Understanding HPRD and Nursing Home Staffing Grades
A guide to how nursing home staffing is measured in hours per resident day (HPRD) and how Healthcare Trends Insight assigns letter grades.
What Is HPRD?
Hours Per Resident Day (HPRD) is the standard metric used by the Centers for Medicare & Medicaid Services (CMS) to measure nursing home staffing levels. It represents the total hours of care provided by nursing staff divided by the number of residents in the facility on a given day.
The CMS minimum staffing standard is 3.48 HPRD for total nursing staff. Research suggests 4.10 HPRD delivers meaningfully better patient outcomes (STRIVE study).
Key Staffing Roles
Nursing staff in long-term care facilities is composed of three primary roles:
- Registered Nurses (RN) — handle assessments, care plans, and medications. CMS recommends at least 0.75 RN HPRD.
- Licensed Practical/Vocational Nurses (LPN/LVN) — provide bedside care under RN supervision.
- Certified Nursing Assistants (CNA) — deliver the majority of direct resident care including bathing, feeding, and mobility assistance.
How We Assign Grades
Healthcare Trends Insight assigns a letter grade from A+ to F based on total nursing HPRD:
Weekend Staffing Drop-Off
One of the most concerning patterns in nursing home data is the weekend staffing drop-off — the percentage reduction in staffing hours on Saturdays and Sundays compared to weekdays.
Nationally, nursing homes see an average 15–20% drop in staffing on weekends. Some facilities experience drops exceeding 30%, putting residents at higher risk.
This metric matters because residents need consistent care seven days a week. Facilities with large weekend gaps may struggle with falls, medication errors, and delayed responses to emergencies.
Agency and Contract Staff
Another key indicator is the percentage of hours filled by agency or contract workers rather than permanent staff. While agency nurses help fill gaps, high reliance on temporary workers is linked to lower continuity of care and poorer outcomes.
Use our Trends page to see how agency staff reliance varies by state and has changed over time.
Explore the Data
- Visit the Trends page to see national and state-level staffing trends
- Use Compare to evaluate two facilities side by side
- Browse State pages for state-level summaries and rankings