3G Healthcare Real Estate · SNFRadar Intelligence
An independent study · August 2026
The Bedside Hour
What nine years of federal payroll and staffing records say about the cost of caring for one resident for one day, and why the industry’s hardest problem is no longer the one it is being measured on.
The short version
Six findings, if you read nothing else
- Skilled nursing is running on 13,459 fewer workers than in 2019 while paying 36.7% more per week. The workforce never came back; the wage bill did.
- Care intensity has not moved in seven years. Nursing time per resident sits at 3.86 hours a day, within a rounding error of 2019, while occupancy has fully recovered to 81%.
- A resident-day of care costs the median state $185 in facility payroll, and every nursing hour delivered carries $46 of that payroll, from $31 in Wyoming to $65 in Oregon.
- Agency staffing more than tripled in the crisis and never went home. It was 3.0% of nursing hours in 2019, peaked at 10.5%, and is 5.3% today, still 77% above where it started, and it stopped falling last quarter.
- Thin staffing barely predicts hospital readmissions: 20.5% at the worst-staffed fifth of buildings against 20.3% at the best. The link the sector assumes is not in the data.
- Medicare pays as though it were, and it now prices staffing directly. 78.6% of all facilities are being penalized, and the gap between the best and worst staffed is worth about $147,000 a year.
The rest of the study
Every finding, every chart, and the method behind each figure.
The body of the study opens with an account. It is free, it takes one text message, and it opens every state report we publish along with it.
The state table below stays open to everyone, account or not, and so does the CSV.
Every state · free to use, free to cite
The numbers behind all of it
This is the table we would want if we were writing about this industry, so we are publishing it whole. Turnover, agency reliance, nursing hours, staffing rating, occupancy, payroll cost, wages, readmissions and Medicare penalty rate, for every state with at least 40 reporting facilities.
| State | Facilities | Nurse turnover | Agency share | Hrs / res day | Staffing stars | Occupancy | Payroll / res day | Payroll / nursing hr | CNA mean pay | Readmission | Penalized |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MO | 487 | 57.1% | 3.9% | 3.47 | 2.19 | 71.2% | $149 | $42.98 | $38,410 | 20.9% | 90.4% |
| OK | 284 | 55.4% | 2.2% | 3.87 | 2.60 | 63.0% | $154 | $39.71 | $35,920 | 21.5% | 83.9% |
| MT | 61 | 55.2% | 11.6% | 3.93 | 3.22 | 64.9% | $229 | $58.27 | $43,160 | 19.2% | 77.6% |
| NM | 68 | 53.2% | 14.2% | 3.67 | 2.76 | 81.1% | $212 | $57.88 | $41,400 | 20.9% | 90.6% |
| UT | 98 | 51.3% | 2.8% | 4.00 | 3.08 | 72.4% | $219 | $54.83 | $40,450 | 19.4% | 76.4% |
| TX | 1176 | 50.9% | 2.2% | 3.40 | 2.12 | 66.7% | $151 | $44.41 | $38,780 | 21.0% | 91.4% |
| AR | 221 | 50.1% | 2.0% | 4.10 | 3.18 | 77.7% | $147 | $35.95 | $33,970 | 21.0% | 81.5% |
| NH | 74 | 50.0% | 13.1% | 4.00 | 3.21 | 80.7% | $169 | $42.38 | $49,290 | 19.7% | 75.0% |
| NE | 179 | 50.0% | 7.1% | 4.15 | 3.32 | 71.6% | $202 | $48.72 | $42,390 | 20.3% | 69.9% |
| NC | 420 | 49.9% | 8.0% | 3.82 | 2.66 | 81.9% | $159 | $41.48 | $39,280 | 20.3% | 78.6% |
| SD | 96 | 49.7% | 9.1% | 3.88 | 3.32 | 83.6% | $163 | $42.04 | $39,510 | 19.6% | 79.2% |
