Most US nursing homes fall short of the staffing standard Congress blocked
Measured against the federal minimum staffing rule — finalised in 2024, then vacated by a court, blocked by Congress and repealed — 78.2% of US nursing homes (11,178 of 14,288) report staffing below at least one of its three thresholds. The rule is not in force. No facility below these lines is breaking any law. The thresholds are used here only as a yardstick, because they are the numbers the sector spent two years arguing over.
What the standard asked for
CMS finalised three hour-per-resident-per-day minimums: 3.48 total nurse hours, of which at least 0.55 from a registered nurse and 2.45 from a nurse aide. Against the most recent CMS extract (2026-08-01), reported staffing falls below:
- 36.0% below 3.48 total nurse hours (5,143 homes)
- 45.0% below 0.55 RN hours (6,432 homes)
- 67.3% below 2.45 nurse aide hours (9,612 homes)
The finding does not depend on which staffing measure you use
CMS publishes both actual reported hours and a case-mix-adjusted series that accounts for how sick a home’s residents are. The rule set actual hours, so those are used above — but the picture barely moves either way:
| Measure | Homes | <3.48 total | <0.55 RN | <2.45 aide | Below any |
|---|---|---|---|---|---|
| Reported (actual hours) | 14,288 | 36.0% | 45.0% | 67.3% | 78.2% |
| Adjusted (case-mix adjusted) | 14,271 | 35.6% | 45.0% | 61.9% | 73.8% |
Where you live matters more than any national average
The spread between states is far wider than the national figure suggests: LA at 98.4% against ME at 20.5%. States with fewer than 25 reporting homes are omitted.
| State | Below any threshold | Homes reporting | Share |
|---|---|---|---|
| LA | 249 | 253 | 98.4% |
| TX | 1,085 | 1,141 | 95.1% |
| OK | 246 | 259 | 95.0% |
| TN | 279 | 302 | 92.4% |
| GA | 314 | 343 | 91.5% |
| AR | 195 | 218 | 89.4% |
| OH | 810 | 907 | 89.3% |
| MO | 414 | 467 | 88.7% |
| IN | 442 | 501 | 88.2% |
| WV | 106 | 121 | 87.6% |
| MD | 190 | 218 | 87.2% |
| VA | 244 | 283 | 86.2% |
| NY | 500 | 582 | 85.9% |
| MA | 286 | 335 | 85.4% |
| NJ | 287 | 341 | 84.2% |
| NC | 340 | 404 | 84.2% |
| NM | 55 | 66 | 83.3% |
| IL | 540 | 652 | 82.8% |
| FL | 555 | 679 | 81.7% |
| SC | 150 | 184 | 81.5% |
| PA | 513 | 637 | 80.5% |
| AZ | 109 | 136 | 80.1% |
| CT | 148 | 185 | 80.0% |
| DE | 34 | 43 | 79.1% |
| KY | 201 | 259 | 77.6% |
| CO | 156 | 203 | 76.8% |
| MI | 316 | 415 | 76.1% |
| MS | 145 | 196 | 74.0% |
| UT | 63 | 90 | 70.0% |
| NV | 44 | 63 | 69.8% |
| RI | 47 | 69 | 68.1% |
| NH | 49 | 72 | 68.1% |
| CA | 751 | 1,128 | 66.6% |
| AL | 147 | 221 | 66.5% |
| WY | 22 | 35 | 62.9% |
| ID | 49 | 79 | 62.0% |
| IA | 233 | 379 | 61.5% |
| SD | 55 | 91 | 60.4% |
| NE | 98 | 170 | 57.6% |
| MT | 31 | 58 | 53.4% |
| WI | 166 | 317 | 52.4% |
| KS | 148 | 285 | 51.9% |
| WA | 92 | 188 | 48.9% |
| VT | 15 | 31 | 48.4% |
| MN | 154 | 328 | 47.0% |
| OR | 45 | 125 | 36.0% |
| HI | 12 | 41 | 29.3% |
| ND | 16 | 70 | 22.9% |
| ME | 16 | 78 | 20.5% |
Where the standard actually stands
This is the part most coverage gets wrong, so it is worth stating precisely. The rule (CMS-3442-F, 89 FR 40876) took effect on 21 June 2024, but its hour requirements never did. It was vacated in AHCA v. Kennedy (N.D. Tex., 7 April 2025); enforcement was separately barred by Congress until 30 September 2034 under §71111 of P.L. 119-21; and CMS then repealed it outright by interim final rule (90 FR 55687), effective 2 February 2026.
What federal law requires today is that a home have “sufficient” nursing staff, plus a registered nurse on duty 8 consecutive hours a day, 7 days a week (42 CFR §483.35). There is no federal hours-per-resident floor.
What this does and does not tell you
Staffing hours are the single best-evidenced predictor of nursing home quality, but they are not a verdict on any individual home. A home below a threshold may be excellent; one above it may not be. These are self-reported payroll-based figures (CMS PBJ), they cover a single quarter, and 14,288 of the 14,690 homes in the file report usable staffing — the rest are excluded rather than guessed at.
Look at any specific home’s own record before drawing a conclusion: its inspection history, its citations and its staffing are all on its page here.
Method, in full
Source: the CMS Provider Data Catalog nursing-home extract (2026-08-01), a public record, joined on CMS provider number. A home counts as below a threshold when its reported hours for that measure are strictly less than the figure shown. Homes with missing or zero staffing are excluded from every count and from the denominator. State shares use the same rule and omit states with fewer than 25 reporting homes, because a handful of facilities makes a percentage meaningless. Every number on this page is recomputed from the source file on each build; none is typed in by hand.
Full sources, coverage and a downloadable state-level CSV of the table above: Data & methodology.
Published 2026-07-26. Free to quote or reproduce with a link to this page. The underlying data is public; our arithmetic is described above so you can reproduce it.