Best to Worst Nursing Home Ratings by State for Staffing and Abuse Understaffed nursing homes put America’s most vulnerable residents at risk. A new analysis of federal data covering more than 14,700 nursing homes across the country reveals stark differences among states for staff levels, abuse citations, and enforcement. Check nursing home ratings by state and get help if your loved one was harmed. Reviewed by Ricky A. LeBlanc, Esq. Managing Attorney, Sokolove Law Home / Nursing Home Abuse / Best to Worst Nursing Home Ratings by State for Staffing and Abuse 2026 State Rankings Statistics on the Worst & Best Nursing Homes by State in 2026 5 Safest States New Hampshire Alaska Alabama Minnesota Maine 5 Most At-Risk States Louisiana Texas Missouri Oklahoma Illinois Facilities analyzed 14,700 nationwide On CMS Special Focus list 528 facilities Below federal RN minimum 44% of all homes Carry CMS Abuse Icon flag 1 in 10 facilities Avg annual staff turnover 46% of workforce Louisiana avg RN hrs/day 0.31 (min: 0.55) The Rankings: All 50 States Rated for Nursing Home Staffing and Abuse Our team examined nursing home abuse and neglect citations, staffing levels, enforcement actions, and penalty records for long-term care facilities nationwide. This was done using data from the CMS Care Compare database, which contains records for over 14,700 nursing home facilities. We used 4 data points to rank each state: Abuse and neglect citations: We counted the number of citations each facility received and weighted them by severity. For example, “Immediate Jeopardy” citations noted in CMS data counted more than less serious citations. Registered nurse (RN) staffing deficits: We measured how far facilities fell below the 0.55 RN hours per resident per day standard set in CMS’s 2024 staffing rule. Staff turnover: We factored in annual nursing staff turnover because higher rates can be a sign of instability and inconsistent care. Abuse Icon and SFF Status: We gave more weight to facilities flagged by CMS for abuse or neglect citations or chronic underperformance. Each facility received a score based on these factors. States were then ranked and graded by the average score across all facilities within each specific state. This way, larger states were not unfairly penalized. Lower scores and higher grades mean safer states. Nursing Home Safety Rankings: All 50 States Each state is graded A–F on staffing levels, abuse citations, turnover, and enforcement flags. Lower score = safer for residents. The full ranking A Excellent Scores 18.11 – 23.85 1New Hampshire18.11 2Alaska18.71 3Alabama20.02 4Minnesota20.71 5Maine21.01 6Hawaii22.62 7Kentucky22.62 8Nebraska22.86 9North Dakota22.90 10Florida23.21 11Iowa23.85 B Above average Scores 24.04 – 27.64 12Idaho24.04 13Wisconsin24.08 14Indiana25.28 15New York26.24 16Tennessee26.44 17South Dakota26.67 18Utah26.79 19New Jersey27.28 20Nevada27.60 21Massachusetts27.64 C Average Scores 27.70 – 29.24 22Wyoming27.70 23Rhode Island27.89 24Arizona27.93 25Pennsylvania27.96 26Mississippi28.10 27Maryland28.25 28Ohio28.71 29Kansas28.80 30Michigan29.22 31Colorado29.24 D Below average Scores 29.27 – 32.99 32Delaware29.27 33South Carolina29.70 34Connecticut29.85 35Oregon30.01 36Vermont30.13 37Washington30.95 38Montana31.78 39West Virginia32.12 40California32.78 41North Carolina32.99 F Most at risk Scores 33.48 – 50.39 42Washington, D.C.33.48 43Georgia34.04 44Virginia34.92 45Arkansas35.92 46New Mexico40.84 47Illinois41.67 48Oklahoma45.22 49Missouri46.18 50Texas47.22 51Louisiana50.39 Safest: New Hampshire, 18.11 Most at risk: Louisiana, 50.39 Source: CMS Care Compare data, 14,700+ facilities. Composite score reflects citations, staffing, turnover, and enforcement flags. Lower score = safer state. In all, 11 states earned an A grade in our analysis. These states typically had stronger staffing levels, fewer abuse and neglect citations per facility, and lower rates of federal penalties. They show that protecting nursing home residents is achievable, regardless of state size or geography. A total of 19 states and Washington, D.C., received a D or F grade. These worst nursing homes by state had major problems with understaffing, abuse, and neglect. If your loved one lives in one of these states, it is key to review their facility’s records, ask questions about staffing levels, and look into any recent inspections. Top 5 Worst Nursing Home States The 5 worst states for nursing home care in our analysis were Louisiana, Texas, Missouri, Oklahoma, and