Nursing Home Staffing and Turnover
In the average American nursing home, 45.7% of the staff leave within a year. Among registered nurses it is 43.0%. That is the figure almost no family is given on a tour, and it is the one that quietly shapes everything else about a stay.
Turnover is not an abstraction when it is your mother. It is whether the person who helps her to the bathroom at two in the morning knows that she is frightened of being lifted, or is reading it off a chart for the first time. It is whether somebody notices she has gone quiet, because they remember what she is like when she is well. Continuity of care sounds like administrative language. In practice it is simply whether anyone in the building knows her.
These figures come from the federal staffing data every certified nursing home is required to report, drawn from payroll records rather than from what a home chooses to say about itself. We publish them here across all 11,848 reporting homes because the number is genuinely useful to a family and is genuinely hard to find.
Homes with high turnover have worse inspections
We grouped every reporting home by its annual staff turnover and looked at how those groups fared on the things CMS measures independently. The pattern holds at every single step, which is the part worth paying attention to. It is not one unusual group pulling the result.
| Annual staff turnover | Homes | Average overall ratingout of 5 | Average inspection ratingout of 5 | Average health deficiencies | Nurse hours per resident per day |
|---|---|---|---|---|---|
| Under 30% | 1,678 | 3.72 | 3.29 | 7.9 | 4.12 |
| 30 to 40% | 2,620 | 3.40 | 3.06 | 8.3 | 3.91 |
| 40 to 50% | 3,128 | 3.05 | 2.85 | 8.8 | 3.77 |
| 50 to 60% | 2,499 | 2.58 | 2.52 | 10.1 | 3.69 |
| 60 to 70% | 1,242 | 2.13 | 2.25 | 11.9 | 3.61 |
| 70% or more | 681 | 1.92 | 2.12 | 12.5 | 3.49 |
Homes that keep their staff, under 30% turnover in a year, average 3.72 stars and 7.9 health deficiencies. Homes replacing 70% or more of their staff average 1.92 stars and 12.5. There are 681 homes in that last group, and 27 of them report replacing every member of staff within the year.
What this does and does not prove
It would be easy to read the table above as turnover causing poor care, and we want to be careful here, because a family making a decision deserves better than a confident overstatement. These figures show that the two travel together closely and consistently. They cannot by themselves separate cause from effect, and the honest reading is that it runs both ways: a home that is short staffed and badly run is a hard place to work, and people leaving makes it harder still. A home can also be chronically understaffed on paper and still be a kind, careful place, and a few are.
What the figures do give you is a reliable signal. If you are comparing two homes and one replaces a third of its staff each year while the other replaces two thirds, you have learned something real about both, and you have learned it from payroll records rather than from a brochure.
Read the same thing from the other direction
Starting from the rating instead of the turnover gives the matching picture. The best rated homes in the country keep their people. The worst rated ones cannot.
| Overall rating | Homes | Average staff turnover | Average RN turnover | Nurse hours per resident per day |
|---|---|---|---|---|
| 5 stars | 2,319 | 37.1% | 31.0% | 4.29 |
| 4 stars | 2,252 | 42.7% | 37.7% | 3.88 |
| 3 stars | 2,330 | 45.3% | 42.1% | 3.75 |
| 2 stars | 2,449 | 48.2% | 47.4% | 3.63 |
| 1 star | 2,426 | 54.4% | 55.6% | 3.47 |
Five star homes average 37.1% turnover and 4.29 nurse hours per resident per day. One star homes average 54.4% and 3.47 hours. The gap in nursing time works out to roughly 49 extra minutes of nursing attention per resident per day.
Turnover by state
Where a home is matters more than most families expect. Missouri averages 55.9% turnover across its 361 reporting homes. DC averages 34.0%. That is a spread of 21.9 percentage points between the hardest and the steadiest places in the country to be a nursing home resident, and it tracks state wage levels, Medicaid reimbursement rates and staffing law closely.
States with fewer than five reporting homes are left out rather than shown with an average that one building could swing.
| State | Reporting homes | Staff turnover | RN turnover | Nurse hoursper resident per day | Average staffing ratingout of 5 | Average overall ratingout of 5 |
|---|---|---|---|---|---|---|
| Missouri | 361 | 55.9% | 48.1% | 3.35 | 2.21 | 2.52 |
| Texas | 840 | 55.8% | 55.3% | 3.37 | 1.92 | 2.64 |
| Vermont | 29 | 55.4% | 40.4% | 4.19 | 3.25 | 2.79 |
| Oklahoma | 208 | 55.1% | 52.9% | 3.76 | 2.84 | 2.78 |
| Montana | 51 | 54.6% | 47.8% | 4.08 | 3.70 | 3.00 |
| New Mexico | 50 | 53.1% | 54.3% | 3.45 | 2.88 | 2.92 |
| Utah | 67 | 52.0% | 41.2% | 3.75 | 2.98 | 3.20 |
| Idaho | 55 | 50.8% | 40.5% | 3.87 | 2.98 | 3.17 |
