Nursing Home Staffing Data: State-by-State Benchmarks (2026)

Across the 14,696 Medicare-certified nursing homes evaluated in this analysis, the average staffing score stands at 55.5 out of 100 as of May 21, 2026. Staffing—the number of nurses and aides caring for residents each day—is the most consistent predictor of care quality in long-term care facilities.

Yet staffing levels vary dramatically by state. Hawaii currently leads the nation with an average score of 88.2, while Texas scores just 37.9—a difference that can translate to meaningful gaps in how quickly staff can respond to call bells, manage medications, and prevent falls. Nearly half of all facilities nationwide (45.9%) score below the midpoint of 50.

The tables below highlight where nursing home staffing is strongest and where families should ask the most detailed questions about daily nurse-to-resident ratios before choosing a facility.

Top-Ranked States Show Consistent Strength

Hawaii's 42 facilities average a staffing score of 88.2, far exceeding the national benchmark. Maine follows at 78.6 across 78 homes, and Minnesota—with a much larger pool of 338 facilities—maintains a strong 76.0 average. North Dakota (75.8 across 72 homes) and Wisconsin (75.2 across 323 homes) round out the top five. The top ten also includes Washington (73.8), Alaska (72.6), Oregon (72.1), Delaware (71.7), and Utah (71.0). These states demonstrate that strong staffing can be sustained across both small and large nursing home markets.

Southern and Central States Trail National Benchmarks

Texas, with the largest number of facilities in the bottom tier—1,176 homes—scores an average of just 37.9. Missouri (40.1 across 488 facilities) and Louisiana (40.4 across 266 facilities) also rank near the bottom. Oklahoma (42.2), Georgia (44.2), North Carolina (48.8), Arkansas (49.3), New Mexico (49.5), Virginia (51.1), and South Carolina (52.0) complete the bottom ten. Lower scores do not mean every facility in these states provides poor care, but the state-level averages signal that families should compare individual homes carefully and request specific staffing numbers for day, evening, and night shifts.

What the Numbers Mean for Families

Staffing scores are built from payroll-based data reported to Medicare, reflecting actual nurse and aide hours relative to the number of residents. A score of 55.5 represents the current national average; facilities scoring well below that threshold may struggle to provide timely assistance with daily activities, medication management, and emergency response. Conversely, homes scoring in the 70s and 80s typically maintain higher nurse-to-resident ratios, which research links to fewer pressure ulcers, infections, and preventable hospitalizations.

The 50-point gap between Hawaii and Texas underscores how much state-level factors—including Medicaid reimbursement rates, labor markets, and regulatory standards—shape staffing. Families researching nursing homes in lower-scoring states should ask each facility for its current staffing plan, including how many registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) are scheduled per shift, and whether those levels hold on weekends and holidays.

Context and Caveats

This analysis covers Medicare-certified nursing homes only; it does not include assisted living facilities or memory care communities that are not Medicare-certified. Staffing scores are averaged at the state level, so individual facilities within a state can and do vary widely. A low state average does not mean every home there is understaffed, just as a high state average does not guarantee every facility meets that benchmark. Always compare individual facility scores and visit in person to observe staff availability during different times of day.

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