Hours per resident per day
CMS collects daily paid hours through the Payroll-Based Journal and divides staff hours by the resident census for the same days. The result is hours per resident per day. A registered-nurse figure of 0.55 means a little over half an hour of registered-nurse time per resident per day, averaged across the days in the measure. It does not mean each resident had a nurse at the bedside for 33 minutes, and it does not show how those hours were spread across the night shift.
The level measures cover one quarter. Turnover uses six consecutive quarters. Which calendar quarter sits in a given catalog release is listed in the Nursing Home Data Collection Intervals file on the nursing home topic page. This site repeats the hours CMS published and does not relabel them with a quarter the provider row does not name.
The Provider Information file reports these nurse-hour measures:
- Nurse aide hours, including certified nurse aides, aides in training, and medication aides.
- Licensed practical or vocational nurse hours.
- Registered-nurse hours, including the director of nursing, registered nurses with administrative duties, and registered nurses.
- Total nurse staff, the sum of those groups.
- Total nurse staff on Saturday and Sunday.
- Registered-nurse hours on Saturday and Sunday.
Physical-therapy hours are also in the file. They are not part of the six measures that produce the staffing star. Job codes in the September 2026 Technical Users' Guide put registered nurses in codes 5 through 7 and all nurse staff used for the total in codes 5 through 12.
U.S. averages in this release
The State US Averages file in the same release reports these national averages. They are CMS's published averages, not a minimum and not a target this site sets.
| Measure | U.S. average |
|---|---|
| Nurse aide hours per resident per day | 2.32 |
| LPN/LVN hours per resident per day | 0.86 |
| Registered-nurse hours per resident per day | 0.69 |
| Total nurse hours per resident per day | 3.86 |
| Weekend total nurse hours per resident per day | 3.42 |
| Weekend registered-nurse hours per resident per day | 0.48 |
| Total nurse turnover | 45.8% |
| Registered-nurse turnover | 42.9% |
Weekend averages sit below the all-week averages in this file. That pattern is why CMS scores weekend hours as their own measure. A home can look adequately staffed on a weekday average and thinner on Saturday and Sunday.
Reported hours, case-mix hours, and adjusted hours
Reported hours are what the home submitted. Residents differ in how much nursing time their conditions imply. CMS accounts for that with the Patient Driven Payment Model nursing case-mix groups. From the daily mix of those groups, CMS calculates case-mix hours: the hours that would be expected if the home staffed at the national average for a resident mix like its own. Adjusted hours rescale the home's reported hours:
Adjusted hours = (reported hours / case-mix hours) × national average hours.
If reported hours match case-mix hours, adjusted hours equal the national average. If the home staffs above the case-mix expectation, adjusted hours land above the national average. The staffing star uses the adjusted total, adjusted registered-nurse, and adjusted weekend totals, not the raw reported numbers alone. Facility pages show both, so a reader can see the hours that were worked and the hours that entered the rating.
Turnover
Total nurse turnover and registered-nurse turnover in the file are percentages from 0 to 100. CMS builds them from Payroll-Based Journal employee identifiers, not from a resignation form. An employment spell counts in the denominator when the person worked at least 120 hours in a 90-day eligibility window. It counts in the numerator when that person then has 90 consecutive days with no hours at that home. Agency staff are included when they meet the hour test. The maximum rate under this definition is 100 percent. Administrator turnover is a count of administrators who left during the measurement year, not a percentage.
The calculation needs six quarters: a baseline quarter, four quarters of the measurement year, and a following quarter so CMS can see 90-day gaps that start near the end of the year. Homes with fewer than five eligible nurses are left out of the nurse turnover rates. Homes that fail to submit a required quarter, or that CMS treats as having invalid data, can be scored at the bottom of the turnover measure instead. Footnotes 26 and 27 in the data dictionary are the codes CMS uses for those situations. A high rate can also be an identifier change rather than people leaving. The guide excludes homes that show 100 percent daily turnover of eligible nurses on a day, which is the pattern CMS associates with swapped employee IDs.
What became of the 2024 numeric minimums
On May 10, 2024, CMS published a final rule, 89 Federal Register 40876, that set numeric minimums for long-term care facilities: 3.48 total nurse staffing hours per resident per day, including at least 0.55 registered-nurse hours and 2.45 nurse-aide hours, and a registered nurse on site 24 hours a day, seven days a week. Those standards were later challenged in court.
On July 4, 2025, Public Law 119-21 became law. Section 71111 prohibits the Secretary from implementing, administering, or enforcing those minimum staffing standards, including the related definitions, until September 30, 2034. On December 3, 2025, CMS published an interim final rule, 90 Federal Register 55687, effective February 2, 2026, repealing the numeric hours and the 24-hour registered-nurse provisions added in 2024. The rule states that the repeal aligns the Code of Federal Regulations with that statutory bar, and that it restores the earlier staffing regulation so the Code still states the statutory minimum.
Sections 1819(b)(4)(C)(i) and 1919(b)(4)(C)(i) of the Social Security Act still require a nursing facility to provide 24-hour licensed nursing service sufficient to meet the nursing needs of its residents, and to use a registered professional nurse for at least eight consecutive hours a day, seven days a week, unless a waiver applies. The interim final rule describes the restored 42 CFR 483.35 in those terms, including a registered nurse as director of nursing on a full-time basis, subject to the waiver rules. The 3.48, 0.55, and 2.45 hour figures, and the 24-hour on-site registered-nurse requirement from the 2024 rule, are the standards section 71111 blocks through September 30, 2034.
The Health Deficiencies file still cites homes under the staffing tags surveyors use. Tag F725 is worded in this file as providing enough nursing staff every day to meet the needs of every resident and having a licensed nurse in charge on each shift. Tag F727 is worded as having a registered nurse on duty eight hours a day and selecting a registered nurse as director of nursing on a full-time basis. Tag F851 covers electronic submission of staffing information from payroll. Those sentences are the descriptions in the deficiencies file, not a restatement of every clause in the regulation.
How hours turn into a star
The staffing rating uses the adjusted hours and the turnover measures, on national thresholds. Higher adjusted hours earn more points. Lower turnover earns more points. The star-rating guide lists the point caps and the Table 3 bands from the September 2026 guide. One staffing star is also assigned when data are missing, when registered-nurse hours are absent on four or more days with residents present, or when an audit fails. A one-star staffing rating then pulls the overall rating down one star, unless the home is already at one star overall from the earlier step.
Compare a home's reported hours with the state average and the U.S. average on the facility page before treating a staffing star as the whole story. The star is case-mix adjusted and national. The state average is the published mean for homes in that state, which may staff differently because resident mix, wages, and Medicaid payment differ.
Sources
- Technical Users' Guide, September 2026, staffing domain, case-mix formula, turnover specifications, and Table 3.
- CMS Payroll-Based Journal staffing data submission.
- Interim final rule repealing the 2024 minimum staffing standards, 90 FR 55687 (December 3, 2025).
- 2024 minimum staffing final rule, 89 FR 40876 (May 10, 2024).
- H.R. 1, 119th Congress, enacted as Public Law 119-21, section 71111.
- Social Security Act section 1819 and section 1919, subsection (b)(4)(C).
- State US Averages and Provider Information files, CMS Provider Data Catalog, processing date September 1, 2026.