Nursing home ratings and staffing by state: CMS averages
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Key takeaways
- CMS data covers 14,690 certified nursing homes in the 50 states, the District of Columbia, Guam and Puerto Rico. Texas has the most, with 1,177.
- The national average is 3.86 nursing hours per resident per day and an overall rating of 3.0 out of 5.
- Among states with at least 10 homes, average reported nurse staffing runs from 3.39 hours per resident per day in Texas to 6.88 in Alaska.
- Health inspection ratings are set within each state, so health inspection and overall star ratings are not a like-for-like comparison across states. Staffing and quality measure ratings use national cut points.
CMS publishes state averages for a range of nursing home measures, including star ratings, staffing, deficiencies, fines and each quality measure. This page puts the main ones in one table, from the CMS data processed Sep 1, 2026: 14,690 certified nursing homes in the 50 states, the District of Columbia, Guam and Puerto Rico. The numbers describe each state's homes as a group. To look at one home, search by name, city or ZIP code.
What are the national averages?
- Overall rating, out of 53.0
- Nurse hours per resident per day3.86
- Nursing staff who left in a year45.8%
- Health deficiencies, latest inspection cycle9.2
- Fines per home, past three years0.9
How does each state compare?
| State | Homes | Overall rating | Nurse hours | Turnover | Deficiencies | Fines per home |
|---|---|---|---|---|---|---|
| Alabama | 224 | 3.0 | 3.88 | 46.9% | 4.0 | 0.3 |
| Alaska | 20 | 3.4 | 6.88 | 50.4% | 9.0 | 0.6 |
| Arizona | 140 | 3.3 | 3.98 | 45.1% | 6.4 | 0.5 |
| Arkansas | 221 | 3.4 | 4.02 | 49.5% | 2.7 | 0.5 |
| California | 1,165 | 3.2 | 4.52 | 36.7% | 15.6 | 0.8 |
| Colorado | 210 | 3.2 | 3.72 | 47.1% | 8.7 | 1.1 |
| Connecticut | 191 | 3.0 | 3.73 | 37.4% | 13.4 | 0.9 |
| Delaware | 44 | 3.2 | 4.35 | 41.3% | 10.9 | 1.5 |
| District of Columbia | 17 | 3.4 | 4.72 | 34.0% | 23.2 | 1.2 |
| Florida | 694 | 3.3 | 3.82 | 41.4% | 7.1 | 0.8 |
| Georgia | 356 | 2.7 | 3.56 | 46.0% | 5.0 | 0.6 |
| Guam | 1 | 3.0 | 7.72 | 15.6% | 16.0 | 1.0 |
| Hawaii | 43 | 3.7 | 4.97 | 36.4% | 9.5 | 0.7 |
| Idaho | 80 | 3.2 | 4.04 | 50.3% | 10.3 | 0.5 |
| Illinois | 666 | 2.5 | 3.45 | 44.5% | 12.6 | 2.2 |
| Indiana | 507 | 3.1 | 3.69 | 45.9% | 7.2 | 0.3 |
| Iowa | 387 | 3.1 | 3.82 | 44.0% | 6.5 | 0.6 |
| Kansas | 296 | 3.1 | 4.07 | 48.1% | 9.5 | 1.1 |
| Kentucky | 267 | 3.0 | 3.95 | 46.4% | 2.9 | 0.7 |
| Louisiana | 265 | 2.6 | 3.76 | 47.6% | 6.4 | 0.9 |
| Maine | 78 | 3.1 | 4.34 | 46.7% | 10.8 | 0.4 |
| Maryland | 221 | 3.2 | 3.87 | 40.2% | 17.0 | 0.6 |
| Massachusetts | 341 | 3.0 | 3.86 | 38.2% | 6.8 | 0.8 |
| Michigan | 422 | 3.1 | 3.99 | 44.1% | 9.9 | 0.7 |
| Minnesota | 338 | 3.2 | 4.19 | 42.2% | 7.1 | 0.8 |
| Mississippi | 202 | 2.7 | 4.18 | 45.7% | 6.8 | 1.1 |
| Missouri | 487 | 2.5 | 3.43 | 56.0% | 11.4 | 0.8 |
| Montana | 61 | 2.9 | 4.05 | 54.8% | 11.2 | 1.5 |
| Nebraska | 180 | 2.8 | 3.98 | 48.7% | 7.4 | 0.4 |
| Nevada | 66 | 3.1 | 4.34 | 45.1% | 9.7 | 0.5 |
