United States PBJ Nursing Home StaffingUnited States PBJ Staffing
14,362 providers • 1,255,969 residents • 3.76 HPRD
3.76 HPRD0.62 RN HPRD5.3% contract
The United States nationwide staffing ratio is 3.76 HPRD, including 3.50 Direct Care HPRD and 0.62 RN HPRD. The typical (median) U.S. nursing home provides 3.69 total nurse HPRD for 78 residents. The nationwide staffing ratio is up slightly (+0.01) since Q4 2024.
Direct staff excludes Admin/DON. Direct staff excludes Admin/DON.
U.S. Staffing Stats
| Metric | Value |
|---|---|
| Total Nurse Staffing HPRD | 3.76 |
| Direct Care Nurse HPRD | 3.50 |
| RN HPRD | 0.62 |
| RN Direct Care HPRD | 0.43 |
| LPN HPRD | 0.86 |
| LPN Direct Care HPRD | 0.78 |
| Nurse Aide HPRD | 2.28 |
| Contract Staff Percentage | 5.3% |
| Number of Facilities | 14,362 |
| Average Daily Census (per facility) | 86 |
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.