Illinois. These states recorded the poorest nursing home grades by state per facility, driven by factors like major staffing shortfalls, numerous abuse and neglect citations, and major federal punishments. AVG RN HOURS / DAY FED MIN 0.55 STATE AVG RN HOURS / DAY FEDERAL MIN 0.55 BELOW MIN ABUSE FLAG TURNOVER Louisiana Rank #51 0.31 BELOW MIN 88% ABUSE FLAG 8.3% TURNOVER 47.0% Texas Rank #50 0.42 BELOW MIN 79% ABUSE FLAG 13.3% TURNOVER 56.4% Missouri Rank #49 0.46 BELOW MIN 73% ABUSE FLAG 13.1% TURNOVER 56.4% Oklahoma Rank #48 0.33 BELOW MIN 85% ABUSE FLAG 10.06% TURNOVER 56.0% Illinois Rank #47 0.72 BELOW MIN 41% ABUSE FLAG 29.5% TURNOVER 45.0% Louisiana — Rank 51 (Worst Overall) Louisiana ranks last in the country for nursing home care. The state’s nursing homes average just 0.31 RN hours per resident per day, less than half the 0.55-hour federal minimum, and 88% of all facilities fall below that threshold. No other state comes close to this level of systematic understaffing. Notable example: Legacy Nursing at St. Christina in Pineville carries a CMS Abuse Icon flag, has accumulated 27 health citations, and has been fined more than $656,000. The facility’s RN hours per resident per day sit at just 0.083, an average of just 5 minutes per resident, one of the lowest figures recorded in the nation. Texas — Rank 50 Texas has the second-worst score in the country, driven by severe understaffing and a higher share of facilities on CMS’s most serious watch lists. Nearly 79% of Texas nursing homes fall below federal RN minimums, and the state has multiple facilities among the nation’s worst individual performers. Notable example: Coral Rehabilitation and Nursing of Austin carries a CMS Abuse Icon flag and has reported 80 deficiencies in the last 3 years. Williamsburg Village Healthcare Campus in DeSoto is flagged as a Special Focus Facility Candidate and carries an Abuse Icon alongside 34 health citations and $126,386 in fines. Missouri — Rank 49 Missouri shows a pattern of serious, repeated violations. Roughly 73% of facilities are below the federal RN minimum staffing hours, with an average of just 0.46 RN hours per resident per day. Several Missouri facilities also ranked among those with the most care violations in the country, with citation tallies that far exceed the national average. Notable example: North Village Park in Moberly has recorded 46 health violations with over $526,000 in fines levied. Heritage Care Center in St. Louis had 25 health violations and more than $424,000 in fines. Both facilities carry an Abuse Icon flag and are designated Special Focus Facility Candidates by CMS. Oklahoma — Rank 48 Oklahoma ranks among the worst states largely due to its staffing crisis. Roughly 85% of facilities fall below the federal RN minimum, with average RN hours of just 0.33 per resident per day — the second-lowest in the country. Staff turnover averages 56%, meaning more than half the nursing workforce cycles out every year. Notable example: Wewoka Healthcare Center carries a CMS Abuse Icon flag, is designated an active SFF, and has recorded 19 health citations and nearly $387,000 in fines. Park Place Healthcare and Rehab in Oklahoma City is also an active SFF, with a 90.7% annual staff turnover rate. Illinois — Rank 47 Generally, the average RN hours per resident per day in Illinois sit above the federal minimum at 0.72. However, nearly 30% of all Illinois nursing homes carry a federal CMS Abuse Icon flag, a designation that requires documented patterns of abuse or neglect. No other state comes close to this rate. Only 10% of facilities nationwide receive this icon. Notable example: La Bella of Danville has accumulated over $406,000 in fines related to care issues. Archer Heights Healthcare in Chicago carries an Abuse Icon and has accrued nearly $597,000 in penalties. Top 5 States With the Best Nursing Homes The 5 safest states in our analysis were New Hampshire, Alaska, Alabama, Minnesota, and Maine. These states demonstrated meaningfully higher staffing levels, fewer citations, and lower rates of abuse and neglect. AVG RNHOURS / DAY FED MIN 0.55 STATE AVG RN HOURS / DAY FEDERAL MIN 0.55 BELOW MIN ABUSE ICON TURNOVER New Hampshire Rank #1 — Safest 0.81 BELOW MIN 16.4% ABUSE ICON 0.0% TURNOVER 46.1% Alaska Rank #2 2.08 BELOW MIN 0.0% ABUSE ICON 5.0% TURNOVER 47.2% Alabama Rank #3 0.65 BELOW MIN 33.9% ABUSE ICON 7.1% TURNOVER 48.0% Minnesota Rank #4 1.07 BELOW MIN 5.3% ABUSE ICON 5.6% TURNOVER 42.5% Maine Rank #5 1.04 BELOW MIN 