Nursing homes that meet recommended staffing levels for certified nursing assistants see significantly fewer injurious falls among residents — but a large majority of facilities across the country still fall short of that threshold, according to a new study published in the March edition of the Journal of the Post-Acute and Long-Term Care Medical Association.
The research, which analyzed data from 11,183 nursing homes covering more than 1.1 million long-stay Medicare residents, found that facilities achieving or exceeding the recommended CNA coverage of 2.45 hours per resident per day showed a clear link between added CNA hours and reduced fall injuries. At those well-staffed facilities, more hands on deck actually meant fewer residents getting hurt.
But at the 7,863 nursing homes — roughly 70% of those studied — that didn’t meet that threshold, the results were more troubling. Adding CNA hours in already under-staffed environments was actually tied to higher rates of injurious falls, not lower ones.
“These findings suggest that simply adding hours without adequate overall staffing may not improve — and may worsen — outcomes,” according to a statement from Hebrew SeniorLife, one of the organizations involved in the research.
The Staffing Gap Is Still Wide
The numbers paint a stark picture of where the industry stands. Of all nursing homes studied, low-staffed facilities were more likely to be for-profit (79.6% vs. 56.8%) and more likely to serve a higher share of Medicaid residents (63.6% vs. 52%). That combination — for-profit ownership and Medicaid-heavy census — has historically pointed to tighter operating margins and leaner staffing models.
The study also found similar patterns for registered nurse staffing. RN hours showed the same directional relationship: in facilities that met recommended coverage, more RN time correlated with fewer fall injuries. The effect didn’t hold in under-staffed settings.
Falls remain one of the most common — and costly — adverse events in nursing home care. Injurious falls can trigger hospitalizations, longer recovery times, and a cascade of complications in already medically complex residents.
Why It Matters Beyond the Numbers
The findings arrive at a moment when the federal staffing mandate is no longer on the table, but state-level efforts continue. As industry reports have noted in recent months, staffing decisions ripple directly into resident safety outcomes, and facilities trying to boost their CNA hours without first achieving baseline coverage may be creating more risk rather than less.
The study’s authors say the results underscore the importance of not just increasing headcount, but ensuring that overall staffing structure is sound before adding hours. For operators reviewing their CNA ratios, the takeaway is clear: getting to the recommended threshold isn’t optional if the goal is resident safety — it’s the starting point.
