Data study
How well staffed are American nursing homes?
Every certified nursing home in the country reports its nursing hours to Medicare from payroll records. We pulled all 14,685 of them. Three things stand out, and the one that gets the least attention is what happens on a Saturday.
CMS data released 14,685 homes, 50 states and DC How we check our data
Registered nurse hours, weekend vs overall
−31%
Median across 14,099 homes. 65.1% cut RN coverage by more than a quarter.
Homes below the staffing CMS expects
53.3%
7,518 of 14,107 homes, measured against each home's own residents. Median shortfall 13.25%.
Nursing staff turnover, median home
45.3%
36.6% of homes replace more than half their nursing staff in a year.
Staffing drops at the weekend, and registered nurses drop hardest
Residents do not need less care on a Saturday. In the median home, total nurse hours fall 11% at the weekend. Registered nurse hours, the most skilled cover in the building, fall 31%.
Still on the floor at the weekend Cover lost Whole bar = the home's overall level
−11% of its nursing cover
−31% of its nursing cover
59.7% of homes drop total nurse hours by more than a tenth at the weekend, and 65.1% cut registered nurse hours by more than a quarter. Only 0.4% hold staffing level or raise it. If you are choosing between homes, this is a fair thing to ask about directly: who is on the floor at 3pm on a Sunday, and how many of them are RNs.
More than half of homes staff below what CMS expects of them
A flat national target would be unfair, because a home full of high-dependency residents needs more nursing than one that is not. CMS handles this by publishing an expected level for each home, adjusted for how much care its own residents actually need. That makes the comparison like‑for‑like.
Measured that way, 53.3% of homes (7,518 of 14,107) fall short of their own expected level, by a median of 13.25%. This is not a measure of homes being below average. Half of anything is below average. It is a measure of homes below the bar set for them.
Where the typical home sits
The median home reports 3.69 nurse hours per resident per day. The spread is wider than the middle of the chart suggests: the best-staffed tenth of homes report 4.86 hours, the worst-staffed tenth 3.08, a gap of 1.6×.
See the numbers behind this chart
| Nurse hours per resident per day | Homes | Share |
|---|---|---|
| 0.5 to 1.0 | 7 | 0.0% |
| 1.0 to 1.5 | 10 | 0.1% |
| 1.5 to 2.0 | 39 | 0.3% |
| 2.0 to 2.5 | 126 | 0.9% |
| 2.5 to 3.0 | 857 | 6.1% |
| 3.0 to 3.5 | 4,122 | 29.2% |
| 3.5 to 4.0 | 4,273 | 30.3% |
| 4.0 to 4.5 | 2,378 | 16.9% |
| 4.5 to 5.0 | 1,125 | 8.0% |
| 5.0 to 5.5 | 565 | 4.0% |
| 5.5 to 6.0 | 254 | 1.8% |
| 6.0 to 6.5 | 121 | 0.9% |
| 6.5 to 7.0 | 59 | 0.4% |
| 7.0 or more | 171 | 1.2% |
For-profit homes are three times more likely to fall short
For-profit operators run 74.1% of American nursing homes. They are also where the staffing gap concentrates.
63.3% of for-profit homes staff below their expected level, against 20.4% of non-profits, a gap of 3×. The median for-profit home runs 3.59 nurse hours per resident per day; the median non-profit runs 4.23. Ownership is printed on every Care Compare listing, and it is one of the few things about a home you can check before you visit.
Staffing by state
State medians range from 5.02 nurse hours per resident per day in OR down to 3.27 in TX. Every state is listed below. States with fewer than 100 homes are marked, because a median over a dozen buildings is a real number and a poor ranking.
