Federal staffing mandates were repealed. Penalty authority was expanded. State laws diverged. Ownership transparency requirements took effect. This page tracks every enforcement mechanism that affects the 14,710 nursing homes in our database — so you don’t have to.
Last updated: April 2026 · Sources cited throughout · SeniorIndex analysis of federal and state regulatory data
These benchmarks remain the industry standard used by investors, U.S. News, and quality researchers — but no longer carry federal enforcement.
Our database tracks 16,915 penalty records across all 14,710 facilities. CMS expanded penalty authority in August 2024 — fines can now stack and look back across three surveys.
Three years of health deficiency citations with scope, severity, and category coding. 10,041 immediate jeopardy citations. 23,831 actual harm findings. Searchable by facility, state, and deficiency type.
Complete ownership chain for every facility — organizational owners, individual managers, association dates, and percentage stakes. Cross-referenced with chain affiliations for 616 tracked chains.
Without federal mandates or state minimums, facilities in these states operate with no regulatory staffing floor whatsoever.
These states enforce their own HPRD minimums with real financial consequences.
Source: NY Public Health Law § 2895-b; CA Health & Safety Code § 1276.5; FL Statutes Ch. 400; 210 ILCS 45; MA 105 CMR 150
| State | Facilities | Avg HPRD | Avg RN HPRD | Below 3.48 | Below 0.55 RN | Zero-RN Days | State Law |
|---|---|---|---|---|---|---|---|
| TX | 1,177 | 3.40 | 0.442 | 70% | 80% | 0.9 | No state minimum |
| CA | 1,139 | 4.52 | 0.651 | 2% | 60% | 0.7 | 3.5 HPRD · $50K fines |
| OH | 919 | 3.73 | 0.630 | 40% | 42% | 0.4 | 2.5 HPRD |
| FL | 685 | 3.88 | 0.745 | 27% | 35% | 0.3 | 3.6 HPRD |
| IL | 658 | 3.51 | 0.729 | 56% | 41% | 0.6 | 3.8 HPRD (skilled) |
| PA | 655 | 3.90 | 0.786 | 34% | 34% | 0.3 | 2.7 HPRD |
| NY | 589 | 3.65 | 0.695 | 47% | 48% | 0.1 | 3.5 HPRD · $2K/day |
| IN | 498 | 3.72 | 0.664 | 41% | 41% | 0.2 | Sufficient staffing |
| MO | 478 | 3.48 | 0.464 | 57% | 76% | 1.5 | No state minimum |
| MI | 409 | 4.03 | 0.775 | 21% | 29% | 0.3 | Sufficient staffing |
| NC | 406 | 3.77 | 0.585 | 41% | 56% | 0.7 | No state minimum |
| GA | 351 | 3.59 | 0.493 | 51% | 65% | 0.4 | No state minimum |
| MA | 339 | 3.87 | 0.648 | 23% | 41% | 0.2 | 3.58 HPRD |
| MN | 333 | 4.24 | 1.060 | 13% | 6% | 0.6 | Acuity-based |
| WI | 321 | 4.20 | 0.962 | 17% | 9% | 0.3 | Acuity-based |
Without mandated minimums, there’s no bright line between “adequately staffed” and “liability.” PE firms evaluating SNF acquisitions need facility-level staffing data, penalty history, ownership structure, and state-specific regulatory context to assess risk. We provide all four.
Contract staffing decisions depend on knowing which facilities are understaffed, which can pay premium rates (payer mix), and which states have the loosest regulatory oversight. Texas alone has 1,177 facilities with no state staffing floor and 80% below the RN benchmark.
The federal yardstick is gone, but CMS surveyors still cite for “insufficient staffing.” Operators need to know where they stand relative to county and state peers, not just against a repealed number. Our data benchmarks every facility against its actual competitive market.
