Sample State has 1,177 Medicare-certified nursing facilities with 133,557 certified beds. As of 2025-Q3, 89.4% of facilities have at least one compliance gap heading into the industry staffing benchmarks. The state’s average staffing stability score is 81.3 out of 100. There are 36 Special Focus Facilities and 2,213 immediate jeopardy citations recorded in the past three years.

Compliance readiness is tracked quarterly using CMS Payroll-Based Journal data against three industry staffing benchmarks: 3.48 total nursing HPRD, 0.55 RN HPRD, and 24/7 registered nurse presence. Facilities meeting all three are “Compliant.” Those meeting two are “At Risk.” The chart above shows Sample State’s compliance trajectory compared to the national average.

A facility’s payer mix is the strongest public signal of its financial health. Higher private pay and Medicare concentrations indicate stronger revenue capacity for staffing investments and contract rates. Sample State’s payer mix is broadly in line with national averages. Revenue composition varies significantly by county — see the chart above for county-level detail.

The Staffing Stability Score is a 0–100 composite of six weighted sub-metrics: staffing volatility (25%), weekend drop-off (20%), zero-RN days (20%), coverage gap (15%), contract dependency (10%), and turnover velocity (10%). Higher scores indicate more stable, reliable staffing patterns.

Contract dependency measures the percentage of total nursing hours provided by agency/contract staff vs permanent employees. Higher dependency indicates either chronic recruitment challenges or seasonal surge patterns. For staffing agencies: counties with high contract utilization represent established markets. Counties with low contract utilization but high non-compliance represent untapped opportunity. Sample State has low contract utilization at 2.1%. Combined with 53.4% non-compliance, this represents an untapped market — facilities need staff but haven’t yet turned to agency solutions at scale.

Staffing Need Score combines: Staffing Gap (30pts), Revenue Quality (25pts), Regulatory Pressure (20pts), Facility Size (15pts), and Violation Signal (10pts). Higher scores indicate facilities that both need contract staff and have the revenue to pay for them.

Violation data is sourced from CMS health inspection records. Immediate jeopardy citations represent the most severe category — conditions that cause or are likely to cause serious injury, harm, impairment, or death. Counties with high violation rates and high non-compliance represent markets under intense regulatory scrutiny, creating urgency-driven demand for contract staffing.

Average fine amount: $32,932. 827 out of 1,177 facilities (70.3%%) have received at least one penalty action in the past three years. Higher enforcement intensity signals markets where facilities face operational pressure and may urgently need staffing support.

Quality measures are derived from the Minimum Data Set (MDS) assessments and Medicare claims data. Lower values indicate better outcomes for adverse measures (falls, pressure ulcers, antipsychotic use). Facilities with poor quality scores face higher regulatory scrutiny and are more likely to need supplemental staffing to improve outcomes to meet industry staffing benchmarks.

Financial data derived from CMS HCRIS cost reports (Form 2540-10). Margin = (revenue - expenses) / revenue. Facilities with incomplete filings excluded. National avg operating margin: -9.1% (FY2024).

This report is generated from the SeniorIndex database, which aggregates multiple federal and state data sources into a unified intelligence platform. Primary data sources include CMS Provider Data Catalog (facility profiles, star ratings, quality measures), CMS Payroll-Based Journal daily nurse staffing files (14.5 million records across 11 quarters), CMS HCRIS cost report data (facility-level payer mix), and CMS health inspection and enforcement records (419,452 deficiencies).

Staffing Stability Score (0–100): Weighted composite of six sub-metrics — Staffing Volatility (25%), Weekend Drop-Off (20%), Zero-RN Days (20%), Coverage Gap (15%), Contract Dependency (10%), Turnover Velocity (10%). Each normalized to 0–100 scale.

Staffing Assessment: COMPLIANT = meets all 3 industry benchmarks (3.48 total HPRD, 0.55 RN HPRD, zero zero-RN days). AT_RISK = meets 2 of 3. NON_COMPLIANT = meets 0–1 with no positive trend. CRITICAL = fails all 3 or 10+ zero-RN days.

Staffing Need Score (0–100): Staffing Gap (30pts) + Revenue Quality (25pts) + Regulatory Pressure (20pts) + Facility Size (15pts) + Violation Signal (10pts).

Limitations: PBJ data reflects paid hours only. Contract percentages are derived from aggregate data. Payer mix is based on most recent available cost report filing. The Staffing Stability Score and Staffing Need Score are proprietary analytical products and do not represent CMS endorsements or regulatory determinations. Compliance projections are estimates and should not be construed as legal advice.