2025 U.S. Nursing Home Staffing Rankings: Top 10, Bottom 10 ... and Other SEO Crimes
Why Staffing HPRD is the Batting Average of Nursing Homes
People love nursing home rankings, Top 10s, Bottom 10s, and listicles. Which means rankings, Top 10s, Bottom 10s, and listicles are good for SEO, good for marketing, and good for 320 Consulting’s web traffic.
So now that you’re here — thanks, Google — some bad news: this article is not exactly about 2025 nursing home staffing rankings or Top 10s or Bottom 10s. Sorry.
The thing about1 nursing home staffing rankings is: they’re kind of garbage.
Nursing home staffing is usually measured by staffing hours per resident day, or HPRD — that is, how much staff time the average resident receives in a given day at a given nursing home, as if each resident on each floor gets precisely 3 hours, 45 minutes, and 43 seconds of staff time.
HPRD is a powerful metric — I’m staking my professional career on it! — but it’s also noisy, limited, and, in the wrong hands, dangerously misleading. HPRD can be especially problematic when used for simple comparisons.
Example 1: a 3.70 HPRD at a 50-bed nursing home in rural Pennsylvania vs. a 3.70 HPRD at a 350-bed nursing home in Brooklyn. On paper, those are the same staffing levels. But what kind of staff? RNs or nurse aides? Who are the residents? Higher-need or lower-need? What are the labor pools? What does “adequate” even mean in each setting?2
Example 2: Delaware (4.13 HPRD, rank: 12) vs. Mississippi (4.10 HPRD, rank: 13). Basically the same staffing levels, right? But Delaware is a small, compact Mid-Atlantic state with a relatively small nursing home market. Mississippi is larger, more rural, poorer, and demographically different. Even before you get to facility-level resident needs, ownership, payer mix, and staffing composition, you are not exactly comparing two versions of the same system.
Example 3: a California nursing home (5.28 HPRD) that’s a mainstay in the federal Special Focus Facility program for worst-performers (48 months) might be staffed more than the 5-star Alabama nursing home with a 4.10 HPRD. But is it staffed better?
⚾🥜🍇🍞 Sports x Nursing Home Crossover Alert ⚾🥜🍇🍞
In Moneyball, the Oakland Athletics are a small-market team trying to compete with the evil New York Yankees and Boston Red Sox. General manager Billy Beane (Brad Pitt) knows the A’s can’t outspend their rivals, so he stops chasing expensive stars with high batting averages — the popular stat that simply divides hits by at-bats — and starts mining the market for undervalued players with ugly girlfriends and a suspicious knack for getting on base.
Think of HPRD as the batting average of nursing homes. In baseball, batting average treats a single, a double, and a home run the same: they all count as one ‘hit.’ HPRD can do the same thing with staffing: it treats an hour from an experienced registered nurse exactly the same as an hour from a brand-new nurse aide.
The basic number only gets you so far. Is it better to add three nurse aides or two highly trained registered nurses? Is a facility with a higher reported HPRD actually better staffed, or just differently staffed? Does the number reflect resident need, or obscure it?
In baseball, we now have better — still imperfect — ways to judge player production: On-base plus slugging (OPS), Wins Above Replacement (WAR), BORPS, SHNORPS, and whatever metric the nerds are arguing about.
Nursing home staffing deserves the same treatment. HPRD is useful, but it works best with context: staffing mix, resident acuity, day-level patterns, and longitudinal trends that compare a facility to itself over time instead of pretending every state, region, and facility belongs on one clean leaderboard.
The lesson is not that numbers are bad. It’s that familiar numbers, used too confidently, can become lazy stand-ins for what you actually care about.
Batting average became a shortcut for offensive production. HPRD has the same risk: it captures staffing time, but not the mix, context, or story behind it. Rankings can make different systems — regions, states, facilities — look directly comparable. Don’t confuse the ranking for the meaning.
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Oh, you’re still here? Well I’ve got a surprise for you! Here are the Definitive #NursingHomeStaffingRankings #Top10 #Bottom10 for #Q4 2025 staffing via the federal Payroll-Based Journal dataset (released April 29, 2026).
So: read the tables. Enjoy the rankings. Notice that Alaska is #1 (5.80 HPRD), which makes sense given Alaska’s 13 reported nursing homes have an average resident count of 43 — small facilities tend to have higher staffing ratios. Notice that Illinois is last, which tells you something, though exactly what it means is for you to decide, dear Illinois readers. And then remember: you are looking at state staffing ratios — that is, the state’s total staffing hours over its total residents on an average day in Q4 2025. These numbers are indicators, but they are thin without context.
This was me, not GPT, I promise!
This is not an argument for or against a federal staffing standard. It is an argument against lazy math.