The top 10 states with the most nursing home citations tied to insufficient staffing so far this year include Iowa, Illinois and California, among others.
An analysis of data from the Centers for Medicare and Medicaid Services (CMS) by the Iowa Capital Dispatch shows that staffing violations don’t result in fines or any other financial penalties in certain states, including Iowa, but short-staffed buildings contribute to safety issues and neglect.
Iowa notably has far fewer nursing homes than more populous states on the list, but the state tops rankings for insufficient staffing citations, with 87 across 393 facilities.
By comparison, California’s 1,169 nursing homes saw 59 citations, and Illinois reported 85 citations across its 669 nursing homes. Other states with the most staffing citations include Michigan with 49 citations across 424 nursing homes, Pennsylvania with 51 citations in its 657 nursing comes, and New York seeing 42 citations across its 597 facilities.
Ohio, Missouri, Minnesota and Wisconsin also made the list.
CMS found that Iowa nursing homes ranked high in citations linked to the requirement of having at least one registered nurse (RN) on duty for at least 8 hours each day, the Dispatch reported.
Nursing homes in the state were cited 16 times for this particular RN requirement. And 15% of all nursing homes in the state, about 60, were cited for overall insufficient staffing in 2025; that statistic is two to five times higher than most other nearby states, the Dispatch found.
And in 2023, 14% of Iowa’s 422 nursing homes were cited for insufficient staffing, which at the time was more than double the national average of 5.9%. The state ranked sixth in a list of the worst state staffing compliance records at the time.
Lagging call light response times are a big indicator of staffing issues in the state, with many operators not having a call light policy in place, The Dispatch reported. Residents at Accura Healthcare of Carroll reported waiting 39 minutes for a nurse to answer their call light, while some residents at Pinnacle Specialty Care in Cedar Falls waited 60 to 90 minutes.
And when call lights didn’t work, residents at Ravenwood Specialty Care in Waterloo and Foxglove Wellness and Rehabilitation Center called the front desk on their personal cellphones instead. All of these examples occurred between October 2025 to present, collected by The Dispatch.
Insufficient staffing trends continued into 2026 for most states, with nine in 10 nursing homes falling below their expected staffing levels in the third quarter of 2025, according to a report this year from the Long-Term Care Community Coalition.
The average facility was understaffed by 24% on a daily basis, according to self-reported payroll information and an assessment of resident needs collected in federal data.
Companies featured in this article:
Centers for Medicare & Medicaid Services, CMS, Iowa Capital Dispatch
