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POSSIBILITIES OF AI
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.
This release of AARP’s new Nursing Home Quality and Safety Dashboard covers the fourth quarter (October through December) of 2025.
Respiratory Illnesses
Following established seasonal patterns, cases and hospitalizations for influenza increased about tenfold from Q3 2025 (summer) to Q4 (fall), with the majority occurring in the last two weeks of the quarter entering the likely peak season of respiratory illness exposure in January and February. RSV cases also increased about fourfold, and hospitalizations doubled from Q3 to Q4. The majority of respiratory cases and hospitalizations in both Q3 and Q4 were due to COVID-19, also an established seasonal pattern, as the second late summer COVID-19 peak spanned both quarters. COVID-19 cases and hospitalizations were down slightly in Q4 compared to Q3 but also rose in the last few weeks of the quarter, going into the main winter peak. Across all three diseases, cases were up slightly (from 35 to 36 per 1000 residents) and hospitalizations approximately doubled (from 2 to 3 per 1000 residents) and are expected to further increase in the first quarter of 2026.
Vaccination rates for COVID-19, influenza, and RSV in December 2025 remain much lower than needed to protect vulnerable residents. As of late December, 35% of nursing home residents were up to date on COVID-19 vaccination, an increase of only 4 percentage points from late September; 57% have been vaccinated against the current seasonal influenza (not available or tracked in Q3); and only 23% for RSV, an increase of 2 percentage points since late September. Recent vaccination rates for flu peaked in 2009 at 78%, and for COVID-19 in October 2021 at 86%. Only 7% of health care staff were up to date with COVID-19 vaccination, down a full percentage point from Q1 and Q2.
Vaccination rates vary considerably by state. As of late December, Vermont has the highest percentage of nursing home residents vaccinated for COVID-19 (60%) and influenza (78%), while North Dakota has the highest percentage vaccinated for RSV (53%). Texas has the lowest resident vaccination rates for both COVID-19 (18%) and RSV (10%), while Arizona has the lowest percent for flu (27%). Staff COVID-19 vaccination rates ranged from 2% in West Virginia to 16% 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 2.35 nurse aide hours per resident per day. Staffing levels varied by state: Alaska had the highest rate with 6.85 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 46% turnover over the last year (with a high of 59% in Vermont and a low of 35% in Washington DC). Over the course of the year, turnover improved slowly but steadily from 48% in Q1 2025. Turnover is similarly high among administrators, with an average of about 0.5 departures per facility in the last year).
Quality Measures
Approximately 14% 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 0.5% in Alaska to 3.1% in Louisiana). Antipsychotics can have dangerous side effects in the older population and are often used inappropriately. Additionally, 5.4% of residents had pressure ulcers (state range from less than 4% in Colorado, Hawaii, Idaho, and Ohio to more than 8% in Alaska, Mississippi, New York, and 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 people 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 and provider info files are updated approximately 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/
