SNF Staffing Benchmarks
Executive Summary
The strongest-performing SNFs consistently balance three workforce levers: staffing levels, overtime, and agency use. This report identifies the benchmarks associated with stronger clinical outcomes, lower labor costs, and better workforce stability.
National staffing benchmarks are based on CMS Payroll-Based Journal (PBJ) data from more than 13,000 skilled nursing facilities across Q2–Q4 2025. Continuing Care Retirement Communities (CCRCs) are excluded.
| Metric | Operational target | Quality differentiation | Ceiling signal | National avg |
|---|---|---|---|---|
| Total adjusted nurse HPRD | 3.75 – 4.5 hrs | 4.5 – 5.5 hrs | > 5.5 hrs | 3.86 hrs |
| Adjusted RN HPRD | 0.65 – 0.80 hrs | 0.80 – 1.00 hrs | ≥ 1.00 hr | 0.66 hrs |
| Overtime % | 3 – 7.5% | < 3% | > 10% sustained | 8.9% |
| Agency / contract % | < 5% | < 1% | > 10% ongoing | 5.7% |
| Total nurse turnover | < 50% | < 40% | > 50% | 46.6% |
Source: CMS PBJ Q2–Q4 2025, n = 13,098 SNFs. CCRCs excluded.
The Four Labor Patterns
Facilities generally fall into one of four labor patterns based on their overtime and agency use. Comparing these patterns to CMS claims data and MDS quality measures reveals clear differences in star ratings, turnover, and regulatory outcomes.
Where does your facility rank?
See how your facility compares to national percentiles
| Percentile | OT % | Interpretation |
|---|---|---|
| P10 — Top 10% | 4.2% | Excellent |
| P25 — Top Quartile | 5.8% | Strong |
| P50 — Median | 8.1% | Average |
| Mean† | 8.9% | National avg |
| P75 — Bottom Quartile | 10.6% | Elevated risk |
| P90 | 13.1% | High risk |
| P95 | 15.0% | Crisis level |
What is your agency dependency costing you?
Enter your agency staffing percentage to see where you rank nationally and estimate the savings from building an internal float pool. Based on Q2–Q4 2025 PBJ data across 13,098 facilities.
| Percentile | Agency % | Interpretation |
|---|---|---|
| P10 – P25 | 0.0% | Zero agency |
| P50 — Median | 0.5% | Minimal agency |
| Mean | 5.7% | National avg |
| P75 | 7.0% | Moderate dependency |
| P90 | 18.5% | High dependency |
| P95 | 27.4% | Structural dependency |
| Above P95 | > 27.4% | Crisis level |
SNF Labor Pattern by State
Click any state
to see its labor profile
| State ↕ | Pattern ↕ | OT % ↕ | P25 ↕ | P75 ↕ | Agency% ↕ | HPRD ↕ | RN HPRD ↕ | Turnover ↕ | Rehosp ↕ | Falls ↕ |
|---|
PBJ Staffing Data · Findings
What high-performing facilities do differently.
Six insights from national PBJ data and frontline workforce surveys that highlight the staffing decisions most closely tied to quality, retention, and financial performance.
Agency use is highly skewed.
Labor AnalysisMost facilities use little to no agency labor. A small group of high-agency facilities drives the national average more than 10x above the median.
RN coverage is the strongest predictor of rehospitalization.
Clinical OutcomeFacilities below 0.65 RN hours per resident day consistently experience higher rehospitalization rates.
Overtime predicts turnover.
Labor AnalysisBelow 7% overtime, every 1-point reduction in OT is associated with a 1–2 point reduction in turnover.
Schedule flexibility ranks ahead of pay as a retention driver.
Frontline surveyFalls are driven by workforce stability, not staffing volume.
Clinical outcomeFacilities with the highest turnover average 3.44% falls with major injury, compared to 2.96% for the lowest-turnover facilities.
Open shifts are a communication problem.
Frontline surveyThirty-four percent of workers say waiting for a scheduler response is their biggest frustration. Another 33% say they learn about open shifts too late to pick them up.
Source: PBJ staffing data and frontline workforce survey responses, analyzed by Covr. CMS Provider Info and Quality Measures May 2026. Figures represent national patterns across long-term care facilities, not a guarantee for any individual facility.
Ready to put
insight into action?
See why thousands of long-term care facilities trust Covr.
