Key Findings

The Top 10

The highest ranked nursing home states include:

Rhode Island (1), New Hampshire (2), Maine (3), Vermont (4), Delaware (5), Florida (6), Hawaii (7), Arizona (8), Utah (9), and North Dakota (10).

The Bottom of the Barrel

The lowest ranked nursing home states that scored an overall failing grade include:

Texas (51), Oklahoma (50), Louisiana (49), Michigan (48), Missouri (47), Iowa (46), New York (45), Illinois (44), Georgia (43), Indiana (42), and New Mexico (41).

Winners and Losers

State nursing home rankings changed dramatically over the last year with 86 percent of states shifting position.  Highlights included:

  • Four of last year’s best nursing home states slid out of the top ten, including Alaska—2013’s highest ranked nursing home state—which plummeted to #16 overall.  The remaining states were Idaho, South Dakota, and Oregon.
  • States that climbed into the top ten were Vermont (4), Delaware (5), Florida (6), and Arizona (8).
  • Six states with the biggest gains in overall ranking were Nevada (17), California (16), District of Columbia (16), Arkansas (14), Arizona (13), and Kentucky (10).
  • South Dakota (-19), Alaska (-15), Oregon (-12), and Georgia (-11) suffered double-digit losses in their state nursing home rankings.
  • Seven state’s rankings did not change over the last year, Texas (51), Louisiana (50), Missouri (47), New York (45), Tennessee (38), Wisconsin (24), and North Dakota (10).

Staffing, Staffing, Staffing

The difference between quality nursing home care and subpar care boils down to an average of 22 extra minutes of direct care per resident daily.  But staffing numbers are widely considered to be inflated as the data are self-reported by facilities and are often unaudited by the states or by the Center for Medicare and Medicaid Services. The skewed data mean that consumers are given a fuzzy nursing home picture while residents have even fewer staff caring for them than is fully realized.  If states want better nursing home care for elderly and disabled residents, then the solution is simple: hire more qualified staff.

Deficiencies Abound

For the second consecutive year, nearly 90% of all nursing homes were cited a deficiency for violations of federal or state laws.

Widespread Abuse and Neglect Continues

Despite a marginal decrease in percentage of facilities with severe deficiencies, 20 percent of nursing homes abused, neglected, or mistreated residents in almost half of all states for the second consecutive year.

Advocates Repeatedly Identify Problems

States where ombudsmen verified the highest percentage (>95%) of identified complaints included:

Alaska (99.22%), Missouri (99.04%), District of Columbia (98.88%), and Massachusetts (96.20%).  In contrast, New Hampshire (34.21%), New Jersey (39.54%), and Nevada (40.02%) had the fewest (<45%) verified complaints.

Health Inspections Abysmally Low

Only one state achieved a majority percentage of above average nursing home inspections (District of Columbia).  The median percentage nationally was 42%, a 12% increase over the previous year.

Best State, Worst State by Category

CategoryBest StateWorst State
Professional Nurse HoursAlaska: 2 hours and 47 minutes per dayOklahoma: 1 hour and 14 minutes per day
Direct Care Staff HoursAlaska: 4 hours and 3 minutes per dayTexas: less than 2 hours and 12 minutes per day
Percentage of Facilities with Above Average Professional Nurse HoursMaine: 100 percentLouisiana: 8.78 percent
Percentage of Facilities with Above Average Direct Care Staff HoursMaine: 99.07 percentTexas: 13.92 percent
Percentage of Facilities with Above Average Health InspectionWashington, D.C.: 52.63 percentTexas: 22.95 percent
Percentage of Facilities with DeficienciesHawaii: 44.68 percent deficiency-free inspectionsAlaska: Zero deficiency-free inspections
Percentage of Facilities with Severe DeficienciesRhode Island: Less than 3 percentIdaho: 44.87 percent
Percentage of Verified Ombudsman ComplaintsNew Hampshire: 36 percentWyoming: 99.02 percent

Regional Perspective

As Table 1 shows, some state’s low scores may be indicative of wider regulatory problems that extend beyond individual state borders.

  • Best Regional Nursing Home Care: Northeast Region — Five of seven states scored an above average grade overall.
  • Worst Regional Nursing Home Care: Southwest Region — three of four states scored failing grades.
  • Biggest Regional Fall: Pacific Alaska Region — each state fell five or more spots in this year’s nursing home report card.

 Table 1-Regional Nursing Home Report Card

RegionABCDF
Central Plains1 (NE)1 (KS)2 (IA, MO)
Great Lakes1 (MN)1 (WI)1 (OH)3 (IL, MI, IN)
Mid-Atlantic1 (DE)2 (DC, NJ)4 (PA, WV, VA, MD)
Northeast4 (RI, NH, ME, VT)1 (MA)1 (CT)1 (NY)
Pacific2 (AZ, HI)1 (CA1 (NV)1 (NV)
Pacific Alaska3 (AK, ID, OR)1 (WA)
Rocky Mountain2 (UT, ND)1 (MT)3 (CO, WY, NM)1 (NM)
Southeast1 (FL)1 (SC)2 (AL, KY)2 (NC, TN)2 (MS, GA)
Southwest1 (AR)3 (LA, OK, TX)