Nursing Home Safety by State: 2026 Rankings

Families searching for nursing homes face a critical question: does location matter for safety? New data from Medicare-certified nursing homes across the United States shows significant differences between states, with average safety scores ranging from 73.2 out of 100 in Hawaii to 55.4 in Texas.

These rankings, current as of May 21, 2026, average the safety scores of all Medicare-certified nursing homes in each state. The scores combine inspection findings, staffing levels, penalties, and complaint data. States must have at least 20 scored facilities to appear in the rankings, ensuring the averages reflect meaningful patterns rather than small samples.

While state averages provide useful context, they are a starting point, not a final answer. Every state contains both excellent and poor-performing facilities. Families should always research individual nursing homes before making a decision.

Top-Performing States

Hawaii leads the nation with 42 facilities averaging 73.2 out of 100. Ten of those facilities—nearly one in four—earned excellent ratings, and zero received poor ratings. Arkansas follows closely at 71.0, with 221 facilities and 21 rated excellent. Indiana ranks third with 507 facilities averaging 71.0, including 59 excellent facilities but also 10 rated poor.

Other strong performers include Alabama (70.9), Nevada (70.9), Maine (70.8), Kentucky (70.5), Arizona (70.0), New Hampshire (69.8), and Alaska (69.7). Maine and New Hampshire stand out among this group by having zero facilities rated poor. Alaska, with just 20 facilities, is the smallest state to qualify for the rankings.

States Requiring Extra Research

Texas ranks lowest with 1,176 facilities averaging 55.4 out of 100. Despite being the largest state by facility count in these rankings, Texas has only 29 facilities rated excellent while 207—nearly one in five—are rated poor. Illinois ranks second-lowest at 55.7, with 667 facilities including 180 rated poor and 66 rated excellent.

New Mexico (57.9), Rhode Island (58.6), and the District of Columbia (59.1) round out the bottom five. New Mexico has 68 facilities with only 3 rated excellent and 11 rated poor. The District of Columbia, with just 17 facilities, has 3 excellent and 2 poor.

Missouri, Louisiana, Montana, Vermont, and South Dakota also appear in the bottom ten, with average scores between 59.2 and 60.3. Missouri stands out with 488 facilities but only 15 rated excellent—a ratio of roughly 1 in 33.

What the Numbers Mean for Families

The 17.8-point gap between Hawaii and Texas represents a substantial difference in average performance. However, these state averages mask important variation within states. Even top-ranked Arkansas has 3 facilities rated poor. Even bottom-ranked Texas has 29 excellent facilities.

Larger states naturally contain more diversity. Texas, Illinois, and Missouri each have hundreds of facilities, meaning families in those states have more options to sort through but also more excellent facilities in absolute numbers. Smaller states like Hawaii, Alaska, and Maine offer fewer choices but show more consistent quality across their facilities.

These rankings reflect Medicare-certified nursing homes only. Some states have additional assisted living or residential care facilities not included in these numbers. The data also represents a snapshot from May 2026; individual facility scores can change as new inspections occur or staffing levels shift.

Data source: Centers for Medicare & Medicaid Services (CMS). Data as of 2026-05-21.