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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Daily nurse-staffing data on every Medicare-certified nursing home — even after the federal minimum was repealed.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 The Trump administration rescinded the Biden-era 3.48 nurse-hour minimum on December 3, 2025 (effective February 2, 2026); the data is still published.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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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 The Biden-era 3.48 federal minimum was rescinded December 3, 2025 (effective February 2, 2026); per-facility transparency is the remaining accountability layer.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.

Methodology · Sources · Corrections log · Editorial policy

What’s on file, by the numbers

Platform snapshot · 2026-08-25

13.4Mproviders & companiesProviders, organizations, owners, and facilities on file
26.2Msource-linked factsSource-linked field facts in the dated platform snapshot
90sources with dataDistinct snapshot source IDs with at least one positive record count
70fresh sourcesDistinct source IDs whose latest positive-data snapshot falls within the preceding 45 days
111sources integratedActive registry rows; integration does not establish a load
13state Medicaid jurisdictionsDistinct states represented in the state-exclusions serving table

Integrated, with-data, and fresh-observation counts are separate. No platform-wide source-completeness count is published. Completeness is source-specific and must be evaluated against the named source's expected scope. State coverage is a separate jurisdiction measure.

Source authority is record-specific

Use the issuer named on the record.

Fonteum spans federal, state, and global public publishers. A source page or returned record identifies its issuer and dataset where that metadata is available. A platform registry count does not assign every page to one authority or establish loaded, fresh, or complete coverage.

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Reproducible by design

Inspect the evidence each published figure actually supplies.

Source and date

Research pages expose the named public file and observation date where those fields are available. Source-file SHA-256 coverage is separate; facts do not currently link deterministically to signatures.

Available derivation

Studies with a retained release and committed derivation link the SQL or method used. Other studies state the evidence and reproduction limits they actually have.

Daily observations

Dated table row-count observations can detect local drift. They do not imply that an upstream publisher released or Fonteum ingested new data that day.

Named medical review

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

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