What Are Nursing Home Minimum Staffing Requirements?
Nursing home staffing requirements are set by the Centers for Medicare & Medicaid Services (CMS) to ensure facilities have enough qualified staff to meet residents’ needs.
Understaffed facilities are strongly linked to nursing home neglect and abuse, as residents may be left without the basic care they need to stay safe, clean, and healthy.
Some states set stricter requirements, but failure to meet CMS standards can lead to fines, penalties, or loss of certification.
CMS minimum staffing requirements for nursing homes only apply to facilities that receive Medicare or Medicaid funding.
These standards cover registered nurses, licensed practical nurses, and nurse aides, based on the number of residents and their care needs.
Staffing shortages can have serious consequences for residents. When facilities fail to follow nursing home staffing rules, residents are put at risk of preventable injuries, worsening health conditions, and even death.
The Nursing Home Abuse Center helps families take action when poor staffing leads to harm. We work with attorneys who investigate understaffed facilities and fight to hold them accountable.
Our legal partners have recovered over $304 million for families affected by nursing home abuse and neglect.
Get a free case review right now to see if we may be able to help your family.
Fight back against nursing home abuse and neglect — start now with a free case review.
Start My Free Case Reviewor call (855) 264-6310
About Staffing Requirements for Nursing Homes
Federal nursing home staffing requirements have been in place since the Nursing Home Reform Act was enacted in 1987.
In April 2024, with support from the Biden administration, CMS finalized updates to nursing home staffing requirements through the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule.
The new requirements introduced detailed minimum staffing requirements for nursing homes to help improve care for residents.
These changes were designed to address long-standing staffing shortages in long-term care facilities — a crisis made more visible during the COVID-19 pandemic.
The federal government also proposed separate programs to support workers, such as tuition reimbursement and scholarships, to help facilities meet nursing home staffing requirements.
However, in April 2025, a federal judge blocked the rule from taking effect, ruling that CMS exceeded its legal authority. Currently, the updated staffing standards are not being enforced.
Initially, these requirements were scheduled to take effect in 2026 for urban facilities and 2027 for rural facilities. Learn about what the proposed new nursing home staffing requirements were to include below.
Staff Nursing Requirement Minimum
CMS proposed a total staffing standard of 3.48 hours per resident per day (HPRD) to help ensure residents receive adequate direct care.
These minimum nursing home staffing ratios would need to include:
- 0.55 HPRD from a registered nurse (RN)
- 2.45 HPRD from a certified nurse aide (CNA)
- 0.48 HPRD from any combination of licensed nursing staff, such as an RN, licensed practical nurse (LPN), licensed vocational nurse (LVN), or CNA
Facilities would also be required to submit their staffing data through the federal Payroll-Based Journal (PBJ) system for monitoring and compliance purposes.
24-Hour RN Availability
The CMS proposed rule would require nursing homes to have an RN on-site 24 hours a day, 7 days a week to provide skilled nursing care.
This ensures residents have continuous access to basic health care, even outside of normal business hours, helping prevent delays in care and medical oversight.
Yearly Facility Assessments to Inform Staffing Decisions
CMS also proposed a requirement for nursing homes to conduct annual assessments of resident care needs to guide staffing decisions.
Each assessment must evaluate the facility’s resident population, care requirements, and resources to determine whether current staffing levels are appropriate.
This process helps ensure that facilities adjust direct care staff and support staff as needed to match changing resident needs and maintain quality of care.
How Staffing Ratios in Nursing Homes Affect Residents
Staffing levels and hiring decisions have a direct impact on the safety and well-being of nursing home residents. When facilities cut corners or fail to meet nursing home staffing requirements, the consequences can be serious.
Risks linked to poor staffing practices include:
- Inadequate supervision, which can lead to falls, wandering, or medical emergencies going unnoticed
- Insufficient training, resulting in mishandled care tasks or medical errors
- Lack of emotional support, especially when overworked staff cannot meet residents’ social or mental health needs
- Neglect due to not having enough staff to assist with daily care, hygiene, meal schedules, or safe feeding
- Unsafe hires, when facilities skip thorough background checks, overlook past misconduct, or ignore clear red flags
- Various types of abuse, often tied to staff shortages or lack of oversight
Residents rely on staff not only for physical care but for safety, dignity, and emotional connection. When those needs are unmet, the risk of harm increases dramatically.
Can Nursing Homes Be Sued for Understaffing?
