1. Summary
- 21.8% of nursing homes report hours at or above all three repealed federal floors (3,110 of the 14,288 that report hours): 55.0% are at or above the registered-nurse floor of 0.55 hours per resident day, 32.7% the nurse-aide floor of 2.45, and 64.0% the total floor of 3.48. The nurse-aide floor is the one the fewest facilities reach.
- The gap by ownership is wide. 13.0% of for-profit facilities are at or above all three floors, against 49.0% of non-profit and 42.2% of government facilities. The comparison controls for nothing.
- The range across states is wider still: from 87.5% in Alaska to 1.6% in Louisiana.
- 1.2 points lower than in January 2019. 23.0% in the 17 January 2019 file, a peak of 28.9% in the 9 October 2020 file, a low of 18.0% in the 26 April 2023 file, and 21.8% in the 26 August 2026 file.
- Many facilities sit close to the line. 35.2% report total hours within a quarter of an hour of the 3.48 floor, on one side or the other.
- What this cannot say. Hours are as reported, not adjusted for resident acuity. The rule also required a registered nurse on site around the clock, which these files cannot test, so the share that would have met the whole rule is lower than the all-three figure.
2. The rule and its repeal
CMS published the minimum staffing final rule on May 10, 2024 (89 FR 40876). It required a registered nurse on site 24 hours a day, 7 days a week, and a minimum of 0.55 registered-nurse, 2.45 nurse-aide and 3.48 total nurse staffing hours per resident day. Under the phase-in CMS published, the total floor and the around-the-clock requirement were due two years after publication and the registered-nurse and aide floors three years after, later for rural facilities.
Section 71111 of Public Law 119-21, signed July 4, 2025, barred CMS from implementing, administering or enforcing those standards until after September 30, 2034, and two federal district courts vacated the hours and around-the-clock provisions. CMS then repealed them in an interim final rule published December 3, 2025 (90 FR 55687) and effective February 2, 2026, which restored the earlier requirement of a registered nurse for at least 8 consecutive hours a day, 7 days a week. No hour floor was ever in force.
This brief asks a counterfactual question of the public data: if the three hour floors applied today, how many facilities report hours at or above them? It follows the approach of KFF's 2024 analysis, which compared reported hours with the floors in the April 2024 file and found 19% of facilities at or above all three. The same test on our copy of that file gives 19.3% (14,455 facilities with hours), which is the check that the method here matches theirs.
3. How many facilities report hours at or above each floor
Of 14,690 certified facilities, 14,288 report staffing hours in Provider Information; the rest are left out of every share. Average reported hours per resident day are 3.86 in total, 0.69 for registered nurses and 2.32 for nurse aides: the averages are above the total floor, above the registered-nurse floor and below the nurse-aide floor. On weekends the total falls to 3.42. Annual nurse turnover averages 45.8%.
- All three floors21.8%3,110 facilities
- RN floor (0.55)55.0%average 0.69 hours
- Aide floor (2.45)32.7%average 2.32 hours
- Total floor (3.48)64.0%average 3.86 hours
4. How close facilities sit to the total floor
35.2% of facilities report total hours within a quarter of an hour of 3.48, so small changes in reported hours move the headline share. 7.1% are half an hour or more below it.
5. Who is above and below
Ownership. For-profit facilities report an average of 3.69 total hours against 4.40 for non-profit facilities; 24.6% of for-profit facilities are at or above the aide floor against 58.0%.
Star rating. The all-three share rises from 8.8% of 1-star facilities to 43.2% of 5-star facilities. Staffing is one of the three inputs to the overall rating, so the two are not independent.
Size. 52.8% of facilities with under 50 beds are at or above all three floors; the lowest share, 12.8%, is among facilities with 100 to 149 beds.
Chains. 14.3% of facilities in a CMS-identified chain are at or above all three floors, against 38.9% of facilities outside one.
Disclosed private equity. Among the 61 facilities that disclose a private-equity owner to CMS and report hours, 14.8% are at or above all three floors, against 21.6% of facilities with no private-equity or REIT disclosure. The group is small and disclosure is incomplete; this is a description, not an estimate of an effect.
6. Where
Among states with at least 10 facilities, the all-three share is highest in Alaska (87.5%), Maine (79.5%), North Dakota (77.1%), Hawaii (70.7%), Oregon (64.0%) and lowest in Louisiana (1.6%), Texas (4.9%), Oklahoma (5.0%), Tennessee (7.6%), Georgia (8.5%). The state map and table carry every floor for every state.
