Nursing-home staffing ratings by state
CMS rates nursing homes on staffing as well as inspections and quality measures. Sorting the country by average staffing rating shows where facilities are most consistently well-staffed relative to their residents. 14,643 facilities 49 states
Key findings
- Hawaii has the highest average staffing rating (4.41 of 5), ahead of North Dakota (4.21) and Minnesota (4.15).
- The lowest average in the table is Texas at 1.88.
- Overall ratings do not always follow staffing: in some states the average overall rating is lower than the staffing rating, meaning inspection or quality results drag the overall score down.
| State | Facilities | Staffing rating | Overall rating | Certified beds |
|---|---|---|---|---|
| Hawaii | 43 | 4.41 ★ | 3.71 ★ | 4,248 |
| North Dakota | 72 | 4.21 ★ | 3.15 ★ | 4,909 |
| Minnesota | 338 | 4.15 ★ | 3.16 ★ | 24,057 |
| Maine | 78 | 4.10 ★ | 3.05 ★ | 5,830 |
| Delaware | 44 | 4.05 ★ | 3.19 ★ | 4,717 |
| Oregon | 128 | 3.88 ★ | 3.12 ★ | 10,602 |
| Mississippi | 202 | 3.81 ★ | 2.73 ★ | 17,511 |
| Iowa | 387 | 3.68 ★ | 3.09 ★ | 25,131 |
| Alabama | 224 | 3.64 ★ | 3.01 ★ | 26,504 |
| Wisconsin | 323 | 3.63 ★ | 2.98 ★ | 24,756 |
| Montana | 61 | 3.61 ★ | 2.88 ★ | 4,997 |
| Michigan | 422 | 3.57 ★ | 3.13 ★ | 44,006 |
| Washington | 193 | 3.56 ★ | 3.25 ★ | 18,781 |
| Wyoming | 36 | 3.56 ★ | 2.86 ★ | 2,938 |
| Kansas | 296 | 3.53 ★ | 3.11 ★ | 18,031 |
States with fewer than 30 rated facilities are excluded.
What the staffing rating measures
CMS compares nurse staffing hours per resident per day with what it expects for the residents a facility actually has, and adjusts for case mix. Turnover is part of the picture too: facilities with high staff churn score worse even when headline hours look adequate.
Method
Average of the CMS staffing rating and overall rating across facilities with a valid rating, by state. Data: CMS Provider Data Catalog, Nursing Home Provider Information (public domain).