| OH | 923 | 49.6% | 4.6% | 3.73 | 2.44 | 82.7% | $170 | $45.48 | $40,520 | 20.8% | 90.4% |
| CO | 210 | 49.4% | 5.9% | 3.71 | 3.04 | 78.1% | $209 | $56.50 | $47,400 | 19.3% | 72.8% |
| ME | 78 | 49.2% | 9.2% | 4.39 | 3.96 | 86.1% | $228 | $51.84 | $47,510 | 19.8% | 58.1% |
| OR | 128 | 49.0% | 6.2% | 5.06 | 3.71 | 67.9% | $327 | $64.58 | $52,160 | 19.6% | 43.2% |
| KS | 299 | 48.9% | 4.8% | 4.14 | 3.46 | 81.2% | $145 | $35.04 | $39,730 | 20.1% | 68.3% |
| VA | 289 | 48.7% | 5.7% | 3.78 | 2.47 | 86.8% | $159 | $42.03 | $42,160 | 20.0% | 78.3% |
| TN | 303 | 48.5% | 4.0% | 3.86 | 2.42 | 73.0% | $179 | $46.42 | $38,230 | 20.2% | 84.0% |
| ND | 73 | 48.5% | 11.7% | 4.55 | 4.33 | 88.1% | $228 | $50.11 | $43,330 | 19.4% | 44.3% |
| AL | 224 | 48.1% | 0.9% | 3.92 | 3.54 | 82.4% | $154 | $39.39 | $33,670 | 21.0% | 76.9% |
| AZ | 140 | 48.0% | 3.3% | 4.14 | 3.04 | 76.3% | $222 | $53.78 | $44,820 | 20.2% | 76.8% |
| MS | 201 | 48.0% | 6.2% | 4.08 | 3.52 | 85.7% | $134 | $32.93 | $32,890 | 21.5% | 72.3% |
| LA | 266 | 47.6% | 3.6% | 3.83 | 2.40 | 74.1% | $126 | $32.83 | $32,250 | 21.4% | 86.8% |
| WI | 323 | 47.4% | 8.8% | 4.21 | 3.62 | 72.5% | $192 | $45.75 | $44,600 | 20.1% | 69.0% |
| GA | 356 | 47.2% | 3.3% | 3.62 | 2.26 | 79.9% | $155 | $42.83 | $38,760 | 20.9% | 86.1% |
| IN | 508 | 47.1% | 3.4% | 3.74 | 2.46 | 73.9% | $169 | $45.05 | $40,200 | 20.1% | 86.1% |
| ID | 80 | 47.1% | 4.9% | 4.15 | 3.35 | 74.1% | $196 | $47.33 | $39,100 | 18.7% | 54.7% |
| WA | 193 | 46.9% | 3.7% | 4.44 | 3.42 | 76.2% | $274 | $61.66 | $52,230 | 19.1% | 63.9% |
| KY | 269 | 46.8% | 3.2% | 3.97 | 2.67 | 86.1% | $161 | $40.50 | $39,170 | 20.9% | 85.8% |
| PA | 657 | 46.8% | 11.3% | 3.92 | 3.39 | 82.3% | $154 | $39.33 | $43,960 | 20.4% | 72.9% |
| SC | 187 | 46.7% | 7.2% | 3.83 | 2.89 | 85.8% | $169 | $44.13 | $37,390 | 21.3% | 85.7% |
| IL | 669 | 46.3% | 5.4% | 3.50 | 2.14 | 73.2% | $161 | $46.00 | $45,230 | 21.1% | 88.0% |
| NV | 66 | 46.1% | 2.7% | 4.36 | 3.11 | 84.5% | $214 | $49.10 | $44,900 | 20.5% | 78.6% |
| WV | 123 | 45.0% | 3.9% | 3.72 | 2.48 | 89.5% | $144 | $38.64 | $37,490 | 20.7% | 85.7% |
| IA | 395 | 44.4% | 4.7% | 3.84 | 3.55 | 78.9% | $160 | $41.70 | $41,490 | 20.2% | 65.2% |
| MI | 424 | 44.3% | 3.3% | 4.05 | 3.50 | 81.7% | $190 | $46.85 | $41,490 | 20.9% | 75.9% |
| FL | 695 | 42.8% | 1.1% | 3.88 | 3.38 | 88.5% | $170 | $43.76 | $39,160 | 21.3% | 83.4% |
| MN | 340 | 42.3% | 5.2% | 4.26 | 4.10 | 82.4% | $268 | $62.97 | $46,030 | 20.1% | 49.0% |
| DE | 44 | 41.9% | 5.7% | 4.58 | 4.02 | 79.5% | $185 | $40.44 | $42,290 | 20.3% | 68.3% |
| NJ | 348 | 41.2% | 11.6% | 3.89 | 3.05 | 81.8% | $189 | $48.55 | $46,810 | 20.5% | 79.5% |
| RI | 73 | 41.1% | 5.4% | 3.76 | 3.46 | 85.0% | $198 | $52.74 | $46,360 | 21.1% | 81.7% |
| MD | 220 | 40.9% | 8.0% | 3.90 | 3.05 | 83.0% | $195 | $50.04 | $43,310 | 19.6% | 74.1% |
| NY | 597 | 40.7% | 9.8% | 3.70 | 2.72 | 89.4% | $186 | $50.30 | $48,800 | 19.8% | 75.5% |
| MA | 341 | 39.9% | 5.0% | 3.90 | 3.00 | 80.7% | $214 | $54.81 | $47,700 | 21.2% | 76.5% |
| CA | 1163 | 38.4% | 2.3% | 4.51 | 3.14 | 87.5% | $239 | $52.94 | $50,190 | 20.3% | 70.5% |
| CT | 193 | 38.4% | 6.0% | 3.84 | 3.24 | 86.2% | $215 | $55.91 | $45,440 | 20.6% | 75.8% |
| HI | 42 | 36.1% | 6.9% | 4.51 | 4.00 | 82.3% | $213 | $47.34 | $45,710 | 19.2% | 33.3% |