2.6% ABUSE ICON 1.3% TURNOVER 48.7% New Hampshire — Rank 1 (Safest Overall) New Hampshire ranks first in the country. It is the only state where 0% of facilities carry a CMS Abuse Icon flag. New Hampshire facilities averaged just under five abuse and neglect citations per facility, which is among the lowest nursing home rates by state nationally. Its RN staffing hours average nearly 50% above the federal minimum. Alaska — Rank 2 Alaska leads the nation in RN staffing levels, with an average of 2.08 RN hours per resident per day, more than 3 times the federal minimum. No Alaska facilities fell below the 0.55-hour RN threshold. Its relatively small number of facilities and high proportion of government-run homes both play big roles in stronger oversight and accountability. Alabama — Rank 3 The strong rankings in Alabama are driven by one of the lowest citation rates in the country, at just 3.8 citations per facility compared to a national average of 13.2. Alabama benefits from a relatively consistent inspection record and fewer facilities with serious enforcement issues or flags. Minnesota — Rank 4 Minnesota averages more than 1.07 RN hours per resident per day, nearly double the federal minimum. Additionally, only 5.3% of facilities in the state fall below the threshold. The state has consistently invested in nursing home oversight regulations and has one of the more active state inspection programs in the Midwest. Maine — Rank 5 Maine earns its ranking through strong RN staffing numbers, averaging over 1.04 hours per resident per day. Also, just 1.3% facilities in the state were flagged with Abuse Icons. The smaller total number of facilities in Maine makes per-facility oversight more manageable, and its inspection record reflects relatively consistent compliance. 4 Key Factors Affecting Nursing Home Rankings by State The gap between the best and worst states is not random. Differences in how states fund, staff, and oversee their nursing home industries drive the outcomes residents experience every day. The 4 most significant factors in our analysis were RN staffing hours, staff turnover rates, state funding through Medicaid, and for-profit ownership. Learn more about each below. 1. RN Staffing Hours Per Resident Per Day In 2024, CMS finalized a landmark rule establishing national safe staffing standards for nursing homes for the first time in history. Under the CMS rule, nursing homes were required to provide at least: 0.55 RN hours per resident per day 2.45 nurse aide hours per resident per day A total nurse staffing minimum of 3.48 hours per resident per day Those federal minimum staffing requirements were later repealed. However, our analysis found that 44% of facilities across the country fall below the basic nursing home staffing requirements by state set in the 2024 rule. In Louisiana, Oklahoma, and Arkansas, the problem is dramatically worse: more than 80% of facilities in these states fail to meet the standard. When there are too few registered nurses on a floor, residents may wait longer for medication or wound care, might not receive prompt help for a fall, and may be at greater risk of neglect or abuse. 2. Staff Turnover Rates The national average annual turnover rate for nursing home staff is 46.2%. In Missouri, Oklahoma, and Vermont, it exceeds 56%. Some individual facilities in our data reported turnover rates above 90%. High turnover and understaffing are both symptoms and causes of poor care. Facilities with chronic understaffing struggle to retain qualified staff, meaning residents are cared for by workers who do not know their routines, medical histories, or preferences. Research has consistently linked high turnover to increased rates of neglect, medication errors, and preventable hospitalizations. 3. State Funding and Medicaid Reimbursement States that set higher Medicaid reimbursement rates for nursing home care give facilities more resources to retain qualified staff and invest in resident safety. The worst states in our ranking often had lower reimbursement rates, signaling that their nursing homes weren’t eligible for additional compensation needed to provide the best possible care to older adults. 