THE ARISING · Markets & Strategy
Over 90% of US Nursing Homes Staff Below Acuity-Based Expected Level, LTCCC Says
More than 9 in 10 US nursing homes are staffing below the level their residents' needs would suggest, according to a new national data report from the Long Term Care Community Coalition (LTCCC), and the share is rising. The expected-staffing figure is described by LTCCC only as 'based on resident acuity'; the report page does not say how it was built.
The report, released October 7, covers 14,690 federally certified nursing homes. It finds the average facility reported 3.86 nurse staffing hours per resident per day, compared with 4.99 hours expected based on resident acuity.
An important caveat: the source page does not explain how the expected-staffing figure is calculated or who set it, and it does not say whether it is a regulatory standard. Readers should treat it as LTCCC's reported comparison, not as a verified legal or clinical threshold. All figures here come from LTCCC itself, and we have not independently checked them.
The trend is the part operators and investors may want to note. In LTCCC's February 2026 report, 87% of facilities were below expected staffing and the average was 3.90 hours. The new figures show more than 90% below, with the average down to 3.86 hours.
Staffing was lower still at chain-affiliated homes. They averaged 3.70 hours per resident day, and about 96% of chain facilities with available data fell below expected staffing. For large multi-facility operators, this puts the gap between reported and expected staffing at the center of any comparison with peers.
Facilities with serious quality problems fared worst. LTCCC groups Special Focus Facilities, Special Focus Facility Candidates and one-star homes as problem facilities. These averaged 3.49 hours, and nearly 98% fell below expected staffing.
These homes are a large part of the sector. According to LTCCC, more than one in five nursing homes fall into that group, caring for about 294,000 residents. The data count 84 Special Focus Facilities, 441 candidates and 3,015 one-star homes. A further 1,426 facilities display the federal abuse icon.
Enforcement data point to concentrated financial exposure. Over roughly three years, 6,514 nursing homes received at least one fine. Facilities were assessed about $456.8 million in fines, and CMS imposed 15,696 penalties, including fines and payment denials. Problem facilities are about 22% of homes but account for about 61% of fines, LTCCC says.
Enforcement is uneven, though. According to the report, 610 problem facilities had no reported federal penalties in the period. Separately, 1,018 homes had gone more than two years since their last standard health inspection. LTCCC argues that long gaps can leave problems undiscovered while old results still shape what families see.
Richard Mollot, LTCCC's executive director, said: "These data show that inadequate staffing remains the norm in U.S. nursing homes, not the exception."
For the sector, the implications are interpretive and should be treated as such. Because the page does not explain the expected-staffing measure, the report should not be read as showing that any facility broke a rule. It does show that a public, searchable dataset now lets families, attorneys, journalists and policymakers rank facilities and chains on staffing, fines and ownership. Operators with low staffing and weak ratings are the most visible in that comparison.
What to watch next
Whether LTCCC's next update shows the share below expected staffing continuing to rise, and whether CMS inspection and enforcement activity changes for the long-overdue and unpenalized facilities the report identifies.