Turnover, nursing hours, staffing rating and occupancy are facility averages within each state. Agency share is hours-weighted across facilities filing 60+ days in the quarter. Payroll per resident day and payroll per nursing hour combine state payroll filings with resident counts. CNA pay is the state mean across all industries, not nursing homes alone. Readmission is Medicare’s risk-adjusted 30-day measure; penalized is the share of facilities receiving a negative payment adjustment.
For journalists and researchers
Use this. We would rather you did.
Every figure in this study comes from public federal records, and the whole state table above is free to reproduce. We are not asking for anything in exchange for it.
Press access. We will give reporters the underlying data behind any figure here, the full methodology, and where useful a cut we have not published: by county, by ownership type, by chain, or the buildings behind a state number. We can usually turn that around the same day.
We are also available as a source on skilled nursing labor, transactions, valuations and closures. We represent sellers, exclusively in this asset class, which is a position worth knowing when you weigh what we say, and it is also why our read on who is selling and why tends to be early.
To request data or an interview: Stan Klos III for interviews and comment, [email protected]. Christian Patrick for data requests and methodology, [email protected]. We will say plainly when we do not know something, which is most of the reason to call us.
Cadence. The staffing and agency figures here are refreshed each quarter, against the next Payroll-Based Journal release CMS publishes. Ask either of us and we will send the update when it lands.
3G Healthcare Real Estate / SNFRadar Intelligence, “The Bedside Hour: an independent study of
skilled nursing staffing, cost and Medicare payment,” August 2026.
About
Who published this
3G Healthcare Real Estate is a brokerage that represents sellers of skilled nursing facilities, exclusively. SNFRadar is the research operation behind it: a continuously updated record of staffing, quality, financial condition and transactions across every skilled nursing facility in the United States.
We publish work like this because the data we maintain to do our job answers questions the industry cannot otherwise get answered, and because being useful in public is a better introduction than a cold call. If you own or operate a facility and want your own building’s numbers, how it compares in its state on every measure in this study, we will put them together and walk you through them, whether or not you are thinking about selling.
3G Healthcare Real Estate · Exclusively SNF Sell-Side Advisors · SNFRadar Intelligence
The Bedside Hour · An independent study · August 2026 · Free to cite with attribution
Sources: CMS Care Compare provider records and archive snapshots; CMS Payroll-Based Journal daily nurse staffing;
CMS Skilled Nursing Facility Value-Based Purchasing; CMS Medicare cost reports; BLS Quarterly Census of Employment
and Wages (NAICS 623110); BLS Occupational Employment and Wage Statistics; Anthropic Economic Index
(anthropic.com/economic-index, CC BY 4.0).
No individual, owner or operator is identified in this study. No private or client information was used.