4. For-Profit Ownership Across our dataset, for-profit facilities, which account for the large majority of nursing homes in most states, tend to have lower staffing levels and higher citation rates than government-run ones. For-profit nursing homes may potentially try to save money by limiting staff, delaying facility improvements, or hiring inexperienced workers. All of these factors can potentially make nursing homes less safe. In states with weak reimbursement structures as well as high concentrations of for-profit nursing homes, neglect and abuse are more likely to occur and less likely to be caught. Expert Panel QuestionIn your experience, what is the relationship between nursing home staffing levels and the likelihood of abuse or neglect occurring?Charlene Harrington, PhD, RN, FAANProfessor Emeritus, UCSF School of Nursing“There are over 125 research studies showing that higher nurse staffing — especially RN staffing — improves resident outcomes. In my experience and based on the research, low staffing is directly related to abuse and neglect of residents. Research conducted by the Centers for Medicare & Medicaid Services in 2000 found that nursing homes should have a minimum of 4.1 total nursing hours per resident day, including 0.75 RN hours per resident day — a standard that has been confirmed by expert panels and additional research studies over the past 26 years.” Eilon Caspi, PhDOwner and Director, Dementia Behavior Consulting LLC“Low staffing levels are a recipe for neglect and abuse that often causes deep psychological trauma, serious physical injuries, and deaths of vulnerable elders living in nursing homes. The well-funded industry’s lobby has been blocking decades-long attempts by elder care advocacy groups to pass meaningful staffing level requirements that, along with adequate staff education and guidance from nursing leadership, would have prevented the majority of these incidents and ensured the dignity and safety of these individuals. It is time that lawmakers wake up, do their job, and put a stop to it.” ×Eilon Caspi, PhDOwner and Director, Dementia Behavior Consulting LLCWebsiteLinkedInAboutEilon Caspi, PhD, has been working in the aging field for 32 years, starting as a nurse aide in a nursing home where his grandfather lived. Since then, he has worked as a social worker, educator, author, dementia behavior consultant, applied researcher, and data-driven elder care advocate. Throughout the past 18 years, he has led several research studies to improve understanding and the prevention of various forms of elder mistreatment in long-term care homes. He is the author of an award-winning book on the prevention of injurious and deadly resident-to-resident incidents in the context of dementia in long-term care homes (Health Professions Press): https://www.healthpropress.com/product/understanding-and-preventing-harmful-interactions-between-residents-with-dementia He is the owner and director of Dementia Behavior Consulting LLC, based in West Hartford, Connecticut, and a founding member and advisor for Elder Voice Advocates, Minnesota. Eilon is the recipient of the 2025 Janet Wells Public Policy Leadership Award from the National Consumer Voice for Quality Long-Term Care. Ricky LeBlanc, Esq.Nursing Home Abuse Lawyer, Sokolove Law“In many cases, understaffing in long-term care facilities directly contributes to nursing home abuse and neglect. When there aren’t enough caregivers, residents don’t get the attention they need. Problems like missed medications, untreated bedsores, and falls then start to happen.” ×Ricky LeBlanc, Esq.Nursing Home Abuse Lawyer, Sokolove LawWebsiteAboutRicky is the managing attorney of Sokolove Law and has been practicing law for over 30 years. As head of the firm and an experienced nursing home abuse lawyer, he works to ensure client satisfaction on an individual case level across various areas of litigation, including nursing home abuse. 10 Key Takeaways About Nursing Home Abuse By State In addition to ranking all 50 states, our team compiled key findings about national patterns in staffing, enforcement, and resident risk from the CMS Care Compare dataset. Here are 10 findings from our nursing home abuse analysis by state: More than 44% of the 14,700 nursing home facilities analyzed fall below the 0.55 RN hours per resident per day minimum in CMS’s 2024 staffing rule. Louisiana is the most critically understaffed state in the country. Its facilities average just 0.31 RN hours per resident per day, 44% below the national average, and 88% of facilities fall below the standard. Nationwide, 10.1% of all nursing home facilities carry a CMS Abuse Icon flag. This means federal regulators have documented confirmed patterns of abuse or neglect at the facility. Illinois has the highest Abuse Icon rate of any state: nearly 30% of facilities were flagged, compared to the national average of 10.1%. 