Nursing Home RN Staffing by Ownership (2024): State Government Homes Average 1.33 RN Hours per Resident-Day, For-Profit LLCs 0.58

A 2024 analysis of CMS Payroll-Based Journal staffing data across 14,289 US nursing facilities, measuring registered-nurse hours per resident-day by ownership type and how staffing tracks with CMS staffing star ratings, from state government homes at 1.331 to for-profit LLCs at 0.577.

Research period: 2024

Compiled byPlainDoctor Editorial, Healthcare Providers Editorial Team · June 2, 2026

Research Question

When families compare nursing homes, the single number that best predicts hands-on clinical care is how much registered-nurse time each resident gets. Registered nurses, the most highly trained members of a facility's bedside staff, assess changing conditions, manage medications, and catch the early signs of trouble that aides are not licensed to treat. This analysis asks a focused question: how many RN hours per resident-day does the typical nursing home provide, and does that figure depend on who owns the building? We also test whether staffing lines up with the staffing star rating that the Centers for Medicare and Medicaid Services already publishes, so readers can judge whether that public score reflects the underlying labor.

Methodology

We worked from the federal payroll record that nursing homes are required to submit, which logs the actual hours each category of staff worked alongside the number of residents present. For every facility that reported, we took its registered-nurse hours per resident-day, a standard CMS measure that divides total RN hours by the daily resident count so that a 40-bed home and a 200-bed home can be compared on equal footing. We then sorted facilities into the ownership categories CMS already records, from state and county government homes through nonprofit corporations and church-affiliated groups to the various for-profit structures, and averaged the staffing figure within each group. Separately, we grouped the same facilities by their published staffing star rating, from one star to five, and averaged RN hours within each band to see whether the rating tracks the labor behind it. The analysis covers the 14,289 facilities that reported RN staffing in the most recent program year.

Findings

A clear ownership ladder, from 1.33 down to 0.58 RN hours per resident-day

Across all 14,289 reporting facilities, the national average comes to 0.68 registered-nurse hours per resident-day. CMS Payroll-Based Journal (PBJ) Staffing Data via Care Compare Provider Information, 2024 That single average hides a wide spread once you separate homes by who runs them. State government facilities sit at the top, averaging 1.331 RN hours per resident-day, roughly double the national figure, though they are a small group of just 140 homes. Nonprofit corporations follow at 0.943, church-related nonprofits at 0.919, and other nonprofits at 0.866. County government homes come next at 0.781, still comfortably above the national mean. The pattern reads as a ladder rather than a cliff, with public and mission-driven operators clustered near the top and commercial operators stacked lower down.

The bottom rungs belong almost entirely to for-profit ownership. For-profit corporations, the largest single category at 4,818 facilities, average 0.627 RN hours per resident-day, already below the national figure. For-profit partnerships report 0.601 and for-profit individual owners 0.587. The lowest figure among the large groups comes from for-profit limited liability companies, which average 0.577 across 4,738 homes. Two of the biggest categories in the entire data, for-profit corporations and for-profit LLCs, together account for more than 9,500 facilities and both sit beneath the all-facility average, which is a large part of why that national average lands where it does.

The for-profit versus nonprofit gap is wide and consistent

Setting the public homes aside and comparing the two dominant private models makes the contrast plain. A typical nonprofit corporation provides 0.943 RN hours per resident-day, while a typical for-profit LLC provides 0.577. CMS Payroll-Based Journal (PBJ) Staffing Data via Care Compare Provider Information, 2024 That is a difference of about 0.37 hours, meaning the nonprofit delivers roughly 60 percent more registered-nurse time for each resident every day. The gap holds across every flavor of for-profit ownership we examined, none of which reaches even the lowest nonprofit category. Because registered-nurse hours carry the highest labor cost of any bedside staffing line, this difference is the clearest place where ownership economics show up in the daily experience of residents. It is not a story about one bad operator; it is a structural pattern visible across thousands of homes.

This staffing gap is the mechanism behind the quality gap that the published five-star ratings already show. Earlier work comparing CMS overall ratings by ownership found nonprofits scoring well above for-profit corporations, and the staffing numbers here supply the why. When a building employs more registered-nurse time per resident, more clinical needs get caught and handled by licensed staff rather than deferred, and that flows through to the inspection and quality measures that feed the rating. Readers who want the rating side of the picture can read our companion analysis of CMS five-star ratings by ownership type alongside these staffing figures.

Staffing rises in lockstep with the CMS staffing star rating

The staffing star rating turns out to be a faithful summary of the labor underneath it. Facilities rated one star for staffing average just 0.403 RN hours per resident-day. CMS Payroll-Based Journal (PBJ) Staffing Data via Care Compare Provider Information, 2024 Two-star homes average 0.506, three-star homes 0.604, and four-star homes 0.804. Five-star facilities average 1.288 RN hours per resident-day, more than three times the one-star figure. Each step up the rating scale buys a meaningful increase in registered-nurse time, with no reversals along the way, which is reassuring for any family relying on the public score as shorthand.

That tight correlation does two useful things at once. It validates the staffing star rating as a real proxy for hands-on nursing care rather than a paperwork artifact, and it confirms that the ownership ladder and the rating ladder are describing the same underlying reality from two angles. A home that staffs richly tends to earn a high staffing star, and the ownership types that staff richly are the ones that cluster among the higher-rated facilities. For a family touring options, the practical takeaway is that the staffing star rating is worth weighting heavily, because it is anchored to a labor figure that is hard to fake. Anyone wanting to rank facilities directly on this measure can use our nursing home staffing rankings.

What this analysis cannot tell us

Registered-nurse hours are only one of several staffing measures, and a complete picture would also weigh licensed practical nurses and certified nursing aides, who together provide most direct resident care. A home that is light on RN time may compensate elsewhere, so this figure should be read as one strong indicator rather than a verdict. The payroll data behind it is self-reported by facilities, and while CMS audits submissions, reporting errors and gaps are possible. Small categories carry extra uncertainty: the 140 state government homes that top the ranking are too few to treat as a stable benchmark, and a handful of unusual facilities can swing a small group's average. The hours-per-resident-day measure also does not adjust for how sick a home's residents are, so a facility caring for higher-acuity patients may need more staffing than the raw number reflects, and case mix differs across both ownership types and rating bands. Finally, these figures describe staffing, not outcomes, and more nursing time makes good care more likely without guaranteeing it for any individual resident.