PBJ stands for Payroll-Based Journal, the federal government’s system for tracking nursing home staffing. Every quarter, CMS publishes daily staffing data for nearly every nursing home in the country. PBJ320 compiles that data back to 2017 so you can see staffing levels and trends at the facility, state, and entity level.
In Q1 2026, CMS reported PBJ data for 14,487 facilities with a nationwide ratio of 3.75 Total Nurse hours per resident day (HPRD), including 0.62 RN and 2.26 nurse aide HPRD.
This page shows how states have fared, not just vs. each other, but vs. themselves over time. Head to PBJ320 to dive deeper into facility, state, and entity-level data, and check out the Special Focus Facilities list here.
Nursing Home PBJ State Staffing Trends, Q1 2026
PBJ320Biggest gains
| # | State | Q1 · yr | HPRD | 4Q Δ | 1Q Δ |
|---|---|---|---|---|---|
| 1 | Utah | 3.91+0.23 | 3.91 | +0.23 | +0.12 |
| 2 | Montana | 3.91+0.16 | 3.91 | +0.16 | +0.14 |
| 3 | Wisconsin | 4.19+0.13 | 4.19 | +0.13 | +0.02 |
| 4 | New Mexico | 3.52+0.09 | 3.52 | +0.09 | -0.04 |
| 5 | Mississippi | 4.09+0.08 | 4.09 | +0.08 | -0.01 |
Biggest declines
| # | State | Q1 · yr | HPRD | 4Q Δ | 1Q Δ |
|---|---|---|---|---|---|
| 1 | Oregon | 4.91-0.09 | 4.91 | -0.09 | -0.08 |
| 2 | Arizona | 3.87-0.09 | 3.87 | -0.09 | -0.12 |
| 3 | Washington | 4.21-0.09 | 4.21 | -0.09 | 0.00 |
| 4 | Colorado | 3.59-0.06 | 3.59 | -0.06 | +0.05 |
| 5 | Connecticut | 3.66-0.05 | 3.66 | -0.05 | -0.07 |
* Excludes states with fewer than 50 facilities.
State staffing rankings, Q1 2026
| 1 | Alaska | 5.73 | -0.07 | -0.43 | — | |
| 2 | Oregon | 4.91 | -0.08 | -0.09 | 2.46 | |
| 3 | Hawaii | 4.63 | +0.17 | +0.18 | — | |
| 4 | North Dakota | 4.57 | -0.02 | -0.04 | — | |
| 5 | District of Columbia | 4.43 | +0.10 | +0.41 | 3.56–4.16 | |
| 6 | California | 4.36 | 0.00 | +0.04 | 3.56 | |
| 7 | Maine | 4.35 | +0.02 | 0.00 | 3.02 | |
| 8 | Vermont | 4.25 | +0.09 | +0.18 | 3.06 | |
| 9 | Washington | 4.21 | 0.00 | -0.09 | 3.46 | |
| 10 | Minnesota | 4.19 | +0.02 | 0.00 | 2.06 | |
| 11 | Wisconsin | 4.19 | +0.02 | +0.13 | 2.06–3.31 | |
| 12 | Mississippi | 4.09 | -0.01 | +0.08 | 2.86 | |
| 13 | Delaware | 4.05 | -0.08 | -0.08 | 3.34 | |
| 14 | Arkansas | 4.05 | -0.05 | +0.02 | 3.42 | |
| 15 | Nebraska | 4.01 | -0.08 | -0.03 | — | |
| 16 | Kansas | 4.01 | 0.00 | +0.07 | 1.91–2.06 | |
| 17 | Michigan | 3.95 | -0.01 | +0.05 | 2.31 | |
| 18 | Montana | 3.91 | +0.14 | +0.16 | 1.90 | |
| 19 | Utah | 3.91 | +0.12 | +0.23 | — | |
| 20 | Idaho | 3.90 | -0.02 | -0.04 | 2.46 | |
| 21 | Alabama | 3.88 | -0.05 | +0.03 | — | |
| 22 | Nevada | 3.88 | -0.02 | +0.03 | — | |
| 23 | Arizona | 3.87 | -0.12 | -0.09 | — | |
| 24 | Kentucky | 3.85 | -0.03 | +0.01 | — | |
| 25 | New Hampshire | 3.85 | 0.00 | -0.02 | — | |
| 26 | Iowa | 3.80 | 0.00 | 0.00 | 1.76–2.06 | |
| 27 | Oklahoma | 3.79 | -0.02 | -0.01 | 2.92 | |
| 28 | Massachusetts | 3.79 | -0.02 | 0.00 | 3.64 | |
| 29 | Florida | 3.76 | -0.02 | -0.02 | 3.66 | |
| 30 | South Dakota | 3.76 | -0.04 | -0.01 | — | |
| 31 | Tennessee | 3.75 | -0.01 | 0.00 | 2.06 | |
| 32 | Maryland | 3.73 | -0.03 | +0.01 | 3.06 | |
| 33 | Pennsylvania | 3.69 | -0.03 | -0.01 | 2.76 | |
| 34 | New Jersey | 3.68 | -0.04 | +0.04 | 2.56 | |
| 35 | Rhode Island | 3.67 | -0.01 | -0.02 | 3.64 | |
| 36 | Connecticut | 3.66 | -0.07 | -0.05 | 3.06 | |
| 37 | North Carolina | 3.65 | +0.01 | +0.06 | — | |
| 38 | Louisiana | 3.64 | -0.06 | +0.01 | 2.41 | |
| 39 | Ohio | 3.64 | -0.04 | +0.02 | 2.56 | |
| 40 | Indiana | 3.63 | -0.02 | +0.02 | — | |
| 41 | South Carolina | 3.62 | -0.01 | 0.00 | 2.01 | |
| 42 | Wyoming | 3.61 | 0.00 | -0.10 | 1.56–2.31 | |
| 43 | Colorado | 3.59 | +0.05 | -0.06 | 2.06 | |
| 44 | Virginia | 3.58 | +0.01 | +0.08 | — | |
| 45 | West Virginia | 3.56 | 0.00 | +0.05 | 2.31 | |
| 46 | New York | 3.55 | -0.04 | -0.01 | 3.56 | |
| 47 | New Mexico | 3.52 | -0.04 | +0.09 | 2.56 | |
| 48 | Georgia | 3.50 | -0.03 | +0.02 | 2.06 | |
| 49 | Puerto Rico | 3.47 | -0.06 | -0.72 | — | |
| 50 | Missouri | 3.34 | -0.02 | +0.04 | — | |
| 51 | Texas | 3.33 | 0.00 | +0.02 | — | |
| 52 | Illinois | 3.26 | -0.04 | +0.02 | 2.56–3.86 |
Q1 2026 is Total Nurse HPRD (statewide hours ÷ resident days). State standard is a MACPAC-derived estimate when listed (floors under 1.0 HPRD omitted) — not a live legal citation (full table). vs prior qtr = change since Q4 2025. vs year ago = change since Q1 2025. Sparklines show the last four quarters. Full interactive map.