| State | Homes | Nurse hours per resident day | Weekend drop | Below expected | Turnover |
|---|---|---|---|---|---|
| AK small sample | 14 | 7.10 | 13% | 0% | 48% |
| OR | 122 | 5.02 | 11% | 0% | 46% |
| DC small sample | 16 | 4.77 | 10% | 25% | 35% |
| HI small sample | 41 | 4.48 | 12% | 32% | 31% |
| ND small sample | 67 | 4.38 | 13% | 8% | 48% |
| ME small sample | 72 | 4.23 | 9% | 21% | 49% |
| CA | 1,043 | 4.23 | 9% | 31% | 37% |
| WA | 186 | 4.15 | 13% | 40% | 44% |
| MN | 325 | 4.11 | 11% | 11% | 40% |
| WI | 318 | 4.08 | 10% | 38% | 46% |
| MS | 195 | 4.02 | 15% | 11% | 45% |
| VT small sample | 32 | 4.00 | 13% | 31% | 61% |
| DE small sample | 44 | 3.98 | 9% | 14% | 41% |
| AR | 216 | 3.94 | 14% | 7% | 48% |
| KS | 278 | 3.94 | 11% | 31% | 49% |
| NE | 168 | 3.93 | 12% | 26% | 48% |
| AL | 218 | 3.93 | 16% | 17% | 48% |
| MI | 413 | 3.87 | 12% | 30% | 44% |
| ID small sample | 78 | 3.82 | 14% | 60% | 49% |
| AZ | 136 | 3.80 | 12% | 55% | 46% |
| KY | 264 | 3.74 | 12% | 72% | 45% |
| NV small sample | 63 | 3.73 | 11% | 54% | 45% |
| MT small sample | 58 | 3.72 | 11% | 38% | 51% |
| MA | 334 | 3.72 | 10% | 58% | 39% |
| CT | 185 | 3.70 | 10% | 58% | 35% |
| LA | 249 | 3.69 | 14% | 41% | 47% |
| OK | 253 | 3.69 | 9% | 16% | 57% |
| IA | 372 | 3.69 | 11% | 30% | 43% |
| UT small sample | 92 | 3.66 | 12% | 72% | 53% |
| FL | 676 | 3.66 | 8% | 48% | 43% |
| MD | 217 | 3.66 | 10% | 69% | 41% |
| NH small sample | 69 | 3.65 | 11% | 51% | 45% |
| TN | 297 | 3.64 | 13% | 74% | 49% |
| PA | 637 | 3.63 | 9% | 55% | 45% |
| NJ | 342 | 3.63 | 9% | 59% | 40% |
| SD small sample | 94 | 3.62 | 14% | 38% | 50% |
| WY small sample | 34 | 3.62 | 13% | 44% | 50% |
| OH | 909 | 3.60 | 11% | 77% | 49% |
| RI small sample | 67 | 3.58 | 10% | 61% | 39% |
| SC | 182 | 3.56 | 12% | 50% | 46% |
| IN | 496 | 3.55 | 12% | 80% | 46% |
| NC | 405 | 3.51 | 11% | 62% | 49% |
| NY | 583 | 3.51 | 12% | 69% | 38% |
| WV | 120 | 3.49 | 13% | 75% | 43% |
| CO | 192 | 3.47 | 11% | 51% | 48% |
| VA | 285 | 3.45 | 12% | 73% | 48% |
| GA | 345 | 3.44 | 13% | 73% | 46% |
| MO | 460 | 3.37 | 12% | 61% | 56% |
| NM small sample | 66 | 3.34 | 12% | 59% | 52% |
| IL | 652 | 3.34 | 11% | 80% | 45% |
| TX | 1,127 | 3.27 | 11% | 80% | 52% |
How we calculated this
Every number here comes from the CMS Provider Data Catalog, dataset 4pq5-n9py, released June 2026. Staffing hours are from Payroll-Based Journal filings, which are drawn from payroll records rather than self-reported estimates.
- Every certified home is included. That is 14,685 homes across the 50 states and DC. Territories are excluded because they sit outside the state benchmarks every comparison here uses.
- 578 homes are left out of the staffing statistics because they report under 0.5 nurse hours per resident per day, which is a filing artifact rather than a staffing level.
- Medians, not averages. A handful of very high-staffed homes pull an average upward and describe nobody. Where the spread matters we show percentiles.
- "Below expected" compares each home to itself. CMS publishes a case-mix expected staffing level per home based on its own residents' care needs. We count a home as short when its reported hours fall under that figure.
- Nothing is estimated. Where CMS suppresses a value the home is dropped from that statistic, and the count beside each figure is the real denominator.
Source: CMS Provider Data Catalog — Nursing homes including rehab services: Provider Information, dataset 4pq5-n9py, released June 2026. Full method on our methodology page. The per-home extract behind these figures is kept in our repository so the numbers can be checked.