Many US skilled nursing facilities currently meet some provisions of the new federal staffing rule at least some of the time, but only 160 — slightly more than 1% — consistently meet all requirements, according to a new analysis.

Facilities located in southern states had the most ground to make up on staffing, based on a review of summer 2023 Centers for Medicare & Medicaid Services data by USA Today. 

The analysis, published Wednesday, includes a searchable database with information on individual facilities — including the facility’s name, address and the average hours of care per resident per day compared to the new national standard of 3.48. 

The analysis further breaks down average HPRD provided by registered nurses and certified nursing assistants but could not measure which nursing homes meet the new 24/7 onsite RN requirement with available public data. Facilities overall tended to be further behind on CNA hours than RN hours in the review, though providers have said that they will have a harder time coming into compliance with 24/7 RN requirements. 

Louisiana was furthest behind on the HPRD requirement for RNs, with facilities meeting the new hourly rule just 6 days out of 92 on average last summer. Oklahoma and Texas had the next largest gaps, while Alaska and Hawaii nursing homes met the requirement 90 and 88 days on average, respectively. 

Texas was again in the bottom three states for meeting the new CNA requirements — only doing so 11 out of 92 days, on average. Alaska and Oregon were the only states where facilities met the new requirements at least 80 days, on average.

Analysis of how much the nursing home workforce will have to expand to meet the final rule continues, following CMS’ decision to raise the HPRD requirements from the initially proposed 3.0 to 3.48. 

Providers have reacted to the increase with open dismay and disappointment, noting a conspicuous lack of funding for nursing homes or workforce initiatives. CMS claimed Tuesday that a $75 million recruitment program and potential future partnerships with state governments would ease the transition to the new staffing standard, which are set to phase in over the next five years.