A major new study has confirmed what many long-term care workers have long argued: when nursing homes don’t have enough certified nursing assistants, residents fall — and get hurt.
The study, published in the Journal of the American Medical Directors Association, analyzed data from more than 1.1 million Medicare beneficiaries across 11,183 nursing homes across the United States. Researchers set a benchmark of 2.45 CNA hours per resident per day — the recommended threshold for adequate coverage. What they found was striking: nearly 70% of nursing homes aren’t meeting it.
And those facilities are seeing the consequences in their fall data.
The staffing-falls connection
Nursing homes that met the recommended CNA coverage and also increased registered nurse hours saw significantly fewer injurious falls. In well-staffed facilities, higher registered nurse staffing hours were associated with roughly a 40% lower rate of injurious falls among long-stay residents.
But there’s a catch — and it matters for how operators think about this problem. Facilities that fell below the CNA threshold actually showed higher rates of injurious falls as they added CNA hours. Simply throwing more hours at an understaffed facility, the researchers found, isn’t enough. Without addressing the overall staffing shortage, incremental increases may not move the needle — and could even make outcomes worse.
“Ensuring resident safety in nursing homes is a multifaceted challenge, and our study underscores the importance of thoughtful staffing strategies tailored to each facility’s baseline resources,” said Sarah Berry, MD, MPH, a co-author of the study and senior scientist at Hebrew SeniorLife’s Marcus Institute for Aging Research. “Greater staffing — especially meeting recommended CNA and RN hours — can protect residents from injurious falls, but simply increasing hours in under-resourced homes without addressing overall staffing shortages may not be enough.”
Why this matters now
Falls are among the most serious safety risks in long-term care settings. They can cause fractures, hospitalizations, and a lasting decline in independence — outcomes that are devastating for residents and costly for facilities.
The findings arrive as the debate over federal and state staffing mandates in nursing homes remains unsettled. The federal minimum staffing rule, which was finalized in 2024 and later repealed, set baseline requirements that many in the industry argued were financially unworkable. This new research adds fuel to that argument on both sides: advocates see it as evidence that adequate staffing saves lives, while operators point to the complexity of achieving it in the current labor market.
The study’s research team — drawn from Harvard Medical School, Hebrew SeniorLife, and Brown University — stressed that staffing improvements need to be matched with genuine workforce investment, not just regulatory mandates applied to facilities already stretched thin.
What operators should take from this
The practical message is clear: meeting the 2.45 CNA hours-per-resident-per-day threshold isn’t just a checkbox. It’s the point at which more staffing actually starts to improve safety outcomes. Below that line, the data suggests, there’s a counterproductive dynamic at play.
For the nearly three in four nursing homes currently falling short of that benchmark, the study is a call to re-examine staffing as a safety strategy — not just a cost line.
