNA Care per Day: State Averages

The table below shows the current (as of October 1, 2024) hours of direct care per day provided by Certified Nurse Assistants (CNAs) in each state and nationwide as well as the monthly and annual trends. The data is updated monthly.

State	Current / Last Month / Last Year	Perc. Chg. Monthly / Yearly
AK	4.22 / 4.36 / 4.30	-3% / -2%
AL	2.46 / 2.40 / 2.36	3% / 4%
AR	2.67 / 2.60 / 2.55	3% / 5%
AZ	2.30 / 2.27 / 2.27	1% / 1%
CA	2.59 / 2.58 / 2.54	0% / 2%
CO	2.22 / 2.18 / 2.22	2% / 0%
CT	2.21 / 2.20 / 2.19	0% / 1%
DC	2.58 / 2.59 / 2.47	0% / 4%
DE	2.47 / 2.44 / 2.33	1% / 6%
FL	2.35 / 2.33 / 2.35	1% / 0%
GA	2.11 / 2.06 / 2.03	2% / 4%
HI	2.81 / 2.77 / 2.76	1% / 2%
IA	2.44 / 2.39 / 2.36	2% / 3%
ID	2.46 / 2.49 / 2.51	-1% / -2%
IL	2.08 / 2.03 / 2.04	2% / 2%
IN	2.23 / 2.19 / 2.23	2% / 0%
KS	2.66 / 2.57 / 2.59	4% / 3%
KY	2.31 / 2.28 / 2.26	1% / 2%
LA	2.26 / 2.21 / 2.23	2% / 1%
MA	2.21 / 2.17 / 2.18	2% / 1%
MD	2.15 / 2.11 / 2.11	2% / 2%
ME	2.79 / 2.81 / 2.95	-1% / -5%
MI	2.27 / 2.24 / 2.28	1% / 0%
MN	2.52 / 2.46 / 2.43	2% / 4%
MO	2.23 / 2.20 / 2.16	1% / 3%
MS	2.37 / 2.30 / 2.34	3% / 1%
MT	2.54 / 2.49 / 2.26	2% / 12%
NC	2.29 / 2.28 / 2.26	0% / 1%
ND	3.08 / 2.98 / 2.95	3% / 4%
NE	2.71 / 2.59 / 2.58	5% / 5%
NH	2.28 / 2.27 / 2.33	0% / -2%
NJ	2.14 / 2.11 / 2.12	1% / 1%
NM	2.21 / 2.17 / 2.23	2% / -1%
NV	2.30 / 2.34 / 2.33	-2% / -1%
NY	2.20 / 2.16 / 2.13	2% / 3%
OH	2.10 / 2.06 / 2.04	2% / 3%
OK	2.48 / 2.48 / 2.50	0% / -1%
OR	3.40 / 3.28 / 3.20	4% / 6%
PA	2.09 / 2.09 / 2.06	0% / 1%
PR	0.00 / 0.00 / 0.00	0% / 0%
RI	2.42 / 2.40 / 2.43	1% / 0%
SC	2.23 / 2.19 / 2.27	2% / -2%
SD	2.52 / 2.42 / 2.40	4% / 5%
TN	2.07 / 2.03 / 2.02	2% / 2%
TX	1.96 / 1.92 / 1.94	2% / 1%
UT	2.32 / 2.35 / 2.44	-1% / -5%
VA	2.08 / 2.00 / 1.97	4% / 6%
VT	2.44 / 2.47 / 2.55	-1% / -4%
WA	2.62 / 2.61 / 2.58	0% / 2%
WI	2.46 / 2.45 / 2.38	0% / 3%
WV	2.01 / 2.04 / 2.05	-1% / -2%
WY	2.50 / 2.45 / 2.37	2% / 5%
US Totals	2.29 / 2.26 / 2.25	1% / 2%