RN Staffing and Nursing Home Cost Comparison (2023 vs 2024)
RN Coverage Definition: "RN coverage" is measured as the average registered nurse hours per resident per day (HPRD). The values below are from CMS Payroll-Based Journal data, which tracks actual staffing hours source. Higher HPRD means more RN care time per resident.
Cost Data Definition: "Average monthly nursing home cost" refers to the median monthly cost for a semi-private room and a private room in a skilled nursing facility. These cost figures come from Genworth's annual Cost of Care Survey, a widely cited benchmark for long-term care costs sourcesource. (Semi-private rooms house two residents; private rooms house one.) All costs are in USD per month.
Top 3 States by RN Staffing Levels
The top three states with the highest RN coverage in 2023 were Alaska, Hawaii, and Utah. These states continued to lead in 2024. The table below shows their RN staffing and costs:
| State | RN Coverage (HPRD) | Avg. Monthly Cost – Semi-Private Room | Avg. Monthly Cost – Private Room | Year |
|---|---|---|---|---|
| Alaska | 1.75 hours source | $31,512 source | $36,378 source | 2023 |
| Alaska | 1.78 hours source | $30,371 source | $30,371 source | 2024 |
| Hawaii | 1.39 hours source | $12,501 source | ~$14,000 (est.) | 2023 |
| Hawaii | 1.43 hours source | $15,087 source | $16,364 source | 2024 |
| Utah | 1.04 hours source | ~$7,200 source | ~$9,500 (est.) | 2023 |
| Utah | 1.05 hours source | $8,365 source | $10,646 source | 2024 |
Notes: Alaska has by far the highest RN staffing in the nation, with about 1.7–1.8 RN hours per resident-day — roughly 3× the national average source. This correlates with Alaska's extremely high nursing home costs. In 2023, Alaska's median price was over $31k per month for a semi-private room and $36k for a private room source – the highest in the U.S. Hawaii also had well-above-average RN time and high costs (around $12.5k for semi-private in 2023, rising to $15k in 2024). Utah, while not as costly as Alaska or Hawaii, still maintained top-tier RN coverage around 1.0+ HPRD, with nursing home costs slightly below the national median source.
Bottom 3 States by RN Staffing Levels
The bottom three states with the lowest RN coverage were Louisiana, Oklahoma, and Texas. These states ranked at or near the bottom in both 2023 and 2024 for RN HPRD. Their RN staffing levels and costs are shown below:
| State | RN Coverage (HPRD) | Avg. Monthly Cost – Semi-Private Room | Avg. Monthly Cost – Private Room | Year |
|---|---|---|---|---|
| Louisiana | 0.24 hours source | $5,759 source | $6,060 source | 2023 |
| Louisiana | 0.25 hours source | $7,482 source | $7,604 source | 2024 |
| Oklahoma | 0.32 hours source | $5,475 source | $6,083 source | 2023 |
| Oklahoma | 0.33 hours source | $6,448 source | $7,604 source | 2024 |
| Texas | 0.35 hours source | $5,125 source | $7,092 source | 2023 |
| Texas | 0.38 hours source | $5,475 source | $7,087 source | 2024 |
Notes: Louisiana had the lowest RN staffing in the country, at only about 0.24–0.25 hours per resident-day (about 15 minutes) sourcesource. Oklahoma and Texas were only slightly higher, around 0.3–0.4 HPRD. These low-RN states also have some of the least expensive nursing homes. In 2023, Texas's median cost for a semi-private room was about $5,125 per month – the lowest of any state source. (For comparison, the national median was about $8,669 in 2023 source.) Louisiana and Oklahoma were similarly low-cost (~$5.5–$5.8k for semi-private). Even in 2024, a semi-private room in these bottom-RN states averaged only about $5.5k–$7.5k per month, well below the national average sourcesource.
Sources: State-average RN hours per resident-day are from CMS Payroll-Based Journal staffing data (2023–2024) sourcesource. Cost data are from Genworth's Cost of Care Survey 2023 and 2024 (median monthly costs by state) sourcesource, as reported by official analyses and surveys (SeniorSite, WorldPopulationReview, Genworth). All figures are the latest available for the year indicated.