| Wyoming | 25 | 50.7% | 42.8% | 3.68 | 3.56 | 2.92 |
| Nebraska | 120 | 50.2% | 48.0% | 3.93 | 3.08 | 2.63 |
| North Dakota | 59 | 49.5% | 39.4% | 4.40 | 4.38 | 3.22 |
| North Carolina | 348 | 49.3% | 45.8% | 3.74 | 2.66 | 2.87 |
| Arkansas | 175 | 49.2% | 44.6% | 3.98 | 3.34 | 3.46 |
| Tennessee | 251 | 49.0% | 43.1% | 3.71 | 2.41 | 2.95 |
| Ohio | 757 | 48.9% | 44.4% | 3.62 | 2.37 | 3.07 |
| South Dakota | 79 | 48.4% | 34.8% | 3.78 | 3.59 | 2.94 |
| Kansas | 241 | 48.3% | 41.9% | 3.98 | 3.55 | 3.08 |
| Virginia | 244 | 48.0% | 48.6% | 3.71 | 2.40 | 2.90 |
| Oregon | 110 | 47.6% | 51.8% | 4.93 | 3.91 | 3.12 |
| Louisiana | 216 | 47.3% | 41.5% | 3.66 | 2.41 | 2.43 |
| Kentucky | 226 | 46.7% | 42.2% | 3.88 | 2.65 | 2.95 |
| Wisconsin | 260 | 46.7% | 39.8% | 4.09 | 3.55 | 2.90 |
| Colorado | 161 | 46.7% | 44.6% | 3.58 | 3.16 | 3.04 |
| Alabama | 197 | 46.5% | 38.9% | 3.87 | 3.71 | 3.03 |
| Georgia | 297 | 46.3% | 45.2% | 3.52 | 2.25 | 2.60 |
| Maine | 60 | 46.2% | 40.3% | 4.28 | 4.20 | 3.07 |
| Washington | 166 | 46.0% | 46.4% | 4.27 | 3.54 | 3.18 |
| Alaska | 9 | 45.9% | 48.0% | 6.67 | 4.50 | 3.22 |
| Indiana | 408 | 45.9% | 40.0% | 3.62 | 2.47 | 3.13 |
| South Carolina | 151 | 45.7% | 42.2% | 3.64 | 2.91 | 2.86 |
| Nevada | 40 | 45.4% | 45.7% | 3.73 | 3.21 | 2.74 |
| Mississippi | 167 | 45.4% | 38.1% | 4.09 | 3.86 | 2.69 |
| West Virginia | 76 | 45.2% | 41.8% | 3.54 | 2.43 | 2.72 |
| Illinois | 558 | 44.7% | 42.1% | 3.40 | 2.08 | 2.51 |
| Pennsylvania | 547 | 44.6% | 39.9% | 3.83 | 3.08 | 3.00 |
| Arizona | 103 | 44.2% | 43.1% | 3.77 | 2.86 | 3.31 |
| Michigan | 331 | 44.1% | 39.4% | 3.96 | 3.63 | 3.10 |
| Iowa | 319 | 44.0% | 42.2% | 3.77 | 3.70 | 3.08 |
| New Hampshire | 67 | 43.8% | 41.3% | 3.87 | 3.26 | 3.11 |
| Minnesota | 259 | 43.0% | 39.0% | 4.09 | 4.22 | 3.12 |
| Florida | 577 | 41.2% | 46.1% | 3.77 | 3.39 | 3.22 |
| Delaware | 35 | 40.9% | 41.5% | 4.37 | 4.00 | 2.97 |
| Rhode Island | 64 | 40.7% | 38.2% | 3.69 | 3.32 | 2.83 |
| New York | 521 | 40.6% | 40.1% | 3.59 | 2.82 | 3.04 |
| Maryland | 199 | 40.4% | 39.1% | 3.80 | 3.15 | 3.09 |
| New Jersey | 298 | 39.5% | 37.6% | 3.77 | 3.04 | 3.30 |
| Massachusetts | 282 | 38.3% | 42.8% | 3.78 | 3.05 | 3.02 |
| Connecticut | 174 | 37.8% | 39.1% | 3.69 | 3.18 | 2.99 |
| California | 957 | 36.7% | 38.3% | 4.46 | 3.42 | 3.21 |
| Hawaii | 38 | 34.4% | 29.4% | 5.04 | 4.46 | 3.68 |
| DC | 15 | 34.0% | 32.5% | 4.80 | 4.20 | 3.33 |
What to ask when you visit
You can get at most of this in a conversation, and how a home answers tells you nearly as much as the answer itself. A well run home will know these numbers and will tell you. Somewhere that becomes vague or defensive has told you something too.
- How many of the people working here today were working here a year ago? This is turnover in the only form that matters to your relative. Ask it about the aides specifically, since they give most of the hands on care.
- How often do you use agency staff? Agency nurses are often excellent and are also strangers. A home relying on them heavily is a home that cannot fill its own rota.
- Who will be looking after my mother at night, and at the weekend? Staffing thins out at both. The honest answer is sometimes uncomfortable, and you want to hear it now rather than in March.
- Can I meet the head of nursing? Administrator turnover is its own warning sign. If the role has changed hands three times in two years, nothing else is likely to be stable either.
- What is your nurse hours per resident per day? The national average is 3.81 hours, of which 0.66 hours is registered nurse time. A home well under that is stretched, whatever else it tells you.
Then check the home against the figures yourself. Every nursing home listing on this site shows that building's own ratings, staffing and inspection history, and links to the federal record so you can confirm it.
Where these numbers come from
All figures on this page are from the Centers for Medicare and Medicaid Services, which collects nursing home staffing from payroll based journal data and publishes it through Care Compare. Turnover is the share of staff who left over a twelve month period. Nurse hours are hours per resident per day, combining registered nurses, licensed practical nurses and nurse aides. Health deficiencies are citations from the most recent standard inspection and any complaint surveys that followed it.
We hold records for 12,819 certified nursing homes, of which 11,848 report turnover. The most recent inspection in this data is dated 24 July 2026. CMS republishes monthly and these pages follow it, so a figure you read here should match the federal record. Averages are unweighted means across homes, not weighted by bed count, so a large home and a small one count the same.
If you find a discrepancy between a figure here and the federal record, we would like to know. Tell us and we will correct it. Our data is only worth publishing if it is right.