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STATE OFFICE
More than 1.2 million people in the United States live and receive care in nursing homes, the vast majority of whom are older adults ages 65 or older. The AARP Public Policy Institute created the AARP Nursing Home Quality and Safety Dashboard to provide quarterly snapshots of national and state data related to the experiences of nursing home residents, staffing, and facility characteristics. This new Dashboard continues the work of the AARP Nursing Home COVID-19 Dashboard, which from 2020-2025 tracked the impact of COVID-19 specifically on nursing homes, residents, and staff.
This release of AARP’s new Nursing Home Quality and Safety Dashboard covers the third quarter (July through September) of 2026.
All areas covered by the Dashboard show continued wide variation in performance between states. Those areas include staffing, quality measures and other characteristics, and respiratory illnesses and vaccination.
Nursing Home Staffing
Over the last three months, nursing homes provided an average of 3.9 nursing hours per resident per day, including 0.7 RN hours, 0.9 LPN hours, and 2.3 nurse aide hours per resident per day. Staffing levels varied by state: Alaska had the highest rate with 6.9 total hours per resident per day, more than twice as much as Texas, which had the lowest with 3.4 hours per resident per day. Nurse staffing was particularly variable: Nursing homes in Alaska, Hawaii, Maine, Minnesota, Nevada, Utah, and Washington D.C., averaged more than one RN hour per resident per day, while those in Arkansas, Louisiana, Missouri, Oklahoma and Texas averaged fewer than 0.5 RN hours per resident per day.
Turnover in the nursing home industry is high. Nationally, nursing staff averaged 46% turnover over the last year (with a high of 56% in Missouri and a low of 34% in Washington D.C.). Turnover among registered nurses and administrators is similarly high. RN turnover averaged 43% nationally, ranging from a high of 55% in Texas to a low of 32% in Hawaii, and there were about 0.5 administrator departures per facility in the last year (with a high of 0.7 in seven states and a low of 0.1 in Hawaii).
Quality Measures
Approximately 15% of long-stay nursing home residents (stays longer than 100 days) received an antipsychotic medication (state range 8% in Washington D.C., to 25% in South Dakota), and 1.6% of short-stay residents (100 day stays or shorter) received an antipsychotic medication for the first time (state range from 0.5% in Alaska to 3.1% in Louisiana). Antipsychotics can have dangerous side effects in the older population and are often used inappropriately. Additionally, almost 5% of residents had pressure ulcers (state range from 3.2% in Idaho to 7.6% in Washington D.C.). Pressure ulcers are often associated with poor care and inadequate staffing.
Other Characteristics
Nearly three-quarters of nursing homes (74%) are privately-owned, for-profit entities, with the greatest share, 90%, in Arkansas and the lowest share, only 6%, in North Dakota. In 44 states, more than half of facilities are for-profit. In addition to North Dakota, the exceptions are Alaska, Minnesota, Nebraska, South Dakota, Wyoming, and Washington D.C. The nursing home occupancy rate averaged about 80% across the country, with a high of 93% in Alaska and a low of 63% in Oklahoma. Nearly all nursing homes had a resident council (95% nationally), including 100% of facilities in Alaska, Montana, New Hampshire, Vermont, and Wyoming. About 12% of facilities also had a family council, with the percentage ranging from only 4% in Arizona and Iowa to 53% in Minnesota.
Respiratory Illnesses
Following the established seasonal patterns of respiratory illness, influenza and RSV cases continued to decline from spring into summer, while there was a moderate increase in COVID-19 cases and hospitalizations. A smaller than usual late summer COVID-19 wave resulting in cases and hospitalizations approximately doubling compared to the previous quarter. However, compared to the summer of 2025, COVID-19 cases and hospitalizations were down by almost 60%.
Vaccination rates for all three illnesses remain much lower than needed to protect vulnerable residents. As of late September, just 26% of nursing home residents were up to date on COVID-19 vaccination, the lowest since the initial vaccine rollout in 2021, and only 24% were vaccinated for RSV. Seasonal influenza vaccination rates were not tracked in Q2 but averaged 58% at the end of Q1. There is still time for residents to get vaccinated to protect themselves ahead of the most dangerous illness season at the beginning of winter.
Vaccination rates vary considerably by state. As of late June, Washington D.C. had the highest percentage of nursing home residents vaccinated for COVID-19 (52%), while North Dakota had the highest percentage vaccinated for RSV (52%). No other state had a resident vaccination rate above 50%. Texas had the lowest resident vaccination rates for both COVID-19 (13%) and RSV (6.5%).
This Dashboard draws from three main sources of data. These are CDC NHSN Nursing Home Data Dashboard (for respiratory diseases and vaccination rates) and two CMS data files on the topic of nursing homes including rehab services: the state averages file (for staffing levels, staff turnover, and quality measures) and the provider info file (for facility characteristics).
The CDC dashboard is updated weekly. The AARP dashboard rates of cases and hospitalizations are calculated by the AARP Public Policy Institute as the sum of the weekly rates over the three months composing the quarter (e.g. weeks ending 1/5/25 through 3/30/25 for the 2025 Q1 dashboard). These rates can be interpreted as: for every 1000 individuals who are in a nursing home for the entire three-month period and have a risk of infection or hospitalization equal to the state average each week, this many people would test positive for, or be hospitalized because of the illness. For 2026 Q3, implausibly high rates of RSV hospitalizations in Idaho and South Dakota (neither state had even a single reported RSV infection) were recoded in the AARP dashboard as missing values. No adjustment was made to the national rate of RSV hospitalizations. An approximate (though not exact) total count of cases and hospitalizations can be calculated by multiplying these rates by the average daily number of residents. Vaccination rates are for the most recent week of non-preliminary data at the time of download, typically the middle or end of the last month of the quarter.
The CMS state averages and provider info files are updated approximately monthly, and the last files of the quarter are used for the Dashboard (e.g. March 2025 for the 2025 Q1 Dashboard). State averages are taken directly from this summary file. Staffing hours are calculated over the most recent three-month period. Staff turnover is calculated over a one-year period. Quality measures are calculated over a period of 4 or 5 quarters. Exact data collection intervals for each indicator can be found in the documentation on the CMS website.
Facility characteristic indicators in the Dashboard are calculated by the AARP Public Policy Institute. A small number of facilities report the number of beds but not the average number of residents. These facilities were included for calculating the total number of beds in the state but excluded for calculating the state occupancy rate. Therefore, the occupancy rate may not exactly match the number of residents divided by the number of beds at the state level.
View the data access dates for each quarterly dashboard.
For more information about nursing homes from AARP, please visit: aarp.org/nursinghomes
For more information about the AARP Public Policy Institute, please visit: www.aarp.org/pri/departments/ppi/
For more information about nursing home care, please visit: https://www.medicare.gov/care-compare/
To review the AARP Nursing Home COVID-19 Dashboard, please visit: https://www.aarp.org/pri/initiatives/aarp-nursing-home-covid-19-dashboard/
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