Nine in Ten Nursing Homes Are Understaffed

What Families Need to Know About Resident Care in 2025

It’s a statistic that should shock every family with a loved one in long-term care: 9 out of 10 nursing homes in the U.S. are understaffed, according to the Long Term Care Community Coalition’s (LTCCC) latest report using new federal data.

This is not just a minor policy issue—it’s a national crisis. Understaffing in nursing homes directly contributes to elder abuse, neglect, avoidable injuries, and even wrongful deaths. At KBD Attorneys, we handle these tragic cases every day, representing families who trusted a facility to provide safe, professional care—only to discover too late that their loved ones were harmed due to chronic understaffing.

Let’s break down the findings, why they matter, and what you can do if your loved one was a victim of nursing home negligence.

What the LTCCC Report Reveals About Staffing in U.S. Nursing Homes

Published on May 2, 2025, the LTCCC alert is based on Q3 2024 payroll-based journal (PBJ) data reported to the Centers for Medicare & Medicaid Services (CMS). These are not guesses or surveys—this is hard data.

Key findings include:

• 90.5% of nursing homes fall below expected staffing levels based on the new evidence-based model.

• The national average expected staffing level is 4.94 hours per resident day (HPRD), but actual staffing averages only 3.73 HPRD.

• That’s a median shortfall of 25.1%—a massive gap between what residents need and what they’re actually receiving.

• Only two states (Alaska and Oregon) met or exceeded expectations.

• States with the worst staffing deficits include Illinois (-37.7%), Texas (-32.1%), Missouri (-31.1%), and Virginia (-30%).

This model uses each facility’s own assessment of resident needs—known as the case-mix index (CMI)—to determine proper nurse staffing. That means these expectations are based on what the homes themselves claim their residents require.

Why Understaffing Is More Than a Number—It’s a Danger

When a nursing home operates with too few nurses or aides, residents suffer. Period.

Understaffing leads to:

• Missed medication doses

• Untreated bedsores (pressure ulcers)

• Falls and broken bones

• Malnutrition or dehydration

• Inadequate infection control

• Poor hygiene and unsafe living conditions

• Emotional neglect or even outright abuse

If staff are stretched too thin, even the most well-intentioned caregiver cannot deliver adequate care. This increases the risk of nursing home abuse, medical neglect, and preventable deaths.

What KBD Attorneys Does About It

At KBD Attorneys, we don’t just wait for headlines—we investigate, write about, and litigate cases involving nursing home abuse and wrongful death. We represent families across the U.S. who have lost loved ones or seen them suffer due to negligent facilities. We also monitor federal data and recall alerts to warn the public, because knowledge is power.

Whether your case involves:

• Failure to provide medical treatment

• Missed dialysis appointments

• Improper infection control protocols

• Unexplained injuries or bruises

• Sexual abuse or physical violence

• Wrongful death in a care facility

—we can help.

We work closely with medical experts and industry professionals to document violations, identify patterns of negligence, and hold these facilities accountable. Our nursing home abuse attorneys understand the state and federal regulations that govern long-term care, and we use that knowledge to build strong, fact-based cases for victims.

Staffing and Accountability: What the LTCCC Model Really Means

One of the most promising aspects of the new LTCCC model is that it creates a transparent, data-driven expectation for care. Instead of comparing homes to generic benchmarks, it asks: What level of staffing do your own residents require? Then it evaluates whether the facility meets that need.

This approach finally gives families and advocates a tool to demand accountability. If your loved one lives in a home that consistently reports staffing levels 20–30% below expected thresholds, you now have evidence to take action.

Regional Trends and Red Flags for Families

The LTCCC’s report also shows troubling geographic disparities in care quality:

• Region 10 (Pacific Northwest) performs best, still falling short at -10.7%.

• Region 2 (New York & New Jersey) is among the worst, with a -28.5% deviation.

• Virginia ranks near the bottom in both staffing hours and deviation, which is deeply concerning.

If your loved one is in a facility in one of the bottom-ranked states—Illinois, Texas, Missouri, Georgia, or Virginia—this should be a wake-up call. These states are repeatedly failing to meet even their own standards for care.

What to Do If You Suspect Neglect or Abuse

Staffing levels are only part of the picture. You might not have access to raw numbers, but you can pay attention to warning signs:

• Is your loved one losing weight unexpectedly?

• Are they developing bedsores, infections, or bruises?

• Are they often sedated, confused, or isolated?

• Are staff members difficult to reach or unwilling to provide updates?

• Has communication stopped entirely, like in many COVID-era lockdown situations?

If any of these sound familiar, your next step should be to talk to an experienced nursing home abuse attorney. Don’t wait for another incident or for a vague promise from the facility to “do better.” Your loved one deserves safety now.

Related Cases We’ve Handled

We’ve seen, covered and litigated many nursing home abuse cases including:

• Cases involving fall-related injuries due to lack of supervision

• Deaths from sepsis and infection caused by poor wound care

• COVID-era communication breakdowns and dangerous isolation practices

Each of these situations was worsened by chronic understaffing.

Final Thoughts: It’s Time for Change

It should not be revolutionary to expect that the elderly and disabled residents in nursing homes receive the care they need to survive. Yet, here we are—90% of homes are not even meeting their own baseline expectations.

At KBD Attorneys, we will continue to fight for justice, raise awareness, and hold negligent nursing homes accountable. The LTCCC report is more than a data point—it’s a call to action.

Contact KBD Attorneys Today

If you believe a loved one has suffered neglect in an understaffed facility, contact us immediately. We offer free consultations, and have the experience you and your loved ones deserve. Our team of nursing home abuse lawyers is ready to investigate, advise, and fight for the compensation and closure for you and your family.

Visit kbdattorneys.com to get started.

Source: LTCCC Staffing Alert – Q3 2024 Report