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 March 2026 release.
According to the federal Centers for Medicare & Medicaid Services Nursing Home Compare program, in the March 2026 release Hawaii leads the nation at an average 3.6 CMS stars across its 42 homes, while Louisiana sits lowest at 2.4; the national average is 3.0 of 5.
All 53 states and territories are ranked, but the best/lowest call-outs count only the 51 states with at least 15 rated homes, 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
- 2.4 ★
- Lowest-rated state - Louisiana
Highest-rated states
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, 6 of the 25 states staffed above the national norm of 3.89 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.
U.S. states by average nurse-staffing hours vs. average CMS overall rating · states with ≥15 certified homes · March 2026
All 53 states and territories
| # | State | Avg Rating | Facilities | 5-Star | 1-Star | Avg RN Hrs | Turnover |
|---|---|---|---|---|---|---|---|
| 1 | Hawaii (HI) | 3.6 | 42 | 15 | 2 | 1.63 | 36.5% |
| 2 | District of Columbia (DC) | 3.5 | 17 | 5 | 1 | 1.74 | 33.2% |
| 3 | Alaska (AK) | 3.5 | 20 | 6 | 3 | 2.15 | 46.8% |
| 4 | Arizona (AZ) | 3.4 | 140 | 43 | 10 | 0.71 | 47.7% |
| 5 | Arkansas (AR) | 3.4 | 221 | 62 | 27 | 0.40 | 50.5% |
| 6 | Utah (UT) | 3.3 | 97 | 25 | 10 | 1.19 | 51.7% |
| 7 | New Jersey (NJ) | 3.3 | 348 | 83 | 36 | 0.69 | 40.9% |
| 8 | Delaware (DE) | 3.3 | 44 | 11 | 4 | 1.03 | 41.8% |
| 9 | Florida (FL) | 3.2 | 694 | 167 | 101 | 0.73 | 42.3% |
| 10 | Washington (WA) | 3.2 | 194 | 47 | 27 | 0.88 | 46.7% |
| 11 | Ohio (OH) | 3.2 | 922 | 204 | 95 | 0.63 | 49.8% |
| 12 | Michigan (MI) | 3.2 | 423 | 107 | 65 | 0.78 | 44.4% |
| 13 | Minnesota (MN) | 3.2 | 338 | 86 | 64 | 1.06 | 42.4% |
| 14 | Puerto Rico (PR) | 3.2 | 9 | 0 | 1 | 2.91 | 33.5% |
| 15 | California (CA) | 3.1 | 1,162 | 280 | 188 | 0.65 | 38.1% |
| 16 | Colorado (CO) | 3.1 | 210 | 50 | 29 | 0.82 | 48.6% |
| 17 | Indiana (IN) | 3.1 | 507 | 114 | 91 | 0.66 | 47.0% |
| 18 | North Dakota (ND) | 3.1 | 72 | 17 | 14 | 0.93 | 49.0% |
| 19 | Idaho (ID) | 3.1 | 80 | 19 | 15 | 0.83 | 49.0% |
| 20 | Rhode Island (RI) | 3.1 | 73 | 15 | 12 | 0.77 | 40.4% |
| 21 | Nevada (NV) | 3.1 | 66 | 16 | 12 | 1.06 | 46.3% |
| 22 | Maryland (MD) | 3.1 | 221 | 53 | 35 | 0.81 | 40.6% |
| 23 | Iowa (IA) | 3.1 | 390 | 87 | 80 | 0.73 | 43.9% |
| 24 | New York (NY) | 3.0 | 596 | 138 | 118 | 0.70 | 40.5% |
| 25 | Wisconsin (WI) | 3.0 | 323 | 78 | 68 | 0.96 | 47.7% |
| 26 | Oregon (OR) | 3.0 | 128 | 24 | 20 | 0.68 | 49.1% |
| 27 | Alabama (AL) | 3.0 | 224 | 38 | 38 | 0.64 | 48.7% |
| 28 | South Carolina (SC) | 3.0 | 187 | 37 | 37 | 0.63 | 47.0% |
| 29 | Virginia (VA) | 3.0 | 289 | 55 | 61 | 0.69 | 48.4% |
| 30 | Montana (MT) | 3.0 | 61 | 10 | 12 | 0.94 | 55.6% |
| 31 | Massachusetts (MA) | 3.0 | 341 | 74 | 73 | 0.65 | 39.5% |
| 32 | Maine (ME) | 3.0 | 78 | 16 | 13 | 1.03 | 49.3% |
| 33 | Pennsylvania (PA) | 3.0 | 657 | 146 | 128 | 0.78 | 46.6% |
| 34 | Wyoming (WY) | 3.0 | 36 | 8 | 7 | 0.90 | 52.8% |
| 35 | Kansas (KS) | 3.0 | 297 | 55 | 64 | 0.71 | 49.5% |
| 36 | Tennessee (TN) | 3.0 | 303 | 51 | 59 | 0.61 | 48.7% |
| 37 | Connecticut (CT) | 3.0 | 191 | 40 | 39 | 0.70 | 37.9% |
| 38 | North Carolina (NC) | 2.9 | 418 | 81 | 87 | 0.59 | 50.4% |
| 39 | Kentucky (KY) | 2.9 | 268 | 41 | 60 | 0.77 | 46.7% |
| 40 | New Hampshire (NH) | 2.9 | 74 | 13 | 15 | 0.74 | 48.5% |
| 41 | South Dakota (SD) | 2.9 | 97 | 19 | 19 | 0.80 | 49.7% |
| 42 | Nebraska (NE) | 2.9 | 179 | 32 | 47 | 0.71 | 49.3% |
| 43 | Vermont (VT) | 2.9 | 34 | 5 | 6 | 0.81 | 59.6% |
| 44 | West Virginia (WV) | 2.8 | 123 | 17 | 27 | 0.71 | 43.1% |
| 45 | Texas (TX) | 2.8 | 1,177 | 154 | 269 | 0.44 | 51.5% |
| 46 | New Mexico (NM) | 2.8 | 68 | 12 | 16 | 0.62 | 53.0% |
| 47 | Oklahoma (OK) | 2.7 | 284 | 40 | 85 | 0.34 | 56.4% |
| 48 | Georgia (GA) | 2.6 | 356 | 50 | 102 | 0.49 | 46.5% |
| 49 | Mississippi (MS) | 2.6 | 202 | 28 | 53 | 0.63 | 47.8% |
| 50 | Illinois (IL) | 2.5 | 668 | 91 | 240 | 0.73 | 45.7% |
| 51 | Missouri (MO) | 2.5 | 487 | 54 | 158 | 0.46 | 57.0% |
| 52 | Louisiana (LA) | 2.4 | 266 | 23 | 94 | 0.32 | 48.0% |
| 53 | Guam (GU) | 1.0 | 1 | 0 | 1 | 2.55 | N/A |
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.