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Fonteum · Staffing

Daily nurse-staffing data on every Medicare-certified nursing home — even after the federal minimum was repealed.

Fonteum snapshot 2026-05-08 (CY2025Q4): national-mean total-nurse HPRD is 3.87 across 14,362 Medicare-certified nursing homes; 4,153 (28.92%) meet the 4.1 HPRD policy-research threshold and 7.4% fall below 3.0 HPRD. The Trump administration rescinded the Biden-era 3.48 nurse-hour minimum on December 3, 2025 (effective February 2, 2026); the data is still published. Fonteum surfaces the staffing layer per-facility from real CY2025Q4 PBJ daily submissions.

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Snapshot May 8, 2026·14,362 Medicare-certified nursing homes · CY2025Q4 · national mean total-nurse HPRD 3.87 · 28.92% meet 4.1 threshold·CMS Payroll-Based Journal (PBJ) Daily Nurse Staffing·Methodology →·Audit Pack →·Verify at CMS PDC → ↗
PBJ publishes quarterly; daily-granularity per facility per day (1.3M rows in CY2025Q4 CSV). Federal 3.48 HPRD minimum rescinded Dec 3, 2025 (effective Feb 2, 2026). Per-facility transparency is now the only mechanism for staffing accountability.
National coverage

Daily Nurse-Staffing Per Facility

Every Medicare-certified nursing home reports daily nurse-staffing via the PBJ system. RN, LPN, CNA hours per resident per day; weekend coverage; contract-staff share.

14,362
National HPRD

Total Nurse Hours per Resident Day

National-mean total-nurse HPRD across 14,362 facilities in CY2025Q4. Direct-care HPRD (RN+LPN+CNA only): 3.41. RN HPRD: 0.47. The Biden-era 3.48 federal minimum was rescinded December 3, 2025 (effective February 2, 2026); per-facility transparency is the remaining accountability layer.

3.87
Adequacy threshold

Meeting 4.1 HPRD Policy Threshold

4,153 of 14,362 facilities meet the 4.1 HPRD policy-research threshold (Lynn et al.); 7.4% fall below 3.0 HPRD. National-mean contract-labor share: 4.96%. AARP FL/USF (Jan 2026) found PE-acquired facilities cut direct-care staffing 13% (4.21 → 3.66 hrs/day).

28.92%
State HPRD distribution (top 10 vs bottom 10)

State staffing variation in CY2025Q4

Mean total-nurse HPRD per facility, by state. Filter: ≥30 facilities reporting. The 4.1 HPRD threshold is the Lynn et al. policy-research baseline (NOT a federally enforceable standard after the December 3, 2025 mandate rescission).

Top 10 — highest mean HPRD
StateFacilitiesMean HPRD
OR1255.07
HI424.68
CA1,0594.52
ND694.42
DE434.40
NV654.34
ME734.33
WA1854.25
VT344.25
MS1954.20
Bottom 10 — lowest mean HPRD
StateFacilitiesMean HPRD
TX1,1553.39
MO4773.45
IL6573.48
GA3493.58
NM663.59
NY5893.66
CO2013.69
WV1223.69
IN5023.69
RI713.71
Research — coming soon

Nursing Home Staffing Analysis — Sprint 2 flagship study

Forthcoming flagship study mining the PBJ daily-granularity dataset for the December 2025 mandate-repeal context. Source material drafted; publication queued for Sprint 2 fast-fold or Sprint 2 proper. Cross-link will populate this slot when the study lands.

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Reviewed by Jennifer Montecillo, MD, medical reviewer. Non-practicing medical reviewer.

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Reviewed by Jennifer Montecillo, MD, medical reviewer. Non-practicing medical reviewer.

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The substrate, by the numbers

9.2Mgraph entitiesProviders, organizations, owners, and facilities
12.5Mlinked identifiersNPIs, CCNs, LEIs and more, resolved to entities
4.7Mgraph edgesSource-attested relationships between entities
44federal source familiesDistinct CMS, OIG, HRSA, FDA and peer datasets
33dataset pagesCitable, downloadable /data catalog pages
47reproducible studiesEach shipping the SQL behind its figures