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Nursing Home Ratings by State

How the average nursing-home safety score compares across all 50 states and Washington, DC — built from federal CMS data on 14,696 Medicare-certified facilities and refreshed monthly. See where your state stands, then check any specific home.

14,696 facilities scored
64.7 national average score (0–100)
Arkansas highest average among states with 100+ homes (71)
Hawaii highest average overall, but only 42 facilities

Read state averages with care. A state figure describes the whole state — not any single home. Every state has both strong and struggling facilities, and the difference between homes within a state is usually larger than the difference between states. Treat this as a map of where closer facility-level review may help, then look up the specific homes you are weighing.

State rating map

Average safety score by state

Each state is shaded by the average Care Safety Score of its nursing homes — darker teal is a higher average. Hover or focus a state for its score, or select it to jump to its row in the ranking below. Alaska and Hawaii are shown inset; smaller Northeastern states and DC are also listed below the map for easier selection.

Hawaii — average score 74.5 across 42 facilities (small sample) Nevada — average score 71.2 across 66 facilities (small sample) Arkansas — average score 71 across 221 facilities Alabama — average score 70.9 across 224 facilities Indiana — average score 70.9 across 507 facilities Kentucky — average score 70.5 across 268 facilities Maine — average score 70.2 across 78 facilities (small sample) Arizona — average score 70 across 140 facilities Minnesota — average score 69.8 across 338 facilities Alaska — average score 69.7 across 20 facilities (small sample) Florida — average score 69.6 across 694 facilities New Hampshire — average score 69.6 across 74 facilities (small sample) Ohio — average score 69 across 922 facilities New Jersey — average score 68.6 across 348 facilities Nebraska — average score 68.1 across 179 facilities Oregon — average score 67.6 across 128 facilities Utah — average score 67.5 across 97 facilities (small sample) Tennessee — average score 67.2 across 303 facilities Wisconsin — average score 67.1 across 323 facilities Michigan — average score 66.7 across 423 facilities New York — average score 66.7 across 596 facilities South Carolina — average score 66.7 across 187 facilities Massachusetts — average score 66.1 across 341 facilities Idaho — average score 66 across 80 facilities (small sample) Iowa — average score 65.9 across 390 facilities California — average score 65.8 across 1,166 facilities North Dakota — average score 65.6 across 72 facilities (small sample) Pennsylvania — average score 65.4 across 657 facilities Washington — average score 65.4 across 194 facilities Virginia — average score 65 across 289 facilities Maryland — average score 63.7 across 221 facilities Colorado — average score 63.6 across 210 facilities Mississippi — average score 63.6 across 202 facilities Connecticut — average score 63.5 across 191 facilities West Virginia — average score 63.5 across 123 facilities Delaware — average score 63 across 44 facilities (small sample) Kansas — average score 62.6 across 297 facilities Georgia — average score 62.3 across 356 facilities Oklahoma — average score 61.8 across 283 facilities Wyoming — average score 61.8 across 36 facilities (small sample) North Carolina — average score 60.8 across 420 facilities South Dakota — average score 60.3 across 96 facilities (small sample) Vermont — average score 59.6 across 34 facilities (small sample) Montana — average score 59.5 across 61 facilities (small sample) Louisiana — average score 59.3 across 266 facilities District of Columbia — average score 59.1 across 17 facilities (small sample) Rhode Island — average score 59.1 across 73 facilities (small sample) Missouri — average score 59 across 488 facilities New Mexico — average score 57.9 across 68 facilities (small sample) Illinois — average score 55.8 across 667 facilities Texas — average score 55.4 across 1,176 facilities VT NH MA RI CT NJ MD DE DC HI
Vermont 59.6 New Hampshire 69.6 Massachusetts 66.1 Rhode Island 59.1 Connecticut 63.5 New Jersey 68.6 Delaware 63 Maryland 63.7 District of Columbia 59.1
Average score: <60 60–63 64–66 67–69 70+ fewer than 100 facilities
Full ranking

Nursing home safety scores for all 50 states and DC

Ranked by average Care Safety Score. “Strong-record homes” counts facilities in our top safety band. Select a column header to re-sort, or select a state on the map above to jump to its row — then open its state guide or facility search.

