States with the Lowest Nursing Home Staffing Ratios

Name: States with the lowest 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, Texas has the lowest median nurse staffing at 3.27 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.

Lower hours mean fewer nurse staff hours recorded per resident day. This is a public staffing metric, not a clinical judgment about any one facility.

Chart

Lowest median nurse staffing hours by state

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

Unit: Median HPRD

Lowest median nurse staffing hours by state
Label	Median HPRD
Texas	3.27
Illinois	3.29
Missouri	3.36
New Mexico	3.42
Georgia	3.44
Virginia	3.46
Colorado	3.47
West Virginia	3.48
New York	3.49
North Carolina	3.52
Indiana	3.55
Wyoming	3.56
South Carolina	3.57
Ohio	3.57
Rhode Island	3.58

Data table

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

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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

HPRD is a staffing input metric. It is not a bedside quality score by itself.

Case mix and specialty populations can change expected staffing needs.

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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