PBJ320 Insights

Staffing ratios appeared to rise in 2020—but mainly because resident census fell faster than total staffing hours. The apparent increase in staffing ratios during 2020-2021 was largely due to decreased resident census (deaths and discharges) rather than increased staffing hours, with some facilities not reporting data for Q1 2020 during early COVID-19.

Watch how staffing patterns shift across states over time. Each state is colored by its HPRD/Contract Percentage for the quarter. Watch how the colors shift as you animate through time—darker purples indicate higher staffing levels. The animation reveals regional staffing patterns across the US.

Loading takeaway from the same quarter as the charts above…

A small share of facilities rely heavily on agency staff; most use barely any. By either metric, nationwide contract staffing increased significantly during the pandemic but has fallen since 2023.

Nurse Aides account for Crunching PBJ... of nursing staff nationally. However, this varies significantly by state—some states rely more heavily on RNs while others use more nurse aides. The state map shows these regional differences, with yellow shading indicating higher nurse aide percentages. You can toggle to view Total RN % (blue) or Direct Care % (red) to see different staffing patterns across the country.

Total Nurse HPRD (the CMS metric) includes administrators and DONs; Direct Care excludes them. The difference shows how much nursing time is administrative. In Q1 2025, Crunching PBJ... of total nursing staff time was administrative/DON, and Crunching PBJ... of RN time was administrative/DON.