528 facilities are currently designated as SFFs or SFF candidates. This means they make CMS’s list of the most chronically underperforming nursing homes in the country. The national average annual staff turnover rate is 46.2%. At some individual facilities, turnover exceeds 90% per year. Washington, D.C. averages more than 31 abuse and neglect citations per facility — the highest of any jurisdiction analyzed, and more than double the national average of 13.2. The largest fine levied against a single facility in the dataset was $937,036, issued to La Bella of Cahokia in Illinois, which also carries an Abuse Icon flag. Georgia has the highest share of facilities below the RN minimum among states with a large number of residents in nursing homes: 64.6% of facilities fall short. Facilities with Abuse Icons or on the SFF list are disproportionately for-profit, LLC-structured, and located in states with lower Medicaid reimbursement rates. Expert Panel QuestionWhat do you see as the single most important thing families should do before placing a loved one in a nursing home — and what red flags should they look for during the process?Julie Rivers, MBA, CSAEldercare Advocate & Certified Senior Advisor“To me, the most important thing is choosing a nursing home that the family can visit regularly. My mother needed memory care, and I saw how important it is to stay involved. Red flags include bad Google reviews, poor CMS reports, strong odors, or barely seeing staff during a tour.” ×Julie Rivers, MBA, CSAEldercare Advocate & Certified Senior AdvisorBioAboutJulie Rivers is an eldercare advocate with over 15 years of dedicated service to victims of nursing home abuse and neglect. Her journey in this field became deeply personal when she assumed the role of an unpaid caregiver during her mother’s battle with Alzheimer’s disease. How Dangerous Is Nursing Home Neglect and Abuse? A citation record alone doesn’t fully reflect the safety of a nursing home. Facilities may accumulate citations over time, and past violations do not always mean a facility is still unsafe. However, several CMS data points are linked with higher rates of nursing home abuse or neglect. When choosing a nursing home, watch out for: An Abuse Icon status SFF designation Multiple citations or fines within the last several years Immediate Jeopardy citations, the most severe designation in the CMS enforcement system, are issued when violations have caused, or are likely to cause, serious injury, harm, impairment, or death to residents. However, signs of nursing home abuse aren’t always immediately apparent. Pressure ulcers, malnutrition, and infections can develop over weeks or months without staff addressing warning signs. Psychological abuse and neglect are often not documented at all. For families, visiting regularly, talking to staff about the care provided, and reviewing a facility’s CMS records often are crucial to keeping nursing home residents safe. Family Safety Guide Nursing Home Abuse and Neglect: A Checklist for Families Families can take concrete steps to protect their loved ones and respond quickly when something seems wrong. Look up the facility’s CMS Care Compare record. Medicare’s CMS Care Compare website lets anyone search nursing homes by name, city, or ZIP and review inspection history, staffing data, Abuse Icon flagging, and SFF designation. Ask about current staffing levels. On a tour, ask the current RN-to-resident ratio on overnight and weekend shifts; when staffing is lowest. Request it in writing and compare against the federal standard of 0.55 RN hours per resident per day. Review the most recent inspection report. Inspection reports for each facility are publicly available through CMS. Note the severity level assigned to each citation — Immediate Jeopardy citations are the most serious. Ask whether the facility is on the SFF list. CMS publishes the Special Focus Facility list publicly. A facility on this list has been found to have persistent, serious problems through repeated inspections. Visit at different times of day. Understaffing and neglect are more likely during nights and weekends. Drop-in visits at non-standard hours give a more accurate picture of daily conditions. Know the signs of abuse and neglect. Unexplained bruising, sudden weight loss, new pressure ulcers, unusual withdrawal or fearfulness, and unclean living conditions are all potential warning signs. File a complaint