Nursing home ratings by state come from a single federal source: Medicare rates every certified nursing home in the country on a five-star scale built from health inspections, staffing levels and quality measures. This directory organises that data for all 14,666 Medicare-certified nursing homes across all 50 states, so you can see how your state compares before you look at any individual facility. Every figure below is reproduced from the CMS Provider Data Catalog dataset processed 2026-07-01 — nothing here is estimated or adjusted.
Click any state name below to see that state’s full breakdown, including its lowest-rated and highest-rated facilities, fines, staffing turnover and inspection history. Each state guide explains how nursing home ratings work in that state and which facilities sit at each end of the scale.
Quick Facts — U.S. Nursing Home Ratings by State (2026)
- 14,666 Medicare-certified nursing homes across the 50 states, of which 14,534 carry an overall star rating
- The national average overall rating is 2.99 of 5 stars — but ratings are scored within each state, so a 3-star home in one state is not directly comparable to a 3-star home in another
- 2,975 facilities are rated one star and 3,000 are rated five stars
- 88 facilities are in the CMS Special Focus Facility program, with 440 more listed as candidates — CMS treats these two groups differently
- 1,433 facilities currently carry the CMS abuse icon
- $462.8M in fines is recorded against nursing homes nationally
- Nursing staff turnover averages 46% nationally — the single quality signal most families never ask about
- 1,023 facilities (7% of the national total) have not had a standard health inspection in more than two years
Nursing Home Ratings by State — All 50 States Compared
The table below compares nursing home ratings by state across all 50 states. Here is what each column means:
Facilities = the number of Medicare-certified nursing homes CMS lists in that state.
Avg Rating = the average CMS overall star rating across every rated facility in the state, out of 5.
1-Star = how many facilities carry the lowest overall rating. CMS assigns one star to roughly the bottom fifth of homes in each state on health inspections.
Fines = total civil monetary penalties recorded against nursing homes in that state.
Notable = the most distinctive figure for that state in the current CMS data.
| State | Facilities | Avg Rating | 1-Star | Fines | Notable |
|---|---|---|---|---|---|
| Alabama | 224 | 3 | 43 | $3.2M | 86% not inspected in over 2 years |
| Alaska | 20 | 3.45 | 3 | $640,818 | Highest average rating in the country (3.45 stars) |
| Arizona | 140 | 3.38 | 9 | $1.2M | 29% of rated homes carry five stars |
| Arkansas | 221 | 3.47 | 23 | $2.0M | Highest average rating in the country (3.47 stars) |
| California | 1,165 | 3.17 | 189 | $29.5M | 6 facilities in the Special Focus program |
| Colorado | 210 | 3.12 | 28 | $5.4M | 52 facilities flagged for abuse citations |
| Connecticut | 191 | 3 | 34 | $4.4M | 46 facilities flagged for abuse citations |
| Delaware | 44 | 3.23 | 2 | $2.9M | 7 facilities flagged for abuse citations |
| Florida | 694 | 3.26 | 90 | $18.3M | $18.3M in recorded fines |
| Georgia | 356 | 2.68 | 100 | $5.1M | 20 facilities flagged for abuse citations |
| Hawaii | 43 | 3.68 | 3 | $883,868 | Highest average rating in the country (3.68 stars) |
| Idaho | 80 | 3.14 | 18 | $1.1M | 7 facilities flagged for abuse citations |
| Illinois | 667 | 2.56 | 241 | $75.9M | Among the lowest state averages (2.56 stars) |
| Indiana | 507 | 3.14 | 87 | $4.2M | 30 facilities flagged for abuse citations |
| Iowa | 388 | 3.09 | 82 | $6.9M | 12 facilities flagged for abuse citations |
| Kansas | 296 | 3.09 | 56 | $6.5M | 25% of rated homes carry five stars |
| Kentucky | 267 | 3.01 | 58 | $4.7M | 7 facilities flagged for abuse citations |
| Louisiana | 266 | 2.50 | 90 | $12.9M | Among the lowest state averages (2.50 stars) |
| Maine | 78 | 3.08 | 13 | $620,209 | 1 facilities flagged for abuse citations |
| Maryland | 221 | 3.12 | 33 | $5.1M | 31 facilities flagged for abuse citations |
| Massachusetts | 341 | 3.04 | 63 | $12.4M | 8 facilities flagged for abuse citations |
| Michigan | 422 | 3.10 | 77 | $13.8M | 63 facilities flagged for abuse citations |
