Disclaimer: General educational research only — not legal, tax or financial advice. Rules differ by state and by family. Talk to an estate planning attorney in your state before you act.
Estate Planning Data & Research → Nursing Home Staffing by State
When a parent needs a nursing home, families usually compare location, cost and star ratings under time pressure. Staffing is one of the clearest numbers to check. Federal data shows U.S. nursing homes average 3.86 hours of nursing care per resident per day, and 45.8% of nursing staff turn over in a year.
This page shows nursing home staffing and turnover in every state and D.C., from the Centers for Medicare & Medicaid Services (CMS).
Choosing a facility goes more smoothly when the legal documents already exist. See how a trust and a will differ.
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Key findings
- U.S. nursing homes average 3.86 total nurse staffing hours per resident per day, including 0.69 registered nurse hours, according to CMS Care Compare state averages (processed Sept. 1, 2026).
- On weekends the average falls to 3.42 hours.
- Staffing is highest in Alaska (6.88), Oregon (5.03), Hawaii (4.97), District of Columbia (4.72), California (4.52), North Dakota (4.42). It is lowest in Texas (3.39), Missouri (3.43), Illinois (3.45), New Mexico (3.54), Georgia (3.56), New York (3.63).
- Average nursing staff turnover is 45.8%, highest in Missouri (56.0%), Oklahoma (55.5%), Vermont (55.4%), Texas (55.3%), Montana (54.8%) and lowest in District of Columbia (34.0%), Hawaii (36.4%), California (36.7%), Connecticut (37.4%), Massachusetts (38.2%).
Nursing home staffing by state
| State | Total nurse hours per resident per day | RN hours | Nurse aide hours | Weekend total hours | Nursing staff turnover (%) | RN turnover (%) |
|---|---|---|---|---|---|---|
| Alabama | 3.88 | 0.65 | 2.44 | 3.26 | 46.9 | 39.5 |
| Alaska | 6.88 | 2.12 | 4.06 | 6.09 | 50.4 | 48.4 |
| Arizona | 3.98 | 0.70 | 2.24 | 3.51 | 45.1 | 43.6 |
| Arkansas | 4.02 | 0.41 | 2.67 | 3.45 | 49.5 | 44.8 |
| California | 4.52 | 0.67 | 2.65 | 4.09 | 36.7 | 38.1 |
| Colorado | 3.72 | 0.82 | 2.21 | 3.29 | 47.1 | 44.6 |
| Connecticut | 3.73 | 0.69 | 2.22 | 3.37 | 37.4 | 38.6 |
| Delaware | 4.35 | 0.97 | 2.40 | 3.89 | 41.3 | 41.2 |
| District of Columbia | 4.72 | 1.46 | 2.66 | 4.31 | 34.0 | 32.5 |
| Florida | 3.82 | 0.73 | 2.31 | 3.49 | 41.4 | 46.0 |
| Georgia | 3.56 | 0.50 | 2.14 | 3.10 | 46.0 | 44.5 |
| Hawaii | 4.97 | 1.75 | 2.88 | 4.41 | 36.4 | 31.5 |
| Idaho | 4.04 | 0.86 | 2.44 | 3.49 | 50.3 | 40.9 |
| Illinois | 3.45 | 0.72 | 2.09 | 3.07 | 44.5 | 41.8 |
| Indiana | 3.69 | 0.67 | 2.24 | 3.25 | 45.9 | 40.3 |
| Iowa | 3.82 | 0.74 | 2.52 | 3.37 | 44.0 | 42.1 |
| Kansas | 4.07 | 0.71 | 2.70 | 3.60 | 48.1 | 42.0 |
| Kentucky | 3.95 | 0.79 | 2.36 | 3.49 | 46.4 | 41.8 |
| Louisiana | 3.76 | 0.31 | 2.27 | 3.21 | 47.6 | 41.6 |
| Maine | 4.34 | 1.05 | 2.83 | 3.92 | 46.7 | 40.2 |
| Maryland | 3.87 | 0.84 | 2.12 | 3.47 | 40.2 | 38.7 |
| Massachusetts | 3.86 | 0.65 | 2.25 | 3.48 | 38.2 | 42.6 |
| Michigan | 3.99 | 0.78 | 2.33 | 3.50 | 44.1 | 39.2 |
| Minnesota | 4.19 | 1.06 | 2.52 | 3.71 | 42.2 | 38.6 |
| Mississippi | 4.18 | 0.64 | 2.43 | 3.50 | 45.7 | 38.5 |
| Missouri | 3.43 | 0.46 | 2.29 | 3.01 | 56.0 | 47.8 |
| Montana | 4.05 | 0.98 | 2.57 | 3.59 | 54.8 | 48.3 |
| Nebraska | 3.98 | 0.67 | 2.64 | 3.48 | 48.7 | 44.1 |
| Nevada | 4.34 | 1.12 | 2.38 | 3.86 | 45.1 | 43.4 |
| New Hampshire | 3.90 | 0.78 | 2.34 | 3.47 | 44.1 | 40.9 |
| New Jersey | 3.85 | 0.68 | 2.23 | 3.50 | 39.7 | 37.7 |
| New Mexico | 3.54 | 0.63 | 2.20 | 3.10 | 53.3 | 53.6 |
