PlainNursing
CMS Nursing Home Compare · August 2026

States Ranked by Nursing Home Quality

According to the federal Centers for Medicare & Medicaid Services Nursing Home Compare program, average nursing-home quality varies widely from one state to the next across the 50-plus U.S. states and territories rated in the August 2026 release.

According to the federal Centers for Medicare & Medicaid Services Nursing Home Compare program, in the August 2026 release Hawaii leads the nation at an average 3.6 CMS stars across its 43 homes, while Missouri sits lowest at 2.5; the national average is 3.0 of 5.

All 53 states and territories are listed, but only the 51 with at least 15 certified homes carry a rank number, and the best/lowest call-outs count only those, so a one- or two-facility territory can't top or bottom the list. CMS also curves the overall star within each state; read it as context. Methodology.

3.6 ★
Highest-rated state - Hawaii
3.0 ★
Median of 51 qualifying states
2.5 ★
Lowest-rated state - Missouri

Highest-rated states

Hawaii3.56 ★Alaska3.45 ★Arkansas3.41 ★District of Columbia3.35 ★Arizona3.32 ★New Jersey3.31 ★Utah3.29 ★Delaware3.28 ★Florida3.27 ★Washington3.21 ★
The 10 highest-rated states by mean CMS overall star rating, among states with ≥15 certified homes · August 2026

Does heavier staffing buy a higher state rating?

You would expect the best-staffed states to be the best-rated. They are not. Because CMS force-curves the overall star within each state, 7 of the 29 states staffed above the national norm of 3.86 nurse hours per resident-day still land at or below the 3.0-star national-average rating. Each dot is a state; the crosshairs are the U.S. averages.