Yes. Families can sue a nursing home for neglect if staffing shortages lead to serious harm. Nursing homes are required to have enough trained staff to meet the daily needs of their residents. When they fail to do so, the results can be dangerous.
Nursing home understaffing may lead to:
- Advanced bedsores and infections due to poor hygiene care
- Delayed emergency response during health crises
- Emotional distress caused by isolation or unmet needs
- Missed medications or failure to provide timely treatment
- Repeated and preventable nursing home falls
Families have the right to hold nursing homes accountable when poor staffing puts loved ones at risk. Nursing home abuse lawsuits may result in compensation for medical costs, pain and suffering, and other damages.
If you believe your loved one was harmed in an understaffed facility, a free legal consultation can help determine your next steps.
Get your free case review right now.
Fight back against nursing home abuse and neglect — start now with a free case review.
Start My Free Case Reviewor call (855) 264-6310What Is Not Covered by Nursing Home Staffing Requirements?
While CMS staffing rules outline minimum levels of hands-on care, several important areas of nursing home staffing are not included in the federal requirements.
These gaps may contribute to inconsistent hiring practices, training, and oversight, and in some cases, may increase the risk of neglect or nursing home abuse.
Background Checks
There is no federal staffing requirement for criminal background checks on nursing home employees. These checks are handled at the state level and vary widely.
In some states, checks may only apply to certain roles or be left to the discretion of the facility.
Mental Health Screenings
CMS does not require mental health or wellness checks for nursing home staff. Each facility can decide for itself, despite the high stress and emotional demands of long-term care work.
Standardized Training
Federal law requires certified nurse aides to complete at least 75 hours of training, but there is no universal standard for other staff roles.
Beyond CNA minimums, training guidelines are often left to each facility or governed by state-specific rules.
These gaps place a greater burden on individual facilities — and sometimes on families — to monitor staff conduct and advocate for resident safety.
Facilities are expected to evaluate their staffing and training practices through annual assessments, but without federal enforcement in these areas, the quality of care can vary significantly.
Get Legal Help for Nursing Home Neglect
Understaffed nursing homes are dangerous. When there aren’t enough trained caregivers on each shift, basic needs go unmet, and residents pay the price with bedsores, infections, pain, and in the worst cases, their lives.
These staffing decisions are often driven by corporate greed, not care. Many nursing home chains cut corners to boost profits, even when it puts vulnerable residents at serious risk.
The Nursing Home Abuse Center works with experienced attorneys nationwide who have recovered over $304 million for nursing home abuse and neglect.
If your loved one was harmed in an understaffed nursing home, legal action may help your family get answers, demand accountability, and access compensation for the harm that was done.
Call us at (855) 264-6310 or get a free case review right now to get started.
Nursing Home Staffing Requirements FAQs
What are the signs that a facility may be dangerously understaffed?
Dangerously understaffed nursing facilities often fail to meet even the most basic care needs, putting residents at serious risk.
5 red flags of nursing home understaffing include:
- Unanswered call bells
- Residents left in soiled clothes
- Missed medications
- Frequent falls
- Unexplained injuries
If you’ve seen these warning signs and your loved one was harmed, you may be able to seek justice and compensation through a nursing home neglect lawsuit.
Call us at (855) 264-6310 or get a free case review right now.
Do understaffing issues have to be reported?
Yes. Nursing homes are required to report staffing levels to the Centers for Medicare and Medicaid Services (CMS) through the Payroll-Based Journal system. Families can also file complaints with their state’s long-term care ombudsman or licensing agency if they suspect unsafe staffing.
Can nursing home staff be held legally responsible for resident injuries?
Yes. If a staff member directly causes harm, especially through abuse or neglect, they may be held personally responsible. In many cases, the facility itself is also legally accountable for failing to hire, train, or supervise staff properly.
Is a facility liable if injuries were caused by untrained staff?
Yes. Nursing homes are responsible for ensuring that all staff are properly trained and supervised. If harm results from inadequate training, the facility can be held legally liable.
Call us at (855) 264-6310 right now to find out if you may be eligible to file a claim for injuries caused by untrained or unsupervised staff.
What is the staff-to-resident ratio in nursing homes?
There is no fixed federal ratio. Staffing requirements vary by state and depend on the level of care each resident needs.
While the Centers for Medicare and Medicaid Services (CMS) finalized a rule in 2024 requiring 3.48 hours of direct care per resident per day, that rule was blocked in April 2025 and is not currently in effect.
Facilities that receive Medicare or Medicaid must still meet general federal nursing home staffing standards, but are not subject to a specific national staffing ratio.
