Missouri PBJ Nursing Home StaffingMissouri PBJ Staffing
476 providers • 34,810 residents • 3.36 HPRD
3.36 HPRD (rank: 49)3.36 HPRD · Rk 490.40 RN HPRD3.8% contract
Missouri's statewide staffing ratio is 3.36 HPRD in Q4 2025. Missouri's statewide staffing ratio is up (+0.07) since Q4 2024. This level is below the national ratio of 3.76 HPRD and ranks #49 out of 51 states.
Missouri
Direct staff excludes Admin/DON. Direct staff excludes Admin/DON.
Missouri
Missouri
Missouri
MO Staffing Stats
| Metric | Missouri | CMS Region 7CMS Region 7 includes Iowa, Kansas, Missouri, and Nebraska.Regional figures are calculated from facility-level data using the same methodology as the state figures. | U.S. | State rankRanks compare the 50 states and D.C. by the displayed metric value. A higher or lower rank is not inherently positive or negative for every metric, including contract staffing share and rural-facility share. |
|---|---|---|---|---|
| Total Nurse Staffing HPRD | 3.36 | 3.68+0.32 vs MO | 3.76+0.40 vs MO | #49 of 51 |
| Direct Care Nurse HPRD | 3.16 | 3.44+0.28 vs MO | 3.50+0.34 vs MO | #49 of 51 |
| RN HPRD | 0.40 | 0.56+0.16 vs MO | 0.62+0.22 vs MO | #47 of 51 |
| RN Direct Care HPRD | 0.27 | 0.38+0.11 vs MO | 0.43+0.17 vs MO | #48 of 51 |
| Nurse Aide HPRD | 2.29 | 2.47+0.18 vs MO | 2.28-0.01 vs MO | #31 of 51 |
| Contract Staff Percentage | 3.8% | 4.6%+0.8 pts vs MO | 5.3%+1.4 pts vs MO | #35 of 51 |
| Median Case-Mix HPRD (Acuity) | 3.71 | 3.44-0.27 vs MO | 3.74+0.03 vs MO | #35 of 51 |
| Rural Facilities (Share) | 41% | 52%+10.9 pts vs MO | 27%-13.4 pts vs MO | #20 of 51 |
PBJ320 High-Risk (183)
PBJ320 high-risk PBJ320 high-risk uses CMS-assigned indicators only (PBJ320 does not assign them): Special Focus Facility or SFF Candidate; abuse icon; one-star overall; one-star staffing. nursing homes in Missouri (183 facilities).
| Facility | Census | CMS ratings | Indicators | Total HPRD |
|---|---|---|---|---|
| Loading facilities… | ||||
Methodology
Staffing from CMS Payroll-Based Journal (PBJ) public files (2017–2025), plus Provider Information and chain data where shown. State staffing context via MACPAC (2022). Methodology · PBJ explained.
Metrics
- Hours Per Resident Day (HPRD): Total staff hours ÷ average residents. Example: 350 hours for 100 residents = 3.5 HPRD.
- Direct Care (excl. Admin, DON): Hours per resident day for direct care staff only (RN, LPN, CNA, NAtrn, MedAide), excluding administrative and supervisory roles.
- Contract Staff %: Share of hours provided by contract staff.
- Census: Average number of residents during the period.
Note: Some states set minimums (e.g., NJ, CA, NY at 3.5 HPRD); a federal 3.48 minimum was recently overturned (2025). A 2001 federal study linked 4.1 HPRD to better outcomes in that study. Staffing needs vary by resident acuity (case-mix), day, and shift. Estimates on PBJ Takeaway assume roughly 60% of staff are CNAs.
Data transparency
The PBJ Dashboard pulls directly from CMS data and is carefully vetted for accuracy. Still, sometimes a bug sneaks into the jelly. That could mean: a systemic CMS data reporting issue (e.g., Q2 2017 contract staffing, missing data in 2020 due to COVID) or there could be a coding error on our part. If you spot something that looks off, please let me know via the contact form so I can set things right.
Trend charts omit quarters with implausible submitted HPRD (total/direct below 0.25; RN, LPN, and aide use role floors and neighbor-quarter rules). Full criteria.
Rankings, within-state percentiles, CMS flags (including abuse icon): How metrics are calculated.