Neighborhood Deprivation and Nursing Home Staffing Gaps Relative to the 2024 U.S. Federal Minimum Staffing Standards

Background The 2024 U.S. federal minimum staffing rule for nursing homes was vacated and repealed before taking effect, but states continue to adopt their own standards. Whether uniform standards impose uneven compliance burdens is unclear. Objective To examine whether the 2024 federal minimums differed by neighborhood deprivation. Methods Cross-sectional analysis of 9,315 U.S. nursing homes linking CMS-reported staffing (April to June 2025) with the Area Deprivation Index (ADI). Results Overall, 42.8%, 67.0%, and 31.3% of facilities staffed below the registered nurse (RN), nurse aide, and total nursing minimums, respectively. Facilities in the most deprived tercile staffed 0.103 RN hours per resident day lower than the least deprived (95% CI, −0.161 to −0.045), with 2.28 times the odds of falling below the RN minimum. Conclusion Uniform staffing standards would concentrate compliance burden on facilities serving deprived urban communities. Future state or federal standards should pair minimums with financing and workforce supports.