with your state ombudsman. Every state has a Long-Term Care Ombudsman Program, where advocates investigate complaints and support residents and their families. Complaints can also be filed directly with your state health department or CMS regional office. Document everything. If you observe potential neglect or abuse, photograph injuries, note dates and times, and write down the names of staff present. This may be critical if legal action is needed. Key resources: Medicare Care Compare (medicare.gov/care-compare), the CMS Special Focus Facility (SFF) list, and your state Long-Term Care Ombudsman Program. Share this guide with anyone helping coordinate a loved one’s care. Legal Compensation for Nursing Home Abuse Victims Residents and families who have suffered harm as a result of nursing home neglect or abuse may be entitled to financial compensation through the civil legal system. It’s possible to file nursing home legal claims in all 50 states, depending on your situation. Nursing home abuse lawsuits can cover medical expenses related to the injury or illness caused by neglect, pain and suffering, and in cases involving wrongful death, compensation for the family’s loss. Common grounds for nursing home abuse lawsuits include: Bedrail injuries Bedsores (pressure ulcers), notably stage 4 bedsores Elopement (residents leaving a nursing home unnoticed) Failure to properly manage diabetes Falls leading to serious injuries Dehydration and associated health issues Improper use of restraints Medication errors Nursing home medical malpractice Serious infections Sexual abuse (new STDs, bruising or bleeding from genitals, and more) Weight loss due to malnutrition Any other serious, preventable nursing home injuries Wrongful death resulting from any of the above We maintain a list of nursing home lawyers, lawsuits, and settlements by state, and may be able to help you get the legal options you need if eligible. If your loved one has been harmed in a nursing home, call (855) 264-6310 to get a free case review and find out your eligibility for a lawsuit. Expert Panel QuestionFrom a legal perspective, what is the most common type of nursing home abuse or neglect case you see — and what evidence do families typically need to build a strong claim?Ricky LeBlanc, Esq.Nursing Home Abuse Lawyer, Sokolove Law“Severe bedsores are one of the clearest signs of nursing home neglect. These wounds take time to form and are almost always preventable with routine care. Experienced nursing home neglect lawyers look at care logs, patient charts, and medical records to see what was actually done and when.” ×Ricky LeBlanc, Esq.Nursing Home Abuse Lawyer, Sokolove LawWebsiteAboutRicky is the managing attorney of Sokolove Law and has been practicing law for over 30 years. As head of the firm and an experienced nursing home abuse lawyer, he works to ensure client satisfaction on an individual case level across various areas of litigation, including nursing home abuse. Help for Nursing Home Abuse Across the Country Every year, thousands of families from all 50 states come forward after discovering that a loved one was neglected or abused in a nursing home they trusted. At the Nursing Home Abuse Center, we work to support these families so they can access the information, resources, and legal help they need throughout the country. We may be able to help you: Determine if your loved one was abused or neglected in a facility Review a facility’s federal inspection and enforcement history Connect with experienced nursing home abuse attorneys in your state Determine any state deadlines that may affect your ability to file a claim Pursue compensation for medical costs, pain and suffering, and more Get a free case review now or call (855) 264-6310 to connect with our team and find out your eligibility. Methodology This analysis used facility-level data downloaded from the Centers for Medicare & Medicaid Services (CMS) Care Compare database. The dataset comprised over 14,700 individual nursing home facility records across all 50 states and Washington, D.C. These 4 data sources were combined for this analysis: Provider Information file: Staffing hours per resident per day (RN, LPN, aide, and total), Abuse Icon designation, Special Focus Facility status, ownership type, staff turnover rates, and fine totals. Health Deficiencies file: Individual F-tag citations per facility, filtered to the 600–699 range covering abuse, neglect, and resident protection. Citations were weighted by