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CMS Nursing Home Compare · Payroll-Based Journal · August 2026

U.S. nursing home staffing: levels, state rankings, and the quality link

According to the federal Centers for Medicare & Medicaid Services Payroll-Based Journal, the average U.S. nursing home reported 3.86 of total nurse staffing per resident-day in August 2026 (0.69 of it registered-nurse time), with nursing-staff turnover averaging 45.8% a year across the 14,690 certified facilities. See our methodology for how these figures are compiled.

How the average nursing day is staffed

Of the 3.86 of nursing care per resident-day, certified nursing assistants provide the bulk of hands-on hours, with licensed and registered nurses layered on top:

Does heavier staffing predict a higher rating?

Not as cleanly as you might expect. Because CMS force-curves the overall star within each state, 7 of the 29 states staffed above the 3.86 national norm 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

Best-staffed states

The 10 states with the highest average total nurse-staffing hours per resident-day, among states with at least 15 certified homes:

Alaska6.69 hrsOregon5.03 hrsHawaii4.97 hrsDistrict of Columbia4.76 hrsCalifornia4.52 hrsNorth Dakota4.42 hrsWashington4.37 hrsDelaware4.34 hrsMaine4.34 hrsNevada4.30 hrs
Top 10 states by average total nurse hours per resident-day · August 2026

Citing this analysis

These staffing figures are compiled from the public-domain CMS Payroll-Based Journal (August 2026 release) and may be cited freely. Suggested attribution: "U.S. nursing home staffing levels, CMS Nursing Home Compare, August 2026." For per-facility staffing, see any facility's record or the state quality rankings.

Source: Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare Payroll-Based Journal nurse staffing · 2026 Staffing is measured in hours per resident-day from payroll records; turnover is the annual rate. Updated quarterly by CMS.