BOSTON, MA — A comprehensive research study examining staffing patterns at more than 11,000 nursing homes nationwide has revealed a significant connection between adequate staffing levels and the prevention of injurious falls among residents, according to findings published February 27, 2026 in the Journal of the American Medical Directors Association.
The research, which analyzed data from over 1.1 million Medicare beneficiaries, found that facilities meeting recommended certified nursing assistant staffing benchmarks of 2.45 hours per resident daily experienced notably fewer falls resulting in injury. According to the study, each additional hour of registered nurse staffing was associated with nearly a 40% reduction in injurious falls at properly staffed facilities.
The findings reveal a troubling staffing landscape across American nursing homes. According to the research, only 29.7% of the 11,183 facilities examined met the recommended CNA staffing threshold, while 70.3% fell short of the benchmark. This widespread staffing shortage has significant implications for resident safety, as falls represent one of the most common and potentially serious incidents in long-term care settings.
Researchers from Hebrew SeniorLife's Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School Center for Bioethics, and Brown University School of Public Health conducted the analysis. Dr. Sarah Berry, a senior scientist at the Marcus Institute and lead author of the study, emphasized the complexity of maintaining resident safety. "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," Berry stated in a press release from Hebrew SeniorLife.
The research uncovered a paradoxical finding that highlights the complexity of staffing issues in long-term care. According to the study, in facilities already operating below the recommended CNA staffing threshold, simply increasing CNA hours without addressing broader staffing deficiencies actually correlated with higher fall rates. This suggests that piecemeal staffing increases may prove ineffective or even counterproductive without comprehensive workforce improvements.
The study's authors noted that "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," according to reporting by McKnight's Long-Term Care News.
Federal regulations require nursing homes to maintain sufficient staffing to meet residents' needs, though specific minimum staffing ratios vary by state. Falls with injury are considered a quality measure tracked by the Centers for Medicare & Medicaid Services and can result in citations during inspections when facilities fail to implement adequate fall prevention programs.
The research team included co-authors Jenna S. Khoja from Harvard Medical School Center for Bioethics, Kylee G. MacLean from the Marcus Institute, and researchers Yoojin Lee, Richa Joshi, and Lori A. Daiello from Brown University School of Public Health. Hebrew SeniorLife, the organization affiliated with several of the researchers, serves more than 4,500 seniors daily across seven campuses in the Greater Boston area, according to reporting by Mirage News.
The study's findings arrive as federal regulators continue to refine staffing requirements for nursing homes. CMS implemented new minimum staffing standards that take effect in phases over the coming years, requiring facilities to meet specific RN and total nursing hours per resident day thresholds.
Falls represent a significant health concern for nursing home residents, often resulting in fractures, head injuries, and other serious complications that can lead to hospitalization, functional decline, or death. The research suggests that appropriate staffing levels, particularly of registered nurses who can assess fall risk and implement prevention strategies, play a crucial role in protecting residents from these preventable injuries.
The publication of this research in the Journal of the American Medical Directors Association, a peer-reviewed publication focused on post-acute and long-term care medicine, adds to a growing body of evidence linking adequate nursing home staffing to improved resident outcomes across multiple quality measures.
Resources for Families
Families with concerns about staffing levels or fall prevention practices at nursing homes can contact their state's Long-Term Care Ombudsman program. The National Long-Term Care Ombudsman Resource Center operates a hotline at 1-800-677-1116 to connect families with local advocates. Additional information and resources are available at https://ltcombudsman.org.
Residents and families can also report concerns about nursing home care quality directly to their state survey agency or through the CMS complaint hotline. Information about a facility's staffing levels, inspection history, and quality measures is publicly available through Medicare's Care Compare website at medicare.gov/care-compare.
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