CMS scope and severity codes, with Immediate Jeopardy citations (J, K, L) weighted at 3x, Actual Harm citations (G, H, I) at 2x, and all others at 1x. Penalties file: Individual fine amounts and payment denial records per facility. Composite scoring: Each facility received a score based on the weighted neglect citation count, RN staffing deficit below the 0.55-hour federal minimum, staff turnover rate, Abuse Icon flag, Special Focus Facility status, and log-scaled fine amount. States were ranked by the average composite score across all facilities within the state — not the total — to avoid penalizing states with more facilities. Limitations of this analysis Citation counts reflect documented violations, not total risk. Facilities in states with more aggressive inspection programs may accumulate more citations than those in states with limited inspection resources — not because conditions are worse, but because they are more closely monitored. A facility with few citations may reflect infrequent inspection rather than genuine compliance. Staffing data in the CMS system is self-reported by facilities and subject to revision. CMS has noted that some facilities may underreport staffing hours. Where staffing data was missing for a facility, the national median was substituted to avoid excluding those facilities from the analysis. These limitations do not invalidate the findings, but they should be considered when drawing conclusions about any individual facility or state. The rankings are best understood as an indicator of relative risk and regulatory compliance activity rather than a definitive measure of care quality at any single location. Nursing Home Staffing and Abuse FAQsWhat is an Abuse Icon, and what does it mean for a nursing home?A CMS Abuse Icon is a federal designation applied to nursing home facilities with confirmed patterns of abuse or neglect. It appears on a facility’s online Care Compare profile and is visible to the public. Facilities carrying an Abuse Icon have been cited for abuse-related violations in at least one inspection cycle and have not resolved those issues to regulators’ satisfaction. Nationally, 10.1% of facilities carry this designation. In Illinois, the rate approaches 30%. What is a Special Focus Facility?The Special Focus Facility (SFF) program is CMS’s designation for nursing homes that have demonstrated a history of serious quality problems across many inspection cycles. Facilities on the SFF list are inspected more frequently than standard nursing homes. Those designated as “SFF candidates” are not on the list but could be added soon. There are 528 facilities on or nominated for the SFF list nationally. Get a free case review now for help determining your options if a loved one was abused or neglected in a poor-quality nursing home. What is the federal minimum staffing standard for nursing homes?In April 2024, CMS finalized a rule establishing the first federal minimum staffing standards for nursing homes. The rule set staffing levels of at least 0.55 registered nurse hours per resident per day, at least 2.45 nurse aide hours per resident per day, and at least 3.48 total nurse staffing hours per resident per day. However, our analysis found that 44% of nursing homes currently fall below the 0.55 registered nurse standard set in the 2024 rule. What are the best states for nursing homes?According to our data, the 5 best states for nursing homes were New Hampshire, Alaska, Alabama, Minnesota, and Maine. Generally, the facilities in these states reported high RN hours per resident per day and minimal violations or citations related to the care residents received. With that said, any nursing home resident could suffer abuse or neglect — even in safe states. If you or a loved one was harmed, call (855) 264-6310 now to get help from our dedicated team. What are F-tags in the 600s range, and why do they matter?F-tags are the citation codes used by CMS to classify serious issues found in long-term care facilities during inspections. Nursing home f-tags in the 600–699 range cover problems like: Abuse Exploitation Neglect Related failures to protect residents. F600 specifically covers physical, mental, and sexual abuse. F609 covers the requirement to timely report suspected abuse. F689, the most commonly cited tag in this range, covers accident hazards and inadequate supervision. The tags are found on PDFs of nursing home inspections, which are posted on the CMS online entries for each facility. A facility with