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Nursing Home Safety by State: 2026 Rankings

HI leads the nation for nursing-home safety with an average score of 74.5 out of 100. The tables rank states from strongest to those families should watch most closely. Safety still varies home by home, so always check the specific facility.

Published June 3, 2026 · CMS data as of Apr 23, 2026

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Search 14,000+ Medicare-certified facilities by name, city, or ZIP — see violations, staffing, and safety signals.

Key Takeaways

  • Best State: HI
  • Best State Score: 74.5
  • Lowest State: TX
  • Lowest State Score: 55.4

Overview

HI leads the nation for nursing-home safety with an average score of 74.5 out of 100. The tables rank states from strongest to those families should watch most closely. Safety still varies home by home, so always check the specific facility.

Data reflects CMS records as of 2026-04-23.

States With The Highest Average Safety Score

State Facilities Avg Score Excellent Poor
HI 42 74.5 11 0
NV 66 71.2 13 2
AR 221 71 21 3
AL 224 70.9 20 9
IN 507 70.9 58 10
KY 268 70.5 39 7
ME 78 70.2 10 0
AZ 140 70 24 2
MN 338 69.8 62 8
AK 20 69.7 8 2

States To Look At Most Carefully

State Facilities Avg Score Excellent Poor
TX 1176 55.4 29 209
IL 667 55.8 65 176
NM 68 57.9 3 11
MO 488 59 15 67
DC 17 59.1 3 2
RI 73 59.1 7 10
LA 266 59.3 6 27
MT 61 59.5 5 9
VT 34 59.6 2 5
SD 96 60.3 7 8

Frequently Asked Questions

Which state has the safest nursing homes?
HI currently has the highest average safety score (74.5 out of 100) in our rankings. See the top table above for the full list of the strongest-performing states.
How are state nursing-home safety scores calculated?
We score each Medicare-certified nursing home from 0 to 100 using CMS inspection, staffing, penalty, and complaint data, then average those facility scores by state. States need at least 20 scored facilities to be ranked, which keeps small-sample states from skewing the list.
Does a high state ranking mean every home in that state is safe?
No. A state average is a starting point, not a guarantee. Even top-ranked states contain lower-scoring homes, and lower-ranked states contain excellent ones. Always check the individual facility before making a decision.
How can I check a specific nursing home in my state?
Search any facility by name, city, or ZIP on Senior Care Report Card to see its full safety score, staffing rating, inspection findings, and penalty history.

How to Read This

Care Safety score
A 0–100 score we calculate from CMS inspection history, staffing data, citation patterns, and complaint summaries. Higher is better. We group facilities into bands: Excellent, Good, Fair, and Poor.

Data source: Centers for Medicare & Medicaid Services (CMS). Data as of 2026-04-23.

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How we built this: Every Senior Care Report Card insight is generated from the federal CMS Care Compare dataset and reviewed by our editorial team before publishing. We do not invent numbers, and we always tell you the date the data was collected. Read our methodology →