Iowa nursing homes received the most CMS citations for insufficient staffing of any state, the Iowa Capital Dispatch found.
The Dispatch reviewed CMS skilled nursing facility citation data to find the states with the most citations for insufficient staffing in fiscal year 2026.
Inadequate staffing is one of the biggest contributors to poor-quality resident care in nursing homes. A 2026 Long-Term Care Community Coalition report found that almost 9 in 10 nursing homes were below their expected staffing levels in the third quarter of 2025. The average facility was understaffed by 24% each day.
Here are the 10 states with the most nursing home citations for insufficient staffing:
| State | Number of citations | Total facilities in the state |
| Iowa | 87 | 393 |
| Illinois | 85 | 669 |
| California | 59 | 1,169 |
| Pennsylvania | 51 | 657 |
| Michigan | 49 | 424 |
| New York | 42 | 597 |
| Ohio | 31 | 926 |
| Missouri | 23 | 489 |
| Minnesota | 16 | 339 |
| Wisconsin | 11 | 323 |
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