Nursing homes provide essential 24-hour long-term and rehabilitative care for 1.4 million Americans, but have long faced persistent staffing challenges that worsened during the COVID-19 pandemic. Nurse staffing hours declined sharply in 2020 and 2021, especially among certified nurse aides (CNAs), while contract staffing rose dramatically before stabilizing in 2022. Staffing shortfalls were particularly acute in facilities serving higher proportions of minority residents and in rural or nonmetropolitan areas, underscoring the importance of adequate and stable staffing for maintaining high-quality care and informing new federal standards and measures of staffing quality.

This article examines changes in nursing home staffing instability during the COVID-19 pandemic and investigates whether instability patterns differed by nursing home characteristics.