Top-rated on leaner staffingWell-staffed & top-ratedLean staffing, lower-ratedWell-staffed, rating curved down3.24.15.05.96.92.52.73.03.33.6Avg total nurse hours / resident-dayAvg CMS overall ratingHI, Avg total nurse hours / resident-day: 4.97 · Avg CMS overall rating: 3.56AK, Avg total nurse hours / resident-day: 6.69 · Avg CMS overall rating: 3.45AR, Avg total nurse hours / resident-day: 4.03 · Avg CMS overall rating: 3.41DC, Avg total nurse hours / resident-day: 4.76 · Avg CMS overall rating: 3.35AZ, Avg total nurse hours / resident-day: 3.97 · Avg CMS overall rating: 3.32NJ, Avg total nurse hours / resident-day: 3.85 · Avg CMS overall rating: 3.31UT, Avg total nurse hours / resident-day: 4.07 · Avg CMS overall rating: 3.29DE, Avg total nurse hours / resident-day: 4.34 · Avg CMS overall rating: 3.28FL, Avg total nurse hours / resident-day: 3.82 · Avg CMS overall rating: 3.27WA, Avg total nurse hours / resident-day: 4.37 · Avg CMS overall rating: 3.21ND, Avg total nurse hours / resident-day: 4.42 · Avg CMS overall rating: 3.2NV, Avg total nurse hours / resident-day: 4.3 · Avg CMS overall rating: 3.17CA, Avg total nurse hours / resident-day: 4.52 · Avg CMS overall rating: 3.16MN, Avg total nurse hours / resident-day: 4.19 · Avg CMS overall rating: 3.15OH, Avg total nurse hours / resident-day: 3.69 · Avg CMS overall rating: 3.15ID, Avg total nurse hours / resident-day: 4.04 · Avg CMS overall rating: 3.14IN, Avg total nurse hours / resident-day: 3.68 · Avg CMS overall rating: 3.14CO, Avg total nurse hours / resident-day: 3.72 · Avg CMS overall rating: 3.13MD, Avg total nurse hours / resident-day: 3.87 · Avg CMS overall rating: 3.13OR, Avg total nurse hours / resident-day: 5.03 · Avg CMS overall rating: 3.13MI, Avg total nurse hours / resident-day: 3.99 · Avg CMS overall rating: 3.12KS, Avg total nurse hours / resident-day: 4.07 · Avg CMS overall rating: 3.11ME, Avg total nurse hours / resident-day: 4.34 · Avg CMS overall rating: 3.09NH, Avg total nurse hours / resident-day: 3.9 · Avg CMS overall rating: 3.08IA, Avg total nurse hours / resident-day: 3.81 · Avg CMS overall rating: 3.07MA, Avg total nurse hours / resident-day: 3.86 · Avg CMS overall rating: 3.04NY, Avg total nurse hours / resident-day: 3.63 · Avg CMS overall rating: 3.03KY, Avg total nurse hours / resident-day: 3.95 · Avg CMS overall rating: 3.01SC, Avg total nurse hours / resident-day: 3.83 · Avg CMS overall rating: 3.01AL, Avg total nurse hours / resident-day: 3.88 · Avg CMS overall rating: 3TN, Avg total nurse hours / resident-day: 3.8 · Avg CMS overall rating: 3CT, Avg total nurse hours / resident-day: 3.73 · Avg CMS overall rating: 2.99WI, Avg total nurse hours / resident-day: 4.21 · Avg CMS overall rating: 2.98WV, Avg total nurse hours / resident-day: 3.66 · Avg CMS overall rating: 2.98PA, Avg total nurse hours / resident-day: 3.89 · Avg CMS overall rating: 2.97VA, Avg total nurse hours / resident-day: 3.76 · Avg CMS overall rating: 2.95NC, Avg total nurse hours / resident-day: 3.83 · Avg CMS overall rating: 2.93RI, Avg total nurse hours / resident-day: 3.71 · Avg CMS overall rating: 2.89WY, Avg total nurse hours / resident-day: 3.87 · Avg CMS overall rating: 2.89MT, Avg total nurse hours / resident-day: 4.05 · Avg CMS overall rating: 2.88SD, Avg total nurse hours / resident-day: 3.79 · Avg CMS overall rating: 2.88VT, Avg total nurse hours / resident-day: 4.22 · Avg CMS overall rating: 2.88NM, Avg total nurse hours / resident-day: 3.53 · Avg CMS overall rating: 2.85MS, Avg total nurse hours / resident-day: 4.18 · Avg CMS overall rating: 2.76NE, Avg total nurse hours / resident-day: 3.98 · Avg CMS overall rating: 2.75OK, Avg total nurse hours / resident-day: 3.79 · Avg CMS overall rating: 2.67TX, Avg total nurse hours / resident-day: 3.38 · Avg CMS overall rating: 2.65GA, Avg total nurse hours / resident-day: 3.56 · Avg CMS overall rating: 2.64IL, Avg total nurse hours / resident-day: 3.45 · Avg CMS overall rating: 2.55LA, Avg total nurse hours / resident-day: 3.73 · Avg CMS overall rating: 2.52MO, Avg total nurse hours / resident-day: 3.43 · Avg CMS overall rating: 2.51

U.S. states by average nurse-staffing hours vs. average CMS overall rating · states with ≥15 certified homes · August 2026

Source: CMS Nursing Home Compare (Provider Information + Payroll-Based Journal) As of August 2026

