CMS has posted a new month of data for us to chew through. As someone who regularly analyzes nursing home data, I’m here to break down the latest numbers in a way that matters to residents, families, and anyone interested in long-term care. And there’s quite a bit to unpack this month, from shifting facility numbers to staffing changes that affect daily care.
First, let’s talk about the big picture. As of March 2025, we’re looking at 14,779 nursing homes across the country, with space for about 1.58 million residents. If you’re wondering whether that’s a lot or a little, here’s some perspective: we’ve actually seen a steady decline over the years. Back in January 2014, we had nearly 900 more facilities and about 87,000 more beds. This month, we lost three more homes and about 487 beds compared to February. This continuing decline isn’t necessarily all bad news – in some cases, it reflects a shift toward home-based care and smaller, more specialized facilities. However, it does raise concerns about access to care, especially in rural areas where options might already be limited.
Now, you might be wondering how full these facilities are. Currently, nursing homes are running at about 77.9% capacity – meaning roughly three out of every four beds are occupied. This number hasn’t changed from last month, which tells us we’re in a period of relative stability. But here’s what’s interesting: despite having fewer facilities than a decade ago, occupancy rates haven’t skyrocketed. This suggests that the industry is right-sizing itself to match demand, though it’s worth noting that occupancy rates can vary significantly by region and facility type. Some high-quality facilities maintain waiting lists while others struggle to fill beds.
Let’s dive deeper into quality ratings, because this is probably what matters most to families looking for care. The Centers for Medicare & Medicaid Services (CMS) rates nursing homes on a five-star scale – think of it like restaurant ratings, but much more important. This rating system considers health inspections, staffing levels, and quality measures like resident care outcomes. This March, we saw some movement in these ratings: 321 homes got better scores (moving up in stars), while 336 saw their ratings drop. That’s actually a pretty small number of changes when you consider we’re talking about nearly 15,000 facilities. What’s particularly interesting is how these changes often reflect improvements or declines in specific areas of care, rather than wholesale changes in facility operations.
Here’s the current breakdown of ratings across the country: about 2,754 nursing homes (roughly 19%) have earned the coveted five-star rating – these are the cream of the crop. These facilities typically excel in all three rating categories: health inspections, staffing, and quality measures. Another 2,493 homes have four stars, and 2,841 maintain a middle-ground three-star rating. On the lower end, we’ve got 3,162 facilities with two stars and 3,423 with one star. A small number (144) are too new to have ratings, as it takes CMS about two years to gather enough data for a proper evaluation. What’s particularly noteworthy is that the distribution of ratings has remained relatively consistent over time, suggesting that while individual facilities may improve or decline, the overall quality landscape isn’t shifting dramatically.
One area that’s been getting a lot of attention is inspections, and the news here is concerning. In March, only 50 new inspections were conducted nationwide. This is actually a serious concern because CMS is supposed to inspect every facility annually, but this hasn’t been happening consistently since COVID-19 disrupted the system. Many facilities haven’t seen an inspector in over a year, which isn’t ideal for maintaining oversight. This inspection backlog means that some star ratings might not reflect current conditions, as health inspection scores make up a significant portion of the overall rating. For families researching facilities, this means it’s more important than ever to visit in person and ask detailed questions about recent changes or improvements.
Perhaps the most important metric for day-to-day care is staffing levels, and this is where the rubber really meets the road. After all, it’s the nurses and aides who provide the actual hands-on care that residents need. The Department of Health and Human Services has been pushing for more registered nurse time per resident since 2023, recognizing that adequate staffing is crucial for quality care. As of March 2025, here’s what the staffing looks like: residents are getting about 40 minutes (0.665 hours) of registered nurse time per day, 2 hours and 19 minutes (2.320 hours) with nursing aides, and a total of nearly 4 hours (3.848 hours) of overall staff time daily. When we compare these numbers to last year, we’re seeing small improvements – staff time is up from 3.780 total hours per resident per day. While any improvement is welcome, many experts argue these levels are still below what’s needed for optimal care, especially for residents with complex medical needs or dementia.
The staffing situation reflects broader challenges in healthcare workforce development. Many facilities struggle to recruit and retain qualified staff, particularly registered nurses who have many employment options. This can lead to increased use of temporary staff, which isn’t ideal for continuity of care. Some innovative facilities are addressing this through partnerships with nursing schools, enhanced benefits packages, and career development programs for their staff.
What does all this mean for residents and families? While the overall number of nursing homes continues to slowly decline, those that remain are maintaining stable occupancy rates and staffing levels. The quality ratings show a pretty even distribution across the spectrum, with roughly equal numbers of facilities at each star level. This suggests that while excellent care is available, there’s still significant room for improvement across the industry. The data also highlights the importance of looking beyond just the numbers – each facility has its own culture, specialties, and challenges.
For families looking into nursing home care, these numbers reinforce the importance of doing your homework. Check those star ratings, but don’t stop there – ask about staffing levels, visit the facility if possible, and remember that recent inspection reports might be harder to come by given the current inspection backlog. Pay attention to staff turnover, observe how staff interact with residents, and ask about specific care practices for conditions relevant to your loved one. It’s also worth asking about staff training programs, emergency procedures, and how the facility handles communication with families.
We’ll keep tracking these numbers month by month, looking for trends that matter to residents and their loved ones. After all, behind every statistic are real people who deserve the best possible care in their golden years. And while the data helps us understand the big picture, it’s the individual experiences of residents and their families that truly matter. By staying informed about these trends and changes, we can all be better advocates for quality long-term care.