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DATA AS OF 2025Q4

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Data journalism · Staffing · ElderCareCosts Research

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 2025Q4, 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 2025Q4.

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 (2025Q4). 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	3.34
New Mexico	3.34
Missouri	3.37
Georgia	3.44
Colorado	3.44
Virginia	3.45
West Virginia	3.49
North Carolina	3.50
New York	3.52
Indiana	3.55
South Carolina	3.56
Ohio	3.60
Rhode Island	3.61
South Dakota	3.61

Data table

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

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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

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

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