Average nursing home Care Safety Score by U.S. state, ranked highest to lowest, with facility counts. Source: CMS, refreshed May 2026.
# State Facilities Avg score Avg staffing Strong-record homes
1 HawaiiFind homes › small sample 42 74.5 88.2 11
2 NevadaFind homes › small sample 66 71.2 68.2 13
3 ArkansasFind homes › 221 71 49.3 21
4 AlabamaFind homes › 224 70.9 59.2 20
5 IndianaFind homes › 507 70.9 54.3 58
6 KentuckyFind homes › 268 70.5 59.7 39
7 MaineFind homes › small sample 78 70.2 77.8 10
8 ArizonaFind homes › 140 70 59.8 24
9 MinnesotaFind homes › 338 69.8 75.7 62
10 AlaskaFind homes › small sample 20 69.7 72.6 8
11 FloridaState guide › 694 69.6 59.1 124
12 New HampshireFind homes › small sample 74 69.6 60.8 7
13 OhioState guide › 922 69 54.3 143
14 New JerseyFind homes › 348 68.6 56.6 46
15 NebraskaFind homes › 179 68.1 60.4 26
16 OregonFind homes › 128 67.6 72.5 18
17 UtahFind homes › small sample 97 67.5 71 15
18 TennesseeFind homes › 303 67.2 52.5 19
19 WisconsinFind homes › 323 67.1 75.2 61
20 MichiganFind homes › 423 66.7 63.2 73
21 New YorkState guide › 596 66.7 52.2 55
22 South CarolinaFind homes › 187 66.7 52 23
23 MassachusettsFind homes › 341 66.1 56.4 36
24 IdahoFind homes › small sample 80 66 67.1 8
25 IowaFind homes › 390 65.9 59.7 37
26 CaliforniaState guide › 1,166 65.8 58.2 153
27 North DakotaFind homes › small sample 72 65.6 75.8 11
28 PennsylvaniaFind homes › 657 65.4 59.6 94
29 WashingtonFind homes › 194 65.4 73.5 22
30 VirginiaFind homes › 289 65 51.2 34
31 MarylandFind homes › 221 63.7 61.9 24
32 ColoradoFind homes › 210 63.6 58.8 19
33 MississippiFind homes › 202 63.6 57.8 12
34 ConnecticutFind homes › 191 63.5 57.1 18
35 West VirginiaFind homes › 123 63.5 53.8 14
36 DelawareFind homes › small sample 44 63 71.7 6
37 KansasFind homes › 297 62.6 60.1 17
38 GeorgiaFind homes › 356 62.3 44.2 17
39 OklahomaFind homes › 283 61.8 42.2 9
40 WyomingFind homes › small sample 36 61.8 64.8 6
41 North CarolinaFind homes › 420 60.8 48.8 31
42 South DakotaFind homes › small sample 96 60.3 62.6 7
43 VermontFind homes › small sample 34 59.6 68.4 2
44 MontanaFind homes › small sample 61 59.5 64.9 5
45 LouisianaFind homes › 266 59.3 40.4 6
46 District of ColumbiaFind homes › small sample 17 59.1 91.8 3
47 Rhode IslandFind homes › small sample 73 59.1 59.8 7
48 MissouriFind homes › 488 59 40.3 15
49 New MexicoFind homes › small sample 68 57.9 49.5 3
50 IllinoisFind homes › 667 55.8 52.1 65
51 TexasState guide › 1,176 55.4 37.9 29

A lower state average does not mean every home there performs poorly — strong facilities exist in every state. Averages are facility-weighted (each home counts once, regardless of size).

How these ratings are built — and what they can’t tell you

Each facility’s Care Safety Score (0–100) combines federal health-inspection citations, payroll-based staffing levels, resident-complaint volume, and CMS enforcement actions. The state figure is the average of those facility scores. Data was last refreshed in May 2026 from CMS and updates as new federal records are released.

What it can show: broad patterns — for example, where staffing tends to run thinner. What it can’t: whether a particular home is right for your family. Inspection and reporting practices vary by state, so cross-state comparisons are directional, not precise. Always compare individual facilities, recent inspections, staffing, and your location-specific needs before deciding.

Looking for individual homes instead of state averages? See the safest nursing homes by state directory.

Check any home

Look up a specific nursing home

State averages are a starting point. Search 14,000+ Medicare-certified facilities by name, city, or ZIP to see each home’s Care Safety Score, violations, staffing, and enforcement history.

Frequently asked questions

How are nursing homes rated by state on this page?
For each state we take every Medicare-certified nursing home and average its Care Safety Score — a 0–100 measure built from federal health-inspection citations, payroll-based staffing levels, resident complaint volume, and CMS enforcement actions. The state figure is the average of the individual facility scores, so each home counts once.
Does a higher state average mean a nursing home there is safe?
No. A state average describes a whole state, not any single home. Every state has strong and weak facilities, and the gap between homes within a state is usually far larger than the gap between states. Use these averages to understand broad patterns, then look up the specific homes you are considering.
Why is the top state one with very few nursing homes?
Smaller states and territories have fewer facilities, so their average can swing high or low on a handful of homes. That is why we show each state's facility count next to its score and flag states with fewer than 100 facilities. Among states with at least 100 facilities, Arkansas currently has the highest average.
How current is this data?
These rankings are built from CMS data last refreshed in May 2026 and are updated as new federal data is released — more recent than static reports or PDF briefs that can be a year or more old.
How do I check a specific nursing home?
Use the search box on this page to look up any U.S. nursing home by name, city, or ZIP. Each facility page shows its Care Safety Score, inspection citations, staffing, and enforcement history in plain English.