| Minnesota | 338 | 3.18 | 64 | $7.7M | 27% of rated homes carry five stars |
| Mississippi | 202 | 2.75 | 49 | $3.9M | 17 facilities flagged for abuse citations |
| Missouri | 487 | 2.51 | 163 | $17.3M | Among the lowest state averages (2.51 stars) |
| Montana | 60 | 2.86 | 14 | $3.4M | Staff turnover averages 54.83% |
| Nebraska | 180 | 2.78 | 47 | $1.6M | 2 facilities flagged for abuse citations |
| Nevada | 66 | 3.26 | 11 | $880,552 | 31% of rated homes carry five stars |
| New Hampshire | 73 | 2.99 | 12 | $563,038 | 0 facilities flagged for abuse citations |
| New Jersey | 348 | 3.30 | 35 | $12.0M | 16 facilities flagged for abuse citations |
| New Mexico | 68 | 2.85 | 14 | $2.9M | 12 facilities flagged for abuse citations |
| New York | 594 | 3.04 | 108 | $14.0M | 18% not inspected in over 2 years |
| North Carolina | 419 | 2.93 | 89 | $15.7M | 37 facilities flagged for abuse citations |
| North Dakota | 72 | 3.17 | 14 | $2.0M | 28% of rated homes carry five stars |
| Ohio | 922 | 3.15 | 127 | $21.2M | 5 facilities in the Special Focus program |
| Oklahoma | 283 | 2.67 | 81 | $6.0M | Staff turnover averages 55.45% |
| Oregon | 128 | 3.12 | 21 | $3.4M | 12 facilities flagged for abuse citations |
| Pennsylvania | 656 | 2.98 | 140 | $16.9M | 4 facilities in the Special Focus program |
| Rhode Island | 72 | 2.92 | 12 | $4.9M | 8 facilities flagged for abuse citations |
| South Carolina | 187 | 3.01 | 39 | $2.7M | 10 facilities flagged for abuse citations |
| South Dakota | 96 | 2.86 | 19 | $3.1M | 9 facilities flagged for abuse citations |
| Tennessee | 303 | 2.96 | 61 | $7.4M | 18 facilities flagged for abuse citations |
| Texas | 1,177 | 2.65 | 312 | $57.0M | 6 facilities in the Special Focus program |
| Utah | 97 | 3.30 | 10 | $2.4M | 26% of rated homes carry five stars |
| Vermont | 33 | 2.88 | 6 | $3.1M | Staff turnover averages 55.43% |
| Virginia | 289 | 2.96 | 62 | $6.3M | 58% not inspected in over 2 years |
| Washington | 193 | 3.23 | 25 | $10.4M | 26% of rated homes carry five stars |
| West Virginia | 123 | 2.98 | 26 | $3.5M | 11 facilities flagged for abuse citations |
| Wisconsin | 323 | 2.99 | 65 | $13.8M | 20 facilities flagged for abuse citations |
| Wyoming | 36 | 2.97 | 7 | $795,320 | 26% of rated homes carry five stars |
How to Compare Nursing Home Ratings by State
There is a trap in the way nursing home ratings compare across state lines, and it is worth naming before you use the table above. CMS calculates the health inspection rating within each state, comparing every facility only against others in the same state. A five-star home in a state with weak overall performance is not necessarily better than a three-star home in a state with strong performance.
That makes state-level nursing home ratings useful for one thing and misleading for another. They are useful for spotting where enforcement, staffing and inspection patterns differ. They are not a ranking of which state has the best care, and they should never be used to compare two facilities in different states.
What does hold across state lines, unlike the nursing home ratings themselves, is the underlying detail: deficiency counts, fines, staffing hours per resident, turnover and whether a facility is in the Special Focus program. Those are absolute figures, not curved ones.
States With the Highest Average Nursing Home Ratings
Hawaii, Arkansas and Alaska carry the highest state averages in the current data, at 3.68, 3.47 and 3.45 stars respectively. Because ratings are curved within each state, a high average generally reflects a smaller spread between the strongest and weakest homes rather than uniformly better care.
States With the Lowest Average Nursing Home Ratings
Louisiana, Missouri and Illinois sit at the bottom of the state averages, at 2.50, 2.51 and 2.56 stars. A low state average is a reason to read individual inspection reports closely; it is not a verdict on any particular facility in that state.
The Largest State Systems
Texas (1,177 facilities), California (1,165) and Ohio (922) operate the largest numbers of certified nursing homes. Larger systems tend to show a wider spread of nursing home ratings, which means both the strongest and the weakest facilities in the country are concentrated in these states.
