Q4 2025 U.S. Nursing Home Staffing Rankings by State and Region

U.S. Nursing Home PBJ Staffing Rankings by State and Region (Q4 2025)

Rank	State	FacilitiesNursing Homes	Residents	SFFs & Candidates	Total HPRDTotal HPRD	RN HPRDRN HPRD	Nurse Aide HPRDNA	% Contract% Ctr	For ProfitFor-profit
Rank	State	FacilitiesNursing Homes	Residents	SFFs & Candidates	Total HPRDTotal HPRD	RN HPRDRN HPRD	Nurse Aide HPRDNA	% Contract% Ctr	For ProfitFor-profit	1	Alaska	13	558	—	5.80	1.76	3.41	14.5%	30.0%
2	Oregon	125	7,200	—	5.00	0.65	3.42	7.3%	85.2%
3	North Dakota	69	4,420	—	4.59	0.91	3.14	12.3%	5.6%
4	Hawaii	42	3,446	—	4.47	1.53	2.59	7.1%	59.5%
5	California	1,059	92,782	—	4.37	0.59	2.62	2.3%	86.9%
6	Maine	73	4,753	—	4.34	1.07	2.81	10.1%	71.8%
7	District Of Columbia	17	2,037	—	4.33	1.23	2.44	6.6%	41.2%
8	Washington	185	13,810	—	4.21	0.87	2.54	3.8%	79.4%
9	Minnesota	331	19,788	—	4.17	1.05	2.50	5.3%	30.5%
10	Wisconsin	320	17,464	—	4.16	0.94	2.56	9.2%	60.4%
11	Vermont	34	2,490	—	4.16	0.78	2.47	23.6%	66.7%
12	Delaware	43	3,877	—	4.13	0.79	2.32	5.6%	72.7%
13	Mississippi	195	14,478	—	4.10	0.58	2.43	5.3%	77.7%
14	Arkansas	219	16,881	—	4.10	0.38	2.76	1.9%	89.6%
15	Nebraska	172	9,502	—	4.09	0.68	2.71	7.1%	40.2%
16	Kansas	287	14,642	—	4.01	0.66	2.65	4.5%	58.6%
17	Arizona	137	11,658	—	3.99	0.64	2.30	2.5%	87.1%
18	Michigan	418	35,630	—	3.96	0.70	2.33	2.8%	77.1%
19	Alabama	221	21,670	—	3.93	0.62	2.52	0.8%	84.4%
20	Idaho	79	4,394	—	3.92	0.78	2.36	5.2%	82.5%
21	Nevada	65	6,022	—	3.90	0.83	2.16	2.9%	86.4%
22	Kentucky	267	21,645	—	3.89	0.70	2.39	3.4%	82.1%
23	New Hampshire	72	5,846	—	3.85	0.73	2.36	13.7%	61.6%
24	Massachusetts	337	33,129	—	3.81	0.62	2.24	5.3%	72.4%
25	Oklahoma	272	16,568	—	3.81	0.32	2.56	2.0%	88.7%
26	Iowa	384	20,084	—	3.80	0.71	2.53	4.6%	54.6%
27	South Dakota	95	4,887	—	3.80	0.81	2.52	9.7%	32.3%
28	Utah	95	5,792	—	3.79	1.06	2.24	2.9%	70.1%
29	Florida	689	74,208	—	3.79	0.70	2.31	1.1%	78.8%
30	Montana	59	3,293	—	3.78	0.84	2.41	9.4%	54.1%
31	Tennessee	299	24,813	—	3.77	0.56	2.13	3.6%	81.2%
32	Maryland	219	22,856	—	3.76	0.74	2.09	7.9%	81.4%
33	Connecticut	192	19,610	—	3.74	0.62	2.25	5.9%	80.1%
34	New Jersey	346	41,681	—	3.72	0.60	2.21	11.4%	82.5%
35	Pennsylvania	649	67,188	—	3.71	0.65	2.16	10.9%	63.0%
36	Louisiana	253	23,372	—	3.71	0.25	2.32	3.3%	80.8%
37	Rhode Island	71	6,875	—	3.68	0.70	2.45	5.5%	84.9%
38	Ohio	921	67,362	—	3.68	0.60	2.12	4.4%	84.6%
39	Indiana	502	36,214	—	3.64	0.61	2.26	3.3%	55.6%
40	North Carolina	407	35,489	—	3.64	0.52	2.27	8.1%	83.6%
41	South Carolina	183	16,801	—	3.62	0.52	2.13	6.3%	79.7%
42	Wyoming	34	1,959	—	3.61	0.85	2.29	6.0%	47.2%
43	New York	589	97,441	—	3.59	0.67	2.19	10.0%	69.1%
44	Virginia	289	28,480	—	3.57	0.54	2.03	5.8%	75.8%
45	West Virginia	122	9,564	—	3.56	0.64	2.03	3.9%	80.5%
46	New Mexico	66	5,602	—	3.55	0.60	2.23	13.1%	85.3%
47	Colorado	201	14,917	—	3.54	0.75	2.11	5.6%	83.3%
48	Georgia	349	31,160	—	3.53	0.46	2.14	3.3%	69.1%
49	Missouri	477	34,883	—	3.36	0.40	2.29	3.8%	79.3%
50	Texas	1,155	87,091	—	3.34	0.40	2.01	2.1%	70.7%
51	Illinois	657	62,156	—	3.30	0.65	2.00	5.2%	81.4%

Terms Explained

Residents: Total residents across all facilities in the state.

Contract %: Percentage of staffing hours provided by contract/temporary staff.

SFFs & Candidates: Special Focus Facilities (SFFs) are nursing homes with a history of serious quality issues. SFF Candidates are facilities being monitored for potential SFF designation.

Median: Shows the median value across all facilities (50% of facilities are above, 50% are below). Each facility counts equally regardless of size. Applies to states, CMS Regions, and national data.

Exclude Admin/DON: Excludes administrative and Director of Nursing hours from staffing calculations. Specifically excludes: RN Admin, RN DON, and LPN Admin hours. Averages are weighted by facility census (via total resident days), so larger facilities contribute more to the average than smaller facilities. Applies to states, CMS Regions, and national data.

Rankings: How state and regional ranks are calculated.

Q4 2025 U.S. Nursing Home Staffing Rankings by State and Region

U.S. Nursing Home PBJ Staffing Rankings by State and Region (Q4 2025)

Terms Explained

State SFF & Candidates

Terms Explained