Care hours decline as deficiencies grow at US nursing homes: 6 notes

The average hours of nursing care received inside U.S. nursing homes has continued to decline as the average number of deficiencies continues to grow, according to a Dec. 6 KFF report. 

The report used data from Nursing Home Compare, Certification and Survey Provider Enhanced Reports and KFF's state health facts to examine characteristics of nursing home facilities and residents between 2015 and 2024. 

Here are six notes from the report:

1. The number of CMS-certified nursing facilities, meaning they adhere to CMS regulations and are therefore eligible for Medicare and Medicaid reimbursements, decreased by 5% from 15,648 in July 2015 to 14,287 in July 2024.
   
   
2. The number of residents living in nursing facilities decreased by 10% from 1,367,548 in 2015 to 1,226,089 in 2024. A steep decline occurred between 2020 and 2021, from 1,316,950 to 1,098,305, reflecting effects of the COVID-19 pandemic.
    
3. The average daily hours of nursing care received per resident decreased by 8% from 4.13 hours in July 2015 to 3.8 hours in 2024. Care from a registered nurse or a nurse aide declined by 21% and 8%, respectively, while care from a licensed practice nurse increased by 6% for the same period.
   
   About 40 states and nonprofits have sued HHS and CMS over a staffing rule that, when implemented in 2026, would require long-term care facilities to have a registered nurse on site for 24 hours per day, seven days a week as opposed to the current requirement of eight hours per day, seven days a week.
   
   The rule also requires total nurse staffing of at least 3.48 hours per resident day, registered nurse staffing of at least .55 hours per resident day and nurse aide staffing of at least 2.45 hours per resident day.
   
   
4. The average number of deficiencies per nursing facility increased by 40% from 6.8 in 2015 to 9.5 in 2024. The share of facilities where deficiencies resulted in "actual harm of jeopardy" increased from 17% in 2015 to 28% in 2024.
   
   
5. As of July 2024, 63% of nursing facility residents were under Medicaid coverage, 13% were under Medicare coverage, and 24% had other coverage sources such as private insurance or out-of-pocket pay.
   
   
6. Ownership status remained "relatively stable" during the report period, with 72% of nursing homes being owned by for-profit companies. Effective May 1, 2025, CMS will require nursing homes to disclose more detailed ownership information.

Read the full report here.