What Nursing Home Ratings Actually Measure
CMS nursing home ratings are a composite of three separate scores, and understanding the difference between them is the most useful thing a family can learn before touring a facility.
Health inspections are the backbone. State surveyors visit and record deficiencies, each with a scope and severity code showing whether a problem affected one resident or many, and whether it caused harm. This portion is gathered by outsiders, which makes it the most independent signal in the rating.
Staffing measures nursing hours per resident per day, adjusted for how sick the residents are. It now also incorporates turnover, which research consistently links to care quality more strongly than headcount alone.
Quality measures come from clinical data the facility reports about its own residents. When a home scores well on quality measures but poorly on inspections, the inspection result is the one to weigh more heavily.
Fines, Special Focus Facilities and Enforcement
Nursing home ratings sit alongside a ladder of enforcement actions CMS can take when a facility fails to meet federal requirements. It can impose civil monetary penalties, deny payment for new admissions, require additional oversight, and ultimately terminate the facility’s Medicare and Medicaid agreement.
Whatever a facility’s nursing home ratings, the Special Focus Facility program is the most serious ongoing designation short of termination. Facilities in the program have shown a persistent pattern of serious problems and are inspected roughly twice as often as other homes until they either improve or lose certification. Nationally 88 facilities are in the program.
CMS also maintains a separate candidate list, currently 440 facilities. A candidate has been identified as having a pattern that could warrant the program but has not been selected into it. The two categories are reported separately here because CMS treats them differently and conflating them would overstate what the data says about a facility.
The Inspection Gap Behind Some Nursing Home Ratings
Standard health inspections are meant to happen roughly every year. In practice, 1,023 facilities nationally — 7% of all certified nursing homes — are flagged by CMS as not having had a standard health inspection in more than two years.
This matters directly to how you read nursing home ratings. A rating built on an inspection from three years ago describes the facility as it was then, under whatever ownership, management and staffing it had at the time. Nursing homes change hands frequently, and a change of owner can reset the culture of a building without resetting its rating.
When you are comparing two facilities, the date of the last standard inspection deserves as much attention as the rating itself. Both are shown on each facility’s CMS listing.
How to Check Any Facility’s Record
Every figure behind these nursing home ratings comes from a public federal source you can search yourself. Medicare’s Care Compare tool holds the current record for every certified nursing home, including the full inspection reports behind each rating.
Three parts of the record behind any facility’s nursing home ratings repay careful reading. The inspection report lists each deficiency with its scope and severity code. The staffing detail shows hours per resident rather than raw headcount. The penalty history shows whether problems recurred after being cited once.
Then visit in person, ideally more than once and at different times of day. Federal data describes what surveyors found on specific dates. It cannot tell you whether call lights get answered at seven in the evening, or how staff speak to residents when no one is watching.
How to Report a Concern
Every state operates a Long-Term Care Ombudsman program that advocates for residents and accepts complaints confidentially, and every state has a survey agency that investigates formal complaints against facilities. You can find yours through the National Consumer Voice directory or the federal Eldercare Locator.
Complaints do more than resolve one situation, and they feed back into nursing home ratings. Complaint investigations feed directly into the health inspection rating, which is why complaint-driven deficiencies are tracked separately from routine ones in the federal data.
Find Your State Guide
Ready to look up nursing home ratings for your own state? Click any state name in the table above, or browse the full directory below.
Browse All 50 State Nursing Home Guides →
Official Sources
- CMS Provider Data Catalog: data.cms.gov — the nursing home provider dataset behind every figure on this page, processed 2026-07-01
- Medicare Care Compare: medicare.gov/care-compare — current ratings, full inspection reports and penalty history by facility
- National Consumer Voice: theconsumervoice.org — state Long-Term Care Ombudsman directory
- Eldercare Locator: eldercare.acl.gov — federal referral service for local aging services
Nursing home ratings by state compiled directly from the CMS Provider Data Catalog, processed 2026-07-01. CMS star ratings are comparative measures calculated within each state and are updated periodically, so a rating shown here may differ from the one currently displayed on Care Compare. Figures are reproduced without adjustment. Last reviewed July 2026.
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About this data. All figures are reproduced from the federal CMS Provider Data Catalog without adjustment. CMS star ratings are comparative measures within each state and are updated periodically. Nothing on this page establishes that any facility caused harm to any resident, and nothing here is legal or medical advice. Confirm any facility’s current standing directly with CMS before making a decision, and contact your state Long-Term Care Ombudsman or survey agency with concerns about a specific resident.