2.1 Million Workers, 514 Million Hours: Inside Nursing Home Staffing
Payroll Based Journal data reveals the true scale of nursing home staffing in America and where the 46.4% turnover crisis is most acute.
Every quarter, nursing homes across America report their staffing data to CMS through the Payroll Based Journal (PBJ) system. The latest data — Q3 2025 — reveals the enormous scale of the nursing home workforce and the persistent crisis threatening its stability.
The Workforce at a Glance
2.1 million unique employees logged 514 million work hours across all 53 reporting states and territories in a single quarter. While this represents improvement from the 52.7% turnover of March 2024, it remains far above levels associated with consistent, high-quality care.
Chain Staffing Comparison
| Chain | Nurse Hrs/Day | Staff Turnover | RN Turnover |
|---|---|---|---|
| PACS Group | 4.0 | 47.7% | 48.1% |
| Life Care Centers | 3.8 | 42.1% | 41.4% |
| The Ensign Group | 3.8 | 46.5% | 43.0% |
| Genesis Healthcare | 3.5 | 46.4% | 45.6% |
| Creative Solutions | 3.1 | 51.6% | 51.2% |
Life Care Centers stands out with the lowest turnover across both total staff (42.1%) and RNs (41.4%). Creative Solutions loses more than half of its staff and registered nurses annually.
The Staffing Mandate Question
CMS has proposed minimum staffing requirements. The current national averages — 3.9 total nurse hours per day and 0.7 RN hours — would need to increase under most proposed standards. For chains like Creative Solutions at 3.1 hours per day, compliance could require a 25-30% increase in staffing levels.
The paradox: The facilities most in need of better staffing are often the ones least able to achieve it. Low staffing leads to burnout, which leads to turnover, which leads to understaffing.
Behind every staffing statistic are real people deciding every day whether this job is worth staying in. Right now, nearly half of them are deciding it isn’t.