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More than 1.2 million people in the United States live and receive care in nursing homes, the vast majority of whom are older adults ages 65 or older. The AARP Public Policy Institute created the AARP Nursing Home Quality and Safety Dashboard to provide quarterly snapshots of national and state data related to the experiences of nursing home residents, staffing, and facility characteristics. This new Dashboard continues the work of the AARP Nursing Home COVID-19 Dashboard, which from 2020-2025 tracked the impact of COVID-19 specifically on nursing homes, residents, and staff.
The first release of AARP’s new Nursing Home Quality and Safety Dashboard covers the first (January through March) and second (April through June) quarters of 2025.
Respiratory Illnesses
Following established seasonal patterns, cases and hospitalizations for COVID-19, flu, and RSV were much higher in Q1 than in Q2 across the US. In the first quarter of 2025, there were 96 confirmed cases of respiratory illnesses (COVID-19, flu, and RSV) and 13 hospitalizations per 1000 residents for these illnesses. COVID-19 was the most prevalent of these illnesses, while influenza was the most common cause of hospitalization. This corresponds to about 120,000 total cases and 16,000 total hospitalizations in the quarter. In the second quarter, the rate of cases declined by 80% and the rate of hospitalizations dropped by 85% to approximately 20 cases and 2 hospitalizations per 1000 residents (approximately 24,000 total cases and 2,000 total hospitalizations), the majority of which were due to COVID-19.
Vaccination rates for respiratory illnesses are lower than previous years. As of mid-June, 60% of nursing home residents received the seasonal flu vaccine, 35% are up to date on COVID-19 vaccination, and only 21% have been vaccinated against RSV. Recent vaccination rates for flu peaked in 2009 at 78%, and for COVID-19 in October 2021 at 86%. Only 8% of health care staff were up to date with COVID-19 vaccination, compared to 74% in October 2021.
Vaccination rates vary considerably by state. States rates for flu vaccination ranged from 32% in Arizona to 78% in North Dakota, for COVID-19 from 19% in Texas to 61% in Washington DC, and for RSV from 9% in Texas to 51% in West Virginia. Staff COVID-19 vaccination rates ranged from 3.5% in Alabama to 18% in Hawaii.
Nursing Home Staffing
Over the last 3 months, nursing homes provided an average of 3.9 nursing hours per resident per day, including 0.7 RN hours, 0.9 LPN hours, and 2.3 nurse aide hours per resident per day. Staffing levels varied by state: Alaska had the highest rate with 6.9 total hours per resident per day, more than twice as much as Texas, which had the lowest with 3.4 hours per resident per day.
Turnover in the nursing home industry is high. Nationally, nursing staff averaged 48% turnover over the last year (with a high of 61% in Vermont and a low of 33% in Hawaii). Turnover is significant among administrators as well, with an average of about 0.6 departures per facility in the last year (Missouri, Oklahoma, and Oregon and had the highest rate of administrator departures at 0.8 per facility).
Quality Measures
Approximately 15% of long-stay nursing home residents (stays longer than 100 days) received an antipsychotic medication (state range 7% in Washington DC to 24% in South Dakota), and 1.6% of short-stay residents (100 day stays or shorter) received an antipsychotic medication for the first time (state range from 0.6% in Alaska to 3.3% in Louisiana). Antipsychotics can have dangerous side effects in the older population and are often used inappropriately. Additionally, 6% of residents had pressure ulcers (state range from 4% in Hawaii to 8% in Washington DC). Pressure ulcers are often associated with poor care and inadequate staffing.
This Dashboard draws from three main sources of data. These are CDC NHSN Nursing Home Data Dashboard (for respiratory diseases and vaccination rates) and two CMS data files on the topic of nursing homes including rehab services: the state averages file (for staffing levels, staff turnover, and quality measures) and the provider info file (for facility characteristics).
The CDC dashboard is updated weekly. The AARP dashboard rates of cases and hospitalizations are calculated by the AARP Public Policy Institute as the sum of the weekly rates over the three months composing the quarter (e.g. weeks ending 1/5/25 through 3/30/25 for the 2025 Q1 dashboard). These rates can be interpreted as: for every 1000 individuals who are in a nursing home for the entire three-month period and have a risk of infection or hospitalization equal to the state average each week, this many would test positive for, or be hospitalized because of the illness. An approximate (though not exact) total count of cases and hospitalizations can be calculated by multiplying these rates by the average daily number of residents. Vaccination rates are for the most recent week of non-preliminary data at the time of download, typically the middle or end of the last month of the quarter.
The CMS state averages file and provider info file are updated monthly, and the last files of the quarter are used for the Dashboard (e.g. March 2025 for the 2025 Q1 Dashboard). State averages are taken directly from this summary file. Staffing hours are calculated over the most recent three-month period. Staff turnover is calculated over a one-year period. Quality measures are calculated over a period of 4 or 5 quarters. Exact data collection intervals for each indicator can be found in the documentation on the CMS website.
Facility characteristic indicators in the Dashboard are calculated by the AARP Public Policy Institute. A small number of facilities report the number of beds but not the average number of residents. These facilities were included for calculating the total number of beds in the state but excluded for calculating the state occupancy rate. Therefore, the occupancy rate may not exactly match the number of residents divided by the number of beds at the state level.
Dates of data access for each quarterly dashboard can be found here.
For more information about nursing homes from AARP, please visit: aarp.org/nursinghomes
For more information about the AARP Public Policy Institute, please visit: www.aarp.org/pri/departments/ppi/
For more information about nursing home care, please visit: https://www.medicare.gov/care-compare/
To review the AARP Nursing Home COVID-19 Dashboard, please visit: https://www.aarp.org/pri/initiatives/aarp-nursing-home-covid-19-dashboard/
