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DATA AS OF 2025Q4

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Data journalism · Staffing · ElderCareCosts Research

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 2025Q4, Alaska has the highest median nurse staffing at 6.84 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 2025Q4.

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

Chart

Highest median nurse staffing hours by state

Median total nurse HPRD (2025Q4). Higher bars mean more reported nurse hours per resident day.

Unit: Median HPRD

Highest median nurse staffing hours by state
Label	Median HPRD
Alaska	6.84
Oregon	5.01
District of Columbia	4.71
Hawaii	4.48
North Dakota	4.37
Maine	4.24
California	4.23
Washington	4.14
Minnesota	4.12
Wisconsin	4.08
Vermont	4.03
Mississippi	4.02
Kansas	3.95
Arkansas	3.94
Delaware	3.94

Data table

State median nurse HPRD (2025Q4), highest first
Rank	State	Facilities	Median HPRD	Average HPRD
1	Alaska	13	6.84	6.58
2	Oregon	125	5.01	5.07
3	District of Columbia	17	4.71	5.09
4	Hawaii	41	4.48	4.64
5	North Dakota	68	4.37	4.41
6	Maine	73	4.24	4.33
7	California	1,057	4.23	4.52
8	Washington	185	4.14	4.25
9	Minnesota	330	4.12	4.19
10	Wisconsin	320	4.08	4.18
11	Vermont	33	4.03	4.24
12	Mississippi	195	4.02	4.20
13	Kansas	286	3.95	4.07
14	Arkansas	219	3.94	4.09
15	Delaware	43	3.94	4.40
16	Alabama	221	3.93	3.93
17	Nebraska	172	3.91	4.07
18	Michigan	417	3.87	3.97
19	Idaho	79	3.83	4.08
20	Arizona	137	3.81	4.11
21	Nevada	65	3.81	4.34
22	Montana	59	3.74	3.96
23	Kentucky	266	3.74	3.99
24	Massachusetts	337	3.72	3.87
25	Oklahoma	272	3.71	3.83
26	Connecticut	191	3.70	3.81
27	Louisiana	253	3.70	3.83
28	Iowa	382	3.68	3.80
29	Utah	95	3.67	3.92
30	Florida	689	3.66	3.86
31	Maryland	219	3.65	3.89
32	New Hampshire	71	3.65	3.99
33	Tennessee	299	3.64	3.82
34	Pennsylvania	649	3.63	3.88
35	New Jersey	346	3.63	3.88
36	Wyoming	34	3.62	3.82
37	South Dakota	94	3.61	3.79
38	Rhode Island	70	3.61	3.72
39	Ohio	920	3.60	3.73
40	South Carolina	183	3.56	3.85
41	Indiana	502	3.55	3.69
42	New York	589	3.52	3.66
43	North Carolina	407	3.50	3.77
44	West Virginia	122	3.49	3.69
45	Virginia	289	3.45	3.77
46	Colorado	201	3.44	3.69
47	Georgia	349	3.44	3.58
48	Missouri	476	3.37	3.45
49	New Mexico	66	3.34	3.59
50	Illinois	656	3.34	3.48
51	Texas	1,154	3.27	3.39

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Source: CMS Payroll-Based Journal (PBJ) nurse staffing, 2025Q4. 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 2025Q4

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: ElderCareCosts Neon tables providers, organizations, provider_quality, provider_inspections (is_demo = false).

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