All 53 states and territories

# State Avg Rating Facilities 5-Star % 1-Star %
1 Hawaii (HI) 3.6 43 34.9% 7.0%
2 Alaska (AK) 3.5 20 35.0% 15.0%
3 Arkansas (AR) 3.4 221 29.4% 10.9%
4 District of Columbia (DC) 3.4 17 23.5% 5.9%
5 Arizona (AZ) 3.3 140 26.4% 7.9%
6 New Jersey (NJ) 3.3 348 22.4% 9.2%
7 Utah (UT) 3.3 97 23.7% 10.3%
8 Delaware (DE) 3.3 44 22.7% 2.3%
9 Florida (FL) 3.3 694 25.2% 13.1%
10 Washington (WA) 3.2 193 24.4% 13.0%
11 North Dakota (ND) 3.2 72 26.4% 19.4%
12 Nevada (NV) 3.2 66 27.3% 18.2%
13 California (CA) 3.2 1,165 23.4% 16.4%
14 Minnesota (MN) 3.1 338 26.3% 19.2%
15 Ohio (OH) 3.1 922 22.3% 13.2%
16 Idaho (ID) 3.1 80 23.8% 22.5%
17 Indiana (IN) 3.1 507 23.1% 17.8%
18 Colorado (CO) 3.1 210 21.4% 12.9%
19 Maryland (MD) 3.1 221 23.5% 15.4%
20 Oregon (OR) 3.1 128 22.7% 17.2%
21 Michigan (MI) 3.1 422 24.9% 18.5%
22 Kansas (KS) 3.1 296 25.0% 18.9%
23 Maine (ME) 3.1 78 23.1% 16.7%
24 New Hampshire (NH) 3.1 73 17.8% 15.1%
25 Iowa (IA) 3.1 387 24.0% 21.2%
26 Massachusetts (MA) 3.0 341 20.2% 19.6%
27 New York (NY) 3.0 593 22.9% 18.7%
28 Kentucky (KY) 3.0 267 19.9% 22.1%
29 South Carolina (SC) 3.0 187 21.4% 21.9%
30 Alabama (AL) 3.0 224 19.6% 18.8%
– Guam (GU) Only 1 certified home (a rank needs 15): shown, not ranked 3.0 1 0.0% 0.0%
– Puerto Rico (PR) Only 9 certified homes (a rank needs 15): shown, not ranked 3.0 9 22.2% 22.2%
31 Tennessee (TN) 3.0 303 19.5% 19.8%
32 Connecticut (CT) 3.0 191 22.0% 18.3%
33 Wisconsin (WI) 3.0 323 23.5% 21.4%
34 West Virginia (WV) 3.0 123 17.1% 21.1%
35 Pennsylvania (PA) 3.0 656 23.5% 21.8%
36 Virginia (VA) 3.0 289 19.4% 21.1%
37 North Carolina (NC) 2.9 419 19.1% 21.5%
38 Rhode Island (RI) 2.9 72 12.5% 16.7%
39 Wyoming (WY) 2.9 36 22.2% 22.2%
40 Montana (MT) 2.9 61 18.0% 23.0%
41 South Dakota (SD) 2.9 96 19.8% 20.8%
42 Vermont (VT) 2.9 33 9.1% 21.2%
43 New Mexico (NM) 2.9 68 20.6% 19.1%
44 Mississippi (MS) 2.8 202 16.3% 23.3%
45 Nebraska (NE) 2.8 180 18.9% 28.3%
46 Oklahoma (OK) 2.7 283 12.7% 26.5%
47 Texas (TX) 2.6 1,177 11.4% 27.3%
48 Georgia (GA) 2.6 356 14.3% 29.2%
49 Illinois (IL) 2.5 666 13.5% 37.1%
50 Louisiana (LA) 2.5 265 8.7% 34.0%
51 Missouri (MO) 2.5 487 10.9% 33.7%

Rows marked "not ranked" have fewer than 15 certified homes, too few for a state average to be compared with full-sample states. They keep their place by average rating but carry no rank number, and the state pages and call-outs use the same 15-home floor.

Using this ranking

State averages set the backdrop, placement decisions still turn on individual facility records.

  • Open your state to see every certified home, its sub-ratings, and penalty history. Browse a state
  • Because ratings are curved within each state, weigh a home against its own state, not the national list. Best-rated homes
  • Higher RN-hours and lower turnover track with better outcomes, scan those columns, not just the rating. How staffing works

State averages reflect facility mix and survey strictness as much as care quality; CMS refreshes the underlying data quarterly.