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Key Takeaways
- Texas has the lowest state staffing sub-score in this dataset at 38 out of 100 — 31% below the national average of 55.6 — across 1,176 facilities.
- Missouri and Louisiana are tied for second-lowest at 40.4, meaning three states cluster well below even Oklahoma (42.5) in fourth place.
- The national average of 55.6 out of 100 is the benchmark — any facility score near or below that number warrants a direct question to staff about daily nurse-to-resident ratios.
- Virginia (51.2) and South Carolina (52.0) are the closest to the national average among the bottom ten, so families there have more variation to work with when comparing individual facilities.
- New Mexico's 49.5 score affects only 68 facilities; Texas's 38.0 score affects 1,176 — ask your specific facility for its individual score, not just the state average.
Texas nursing homes carry an average staffing sub-score of just 38 out of 100 — nearly a third below the national average of 55.6 — across 1,176 facilities, making it the lowest-staffed state in the country as of March 25, 2026. That national average of 55.6 is itself a middling number out of a possible 100, meaning the baseline most families are comparing against is already far from ideal across all 14,689 facilities for which staffing data exists.
The bottom three states are bunched together — and far from the pack.
Texas (38.0), Missouri (40.4), and Louisiana (40.4) form a distinct low cluster separated from the rest of the bottom ten. Oklahoma follows at 42.5 and Georgia at 44.2. The gap between Texas and the national average of 55.6 is 17.6 points — roughly the same size as the gap between Texas and North Carolina (49.0), which sits sixth on the list. In plain terms, choosing between a Texas facility and one in North Carolina is, on staffing scores alone, a meaningful difference.
Size of the state matters for how many families are affected.
Texas's low score is not a small-sample problem. Its 1,176 facilities with staffing data represent by far the largest count among the ten lowest-scoring states. Missouri has 487 facilities in this group, and Georgia 356. By contrast, New Mexico scores the same as Arkansas (both 49.5) but has only 68 facilities — so the low score affects far fewer residents in absolute terms. Families in Texas face the double challenge of a low average score spread across a very large number of facilities to sort through.
The "bottom ten" share a geographic pattern — but the data doesn't explain why.
All ten lowest-scoring states are in the South or border the South. Virginia (51.2) and South Carolina (52.0) are closest to the national average within this group, but both still fall below 55.6. The data does not include explanations for state-level differences — factors such as state regulations, wage levels, or rural geography are not captured here — so families should treat the scores as a starting point for questions, not a verdict on any individual facility.
What the staffing sub-score actually measures — and its limits.
The staffing sub-score is one component of the federal Five-Star Quality Rating system run by the Centers for Medicare & Medicaid Services. It reflects reported staffing hours per resident per day — both registered nurses and other nursing staff — adjusted for the mix of residents' care needs. A higher score means more staffing hours relative to what residents in that facility are expected to need. These scores cover only facilities that submitted staffing data to the federal payroll-based reporting system; any facility not reporting would not appear in the 14,689 counted here.
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 2026-03-25.
Helpful resources
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 →