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 3.89 of total nurse staffing per resident-day in March 2026 (0.68 of it registered-nurse time), with nursing-staff turnover averaging 46.4% a year across the 14,703 certified facilities. See our methodology for how these figures are compiled.
How the average nursing day is staffed
Of the 3.89 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 26 states staffed above the 3.89 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.
U.S. states by average nurse-staffing hours vs. average CMS overall rating · states with ≥15 certified homes · March 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:
Citing this analysis
These staffing figures are compiled from the public-domain CMS Payroll-Based Journal (March 2026 release) and may be cited freely. Suggested attribution: "U.S. nursing home staffing levels, CMS Nursing Home Compare, March 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.