Between the first monthly file of 2019 and the latest, the share rose in 22 states and fell in 29. The largest gains are in Vermont (+20.2 points), Montana (+14.9 points), Alabama (+14.1 points); the largest falls are in Florida (-41.1 points), Idaho (-14.1 points), Utah (-13.4 points).
7. Since 2019
The all-three share was 23.0% in the 17 January 2019 file, peaked at 28.9% in the 9 October 2020 file, when resident counts fell during the pandemic and hours per resident rose, reached a low of 18.0% in the 26 April 2023 file and stands at 21.8%. The series shows no step at the publication of the rule or at its repeal.
For profit: 14.4% in 2019, 13.7% in 2026. Non profit: 44.6% in 2019, 50.0% in 2026. Government: 39.1% in 2019, 42.6% in 2026.
8. What states require
With no federal hour floor, state law is the only numeric floor there is. Our table of state minimum staffing standards, checked against the statute or regulation of each state as of 17 September 2026, finds a numeric minimum in 35 of 51 jurisdictions (the 50 states and the District of Columbia). 29 state a minimum in total hours per resident day, and 7 of those set it at or above the repealed federal total of 3.48; the highest is the District of Columbia at 4.10. State rules differ in which staff count, over what period hours are averaged and what is waived, so they are not interchangeable with the federal floors or with each other.
| State | State minimum, total hours | Citation | Average reported total hours | At or above 3.48 |
|---|---|---|---|---|
| District of Columbia | 4.10 | D.C. Official Code § 44-504(h-1)(1)(B)(ii); 22-B DCMR § 3211.5 | 4.77 | 93.3% |
| Illinois | 3.80 | 210 ILCS 45/3-202.05(d)(5), (e); 77 Ill. Adm. Code 300.1230 | 3.45 | 37.1% |
| Florida | 3.60 | Fla. Stat. § 400.23(3)(b)1. | 3.82 | 71.7% |
| Massachusetts | 3.58 | 105 Code Mass. Regs. 150.007(B)(2)(d), (3)(d) and (4)(d) | 3.86 | 75.2% |
| Rhode Island | 3.58 | R.I. Gen. Laws § 23-17.5-32(c) | 3.71 | 62.3% |
| California | 3.50 | Cal. Health & Safety Code § 1276.65(c)(1)(B)-(C) | 4.52 | 98.1% |
| New York | 3.50 | N.Y. Pub. Health Law § 2895-b(3); N.Y. Comp. Codes R. & Regs. tit. 10, § 415.13(b)(2) | 3.62 | 50.5% |
| Washington | 3.40 | Wash. Rev. Code § 74.42.360(2)-(4); Wash. Admin. Code § 388-97-1090 | 4.37 | 96.3% |
Reported hours on Care Compare are not a state's compliance measure: states count different staff and average over different periods.
9. Limitations
- Reported hours. The hours are the payroll-based hours per resident day that CMS publishes in Provider Information, averaged over a quarter. They are not adjusted for resident acuity, and facilities with no reported hours are left out.
- Around-the-clock registered nurse not tested. That requirement needs daily payroll data. The share that would have met the whole rule is lower than the all-three share.
- A counterfactual. The floors never applied, facilities were never required to meet them, and exemptions the rule allowed are not modelled.
- Not a finding about adequacy. A facility below a floor is not thereby understaffed for its residents, and one above it is not thereby adequately staffed.
- Descriptive comparisons. Differences by ownership, size, chain or disclosure group control for nothing.
- History. The monthly series applies the same test to each archived file; the ownership category of older files comes from the ownership type text of each file.
10. Reproduce, cite, correct
Every study figure is a value in a CSV table committed under analysis/staffing/v2026.08 in the public repository, computed by tcr-open-data staffing-study from release v2026.08 (archived at Zenodo) and the monthly CMS archive. Section 13 of the methodology defines the floors, the hours and each table. The live tables and the state map are on the staffing page.
Cite as: The Care Ratings Team (2026). The floor that never took effect: nursing home staffing against the repealed federal minimums: Staffing brief, first edition (version 1.0, release v2026.08). The Care Ratings. https://thecareratings.com/data/staffing/brief-2026/ Data: https://doi.org/10.5281/zenodo.22780105
Prepared by the Care Ratings Team under the editorial standards. Text and tables are CC BY 4.0. Corrections go to the contact page and are logged on the corrections page.
