States with the Highest Nursing Home Staffing Ratios

Name: States with the highest nursing home staffing ratios
Creator: ElderCareCosts Research
License: https://www.eldercarecosts.com/editorial-standards/

Among states with at least 10 PBJ-reported nursing homes in period 2026Q1, Alaska has the highest median nurse staffing at 6.79 hours per resident day.

EDITORIAL STANDARDS

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What the numbers mean

Figures are CMS Payroll-Based Journal total nurse hours per resident day for period 2026Q1.

States with fewer than 10 reported facilities are omitted from the ranking.

Chart

Highest median nurse staffing hours by state

Median total nurse HPRD (2026Q1). Higher bars mean more reported nurse hours per resident day.

Unit: Median HPRD

Highest median nurse staffing hours by state
Label	Median HPRD
Alaska	6.79
Oregon	4.95
District of Columbia	4.84
Hawaii	4.61
North Dakota	4.37
California	4.24
Maine	4.18
Minnesota	4.16
Vermont	4.16
Washington	4.10
Wisconsin	4.04
Mississippi	4.00
Nevada	3.95
Kansas	3.94
Arkansas	3.91

Data table

State median nurse HPRD (2026Q1), highest first
Rank	State	Facilities	Median HPRD	Average HPRD
1	Alaska	15	6.79	6.55
2	Oregon	125	4.95	5.03
3	District of Columbia	16	4.84	4.85
4	Hawaii	41	4.61	4.81
5	North Dakota	70	4.37	4.42
6	California	1,141	4.24	4.52
7	Maine	78	4.18	4.34
8	Minnesota	335	4.16	4.20
9	Vermont	33	4.16	4.33
10	Washington	187	4.10	4.24
11	Wisconsin	322	4.04	4.20
12	Mississippi	198	4.00	4.18
13	Nevada	64	3.95	4.34
14	Kansas	291	3.94	4.06
15	Arkansas	218	3.91	4.03
16	Delaware	42	3.91	4.20
17	Montana	60	3.91	4.08
18	Nebraska	175	3.91	3.95
19	Alabama	223	3.89	3.88
20	Idaho	79	3.85	4.04
21	Michigan	418	3.80	3.99
22	Arizona	139	3.76	3.99
23	Kentucky	263	3.75	3.95
24	Connecticut	190	3.71	3.74
25	Utah	97	3.71	4.08
26	Massachusetts	339	3.70	3.87
27	Iowa	386	3.68	3.82
28	Oklahoma	270	3.67	3.79
29	Tennessee	302	3.64	3.80
30	New Hampshire	72	3.64	3.90
31	Florida	686	3.63	3.83
32	Pennsylvania	644	3.63	3.89
33	South Dakota	92	3.62	3.75
34	Louisiana	256	3.62	3.75
35	New Jersey	347	3.60	3.86
36	Maryland	219	3.60	3.87
37	Rhode Island	70	3.58	3.72
38	Ohio	917	3.57	3.68
39	South Carolina	186	3.57	3.84
40	Wyoming	35	3.56	3.87
41	Indiana	506	3.55	3.68
42	North Carolina	408	3.52	3.77
43	New York	590	3.49	3.63
44	West Virginia	122	3.48	3.67
45	Colorado	208	3.47	3.71
46	Virginia	287	3.46	3.78
47	Georgia	349	3.44	3.56
48	New Mexico	68	3.42	3.54
49	Missouri	476	3.36	3.42
50	Illinois	656	3.29	3.44
51	Texas	1,163	3.27	3.39

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Source: CMS Payroll-Based Journal (PBJ) nurse staffing, 2026Q1. Live figures on the data journalism hub.

Methodology

Metric: staffing_hours_per_resident_day from CMS PBJ.

State rank uses the median across facilities. States need at least 10 reported facilities.

Source: CMS Payroll-Based Journal (PBJ) nurse staffing · Updated 2026Q1

Limits

Higher HPRD is not automatic proof of better care.

Reporting quirks and low census can inflate some facility values.

Sources

CMS Payroll-Based Journal (PBJ) nurse staffing: Total nurse hours per resident day
CMS Nursing Home Provider Information: Nursing home directory rows, ownership type, and quality snapshot fields
Queryable cut: the ElderCareCosts provider, organization, quality, and inspection records behind this site (placeholder rows excluded).

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