| New Hampshire | 73 | 3.0 | 3.90 | 44.1% | 4.0 | 0.5 |
| New Jersey | 348 | 3.3 | 3.85 | 39.7% | 8.6 | 0.7 |
| New Mexico | 68 | 2.9 | 3.54 | 53.3% | 17.9 | 1.3 |
| New York | 593 | 3.0 | 3.63 | 40.3% | 8.1 | 0.5 |
| North Carolina | 419 | 2.9 | 3.85 | 49.0% | 4.7 | 1.2 |
| North Dakota | 72 | 3.2 | 4.42 | 48.8% | 5.6 | 1.1 |
| Ohio | 922 | 3.2 | 3.69 | 48.7% | 10.5 | 0.6 |
| Oklahoma | 283 | 2.7 | 3.79 | 55.5% | 6.4 | 0.9 |
| Oregon | 128 | 3.1 | 5.03 | 47.4% | 9.2 | 0.8 |
| Pennsylvania | 656 | 3.0 | 3.89 | 44.5% | 10.0 | 0.8 |
| Puerto Rico | 9 | 3.0 | 3.80 | 35.7% | 7.3 | 0.2 |
| Rhode Island | 72 | 2.9 | 3.71 | 40.6% | 9.3 | 2.1 |
| South Carolina | 187 | 3.0 | 3.84 | 45.9% | 3.7 | 1.1 |
| South Dakota | 96 | 2.9 | 3.79 | 48.2% | 6.7 | 1.9 |
| Tennessee | 303 | 3.0 | 3.80 | 48.9% | 4.4 | 0.5 |
| Texas | 1,177 | 2.7 | 3.39 | 55.3% | 9.4 | 1.5 |
| Utah | 97 | 3.3 | 4.09 | 50.7% | 8.8 | 0.9 |
| Vermont | 33 | 2.9 | 4.22 | 55.4% | 7.9 | 1.3 |
| Virginia | 289 | 3.0 | 3.76 | 48.1% | 14.3 | 0.5 |
| Washington | 193 | 3.3 | 4.36 | 45.1% | 15.8 | 1.2 |
| West Virginia | 123 | 3.0 | 3.67 | 44.1% | 11.7 | 0.8 |
| Wisconsin | 323 | 3.0 | 4.21 | 46.9% | 9.5 | 0.9 |
| Wyoming | 36 | 2.9 | 3.87 | 51.8% | 7.8 | 1.2 |
| United States | 14,690 | 3.0 | 3.86 | 45.8% | 9.2 | 0.9 |
Source: CMS State US Averages file. Homes is this site's count of homes in the CMS Provider Information file. Each average is a simple average of the homes that reported data, so a state or territory with very few homes can show an unusual figure.
What does each column mean?
- Overall rating. The average of the homes' overall star ratings, from 1 to 5. See how the star ratings work.
- Nurse hours. Reported total nurse staffing hours per resident per day, counting registered nurses, licensed practical nurses and nurse aides. Homes report these hours to CMS from payroll records. See how much staffing is enough.
- Turnover. The share of nursing staff who left within a year.
- Deficiencies. Health deficiencies in the latest inspection cycle, which counts complaint and infection-control citations along with the standard inspection. See what the severity letters mean.
- Fines per home. The average number of fines over the past three years, across all homes in the state, fined or not.
Can you compare states with these numbers?
Some of them. Staffing hours and turnover come from the same payroll reporting in every state. Star ratings are different: CMS sets the health inspection rating by comparing each home with other homes in the same state (where a state or territory has fewer than five homes, it uses the national distribution), and that rating is the starting point for the overall rating. A state's average overall rating is therefore not a like-for-like comparison with other states. The staffing and quality measure ratings use national cut points.
Inspections are carried out by each state's own survey agency, and staffing rules differ by state. A state average describes the homes in that state as a group. It does not tell you about any one home.