| New York | 3.63 | 0.71 | 2.15 | 3.18 | 40.3 | 39.8 |
| North Carolina | 3.85 | 0.62 | 2.34 | 3.42 | 49.0 | 45.6 |
| North Dakota | 4.42 | 0.93 | 2.97 | 3.80 | 48.8 | 40.3 |
| Ohio | 3.69 | 0.64 | 2.09 | 3.28 | 48.7 | 43.9 |
| Oklahoma | 3.79 | 0.34 | 2.54 | 3.44 | 55.5 | 53.6 |
| Oregon | 5.03 | 0.72 | 3.40 | 4.51 | 47.4 | 51.6 |
| Pennsylvania | 3.89 | 0.79 | 2.19 | 3.53 | 44.5 | 39.9 |
| Rhode Island | 3.71 | 0.77 | 2.46 | 3.34 | 40.6 | 37.9 |
| South Carolina | 3.84 | 0.63 | 2.19 | 3.33 | 45.9 | 42.1 |
| South Dakota | 3.79 | 0.80 | 2.52 | 3.26 | 48.2 | 34.7 |
| Tennessee | 3.80 | 0.60 | 2.12 | 3.31 | 48.9 | 43.2 |
| Texas | 3.39 | 0.43 | 2.01 | 2.98 | 55.3 | 54.6 |
| Utah | 4.09 | 1.25 | 2.36 | 3.58 | 50.7 | 40.6 |
| Vermont | 4.22 | 0.80 | 2.54 | 3.66 | 55.4 | 39.9 |
| Virginia | 3.76 | 0.69 | 2.07 | 3.29 | 48.1 | 48.2 |
| Washington | 4.36 | 0.94 | 2.66 | 3.80 | 45.1 | 45.4 |
| West Virginia | 3.67 | 0.73 | 2.04 | 3.17 | 44.1 | 42.3 |
| Wisconsin | 4.21 | 0.99 | 2.58 | 3.77 | 46.9 | 39.7 |
| Wyoming | 3.87 | 0.94 | 2.43 | 3.37 | 51.8 | 44.1 |
Source: Centers for Medicare & Medicaid Services, Provider Data Catalog, “State US Averages” (dataset xcdc-v8bm), processing date Sept. 1, 2026. Hours are reported nurse staffing hours per resident per day from Payroll-Based Journal data; turnover is the share of nursing staff who left during the measurement year.
What families can do before a move
- Have a health care proxy and power of attorney in place. Someone needs legal authority to sign admission papers, talk with staff and manage bills. See the incapacity gap.
- Check the specific facility, not just the state. State averages hide wide differences between homes. Care Compare lists staffing for each facility.
- Know how the stay will be paid for. Medicaid may pay for long-term care, and many states seek repayment from the estate afterward. See Medicaid estate recovery by state.
Related: nursing home capacity by state · nursing home fines by state · who owns nursing homes
Methodology
CMS Provider Data Catalog dataset “State US Averages” (xcdc-v8bm), downloaded from the CMS datastore API on Oct. 14, 2026 (processing date Sept. 1, 2026). We report the state and national averages exactly as CMS publishes them, rounded to two decimals. Total nurse hours include registered nurses, licensed practical nurses and nurse aides. These are reported hours, not hours adjusted for how sick residents are.
What this doesn’t measure. Quality at any single facility, staffing by shift, or care outcomes.
Frequently asked questions
How many nursing hours does a resident get per day?
The U.S. average is 3.86 total nurse staffing hours per resident per day (CMS, Sept. 2026).
Which state has the most nursing home staffing?
Alaska, at 6.88 hours per resident per day.
Which state has the highest staff turnover?
Missouri, at 56.0%.
Is this legal advice?
No. Talk to an estate planning attorney in your state.
Sources
Public-domain government sources only. Fetched 2026-10-14.
Data
- Centers for Medicare & Medicaid Services, Provider Data Catalog, State US Averages (xcdc-v8bm): https://data.cms.gov/provider-data/dataset/xcdc-v8bm
Cite this data
Family Estate Guide, “Nursing Home Staffing by State,” October 2026. https://familyestateguide.com/estate-planning-data/nursing-home-staffing-by-state/
You’re welcome to reuse the table with a link back to this page. The underlying government data is public.
Published October 14, 2026 by Family Estate Guide. Data vintage: CMS Care Compare State US Averages, processed Sept. 1, 2026. Editorial standards.