multiple 600-range citations has a documented record of failing to protect its residents from harm. How do I find nursing home regulations by state?Every state has its own nursing home laws and regulations that could impact factors like the number of inspections, penalties for violations, and more. Nursing homes throughout the country are also subject to federal laws and rules implemented by CMS. If you or someone you love was harmed while living in a long-term care facility, a nursing home law firm, or a long-term care ombudsman can help you understand applicable laws and regulations in your state. Which state has the best nursing home in the United States? New Hampshire has the best overall nursing homes out of any state in the country. According to our data analysis, nursing homes in this state had just under 5 citations for abuse or neglect on average, which was very low. Also, New Hampshire reported strong RN staffing hours, meaning residents had a better chance of receiving necessary care. How do I find out if my loved one's nursing home has violations?To find out whether your family member’s nursing home has serious violations, use Medicare’s Care Compare tool and search for the facility by name, city, or zip code. From there, click on the facility’s profile and navigate to the “Inspections” and “Penalties” tabs to see its citation history, F-tag codes, fine amounts, and any Abuse Icon or Special Focus designations. Can I take legal action if my loved one was abused or neglected in a nursing home?Yes. Nursing home abuse and negligence lawsuits can be filed against the facility and, in some cases, its corporate ownership for damages resulting from inadequate care. Successful nursing home lawsuits have addressed injuries from falls, pressure ulcers, malnutrition, physical abuse, and wrongful death. It’s possible to file nursing home lawsuits throughout the country after abuse or mistreatment. Call (855) 264-6310 to connect with our team and find out your eligibility for a nursing home abuse or neglect lawsuit in your state. Nursing Home Abuse Support TeamLast modified: July 28, 2026Reviewed by:Ricky A. LeBlanc, Esq.Managing Attorney, Sokolove LawFact-CheckedEditorRicky is the managing attorney of Sokolove Law and has been practicing law for 35 years. As head of the firm and an experienced nursing home abuse lawyer, he works to ensure client satisfaction on an individual case level across various areas of litigation, including nursing home abuse. Written by:Julie Rivers, MBA, CSAEldercare Advocate & Certified Senior AdvisorJulie Rivers is an eldercare advocate with over 25 years of experience focused on nursing home resident safety. She began as a case manager at a nursing home law firm, working with families in crisis. She is a Certified Senior Advisor and also cared for her mother through Alzheimer’s. Her business training deepens her understanding of how for-profit facilities operate. View Sources Centers for Medicare & Medicaid Services. (2026). Adverse events in nursing homes. Retrieved from https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/adverse-events-nhs. Centers for Medicare & Medicaid Services. (2024). Medicare and Medicaid Programs: Minimum staffing standards for long-term care facilities and Medicaid institutional payment transparency reporting final rule (CMS 3442-F). Retrieved from https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0. Centers for Medicare & Medicaid Services. (2024). Nursing homes including rehab services. Retrieved from https://data.cms.gov/provider-data/topics/nursing-homes. Harrington, C., et al. (2024). United States’ nursing home finances: Spending, profitability, and capital structure. Retrieved from https://doi.org/10.1177/27551938231221509. Kaiser Family Foundation. (2025). A look at nursing facility characteristics in 2025. Retrieved from https://www.kff.org/medicaid/a-look-at-nursing-facility-characteristics/. Medicare.gov. (n.d.). Nursing Home Compare. Retrieved from https://www.medicare.gov/care-compare/. Office of Inspector General, U.S. Department of Health and Human Services. (2026). Nursing homes. Retrieved from https://oig.hhs.gov/reports/featured/nursing-homes/. U.S. Government Accountability Office. (2026). Most nursing homes throughout the United States do not have adequate or reliable emergency power systems. Retrieved from https://oig.hhs.gov/reports/all/2026/most-nursing-homes-throughout-the-united-states-do-not-have-adequate-or-reliable-emergency-power-systems/.