Nursing Home Ratings in Washington: Data Analysis of Quality, Safety, and Staffing
Washington has 187 nursing homes averaging 4.28 HPRD — 0.39 hours above the national average of 3.90. 98.4% meet the CMS benchmark.
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Data updated quarterly
This analysis reflects the most recent CMS data release (Q3 2025). Staffing figures, grades, and benchmarks are refreshed every quarter as new federal data becomes available.
Nursing Home Staffing in Washington: What Families Need to Know
Washington is one of the strongest states in the country for nursing home staffing — and the data backs it up. Across 187 facilities serving roughly 13,811 residents on any given day, the state averages 4.28 total nurse hours per resident per day (HPRD), well above the national average of 3.90. An impressive 98.4% of facilities meet the CMS staffing benchmark, and 86.6% earn a B grade or better.
Families here have meaningfully better options than in most of the country. But even in a strong state, quality varies — 6 facilities (3.2%) still fall to D or F. Knowing which homes stand out, and which fall short, takes more than a state average.
Washington leads the nation by a wide margin: 98.4% of facilities meet the CMS staffing benchmark, and only 1 facility earns an F grade. Families here have genuinely better odds of finding well-staffed care than almost anywhere else in the country.
Explore the full Washington profile → View facility rankings, county breakdowns, and trend data on our Washington state page.
The Washington Nursing Home Landscape
Washington operates 187 Medicare and Medicaid certified nursing homes serving approximately 13,811 residents daily. Staffing levels range from well above the research recommendation to critically understaffed — a spread that makes facility-level data essential for any family evaluating care options.
The state averages 4.28 total nurse HPRD, which is 0.39 hours above the national average of 3.90. RN coverage averages 0.88 HPRD (national: 0.68), and 64.71% of facilities meet the 0.75 RN research recommendation. The grade distribution shows 162 facilities (86.6%) earning a B or better, while 6 (3.2%) fall to D or F.
Washington by the Numbers
Grade Distribution
Staffing Compared to the National Average
Additional Metrics
- Median HPRD: 4.13 (less skewed by outliers than the average)
- Meet Research Recommendation (4.10): 53.48% of facilities
- RN Recommendation (0.75): 64.71% of facilities
- Agency/Contract Staff: 4.73% of total hours
What This Means for Families
Washington's RN staffing of 0.88 HPRD meets or exceeds the 0.75 research recommendation at the state level, with 64.71% of individual facilities reaching that threshold. This is a genuine strength — adequate RN coverage means residents have clinical oversight that catches problems early.
Weekend staffing deserves attention. The average 18.03% drop on Saturdays and Sundays means residents receive meaningfully less care on weekends. Since most family visits happen on weekends, the staffing level you observe may actually be better than the weekend norm at many facilities.
Agency/contract staff account for 4.73% of hours, which is near the national average. This indicates a mix of permanent and temporary workers — worth asking about at any specific facility you're evaluating.
How Nursing Home Ratings Are Calculated
Our letter grades are based on Hours Per Resident Day (HPRD) — the total nursing staff hours a facility provides divided by its daily resident count. This metric normalizes for facility size, so a 200-bed home and a 20-bed home are measured on the same scale.
The grade thresholds are anchored to two evidence-based benchmarks:
- 3.48 HPRD — the staffing level CMS established through formal rulemaking as an appropriate standard. (The regulatory requirement was subsequently suspended, but the underlying research remains valid and widely cited.)
- 4.10 HPRD — the level recommended by the landmark CMS-commissioned STRIVE study as the minimum to prevent quality problems.
Grades A+ and A correspond to facilities meeting or exceeding the research recommendation. Grade B meets the CMS benchmark. Grades C through F fall below in progressively concerning ways.
All data comes from CMS Staffing & Quality Data — daily reports that every nursing home is legally required to submit. No facility pays to be rated. No rating is influenced by advertising or referral relationships.
Learn more about how HPRD is calculated in our guide to nursing home staffing metrics.
Key Takeaways for Families in Washington
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Check the facility-level grade, not just the state average. Washington's 4.28 HPRD average masks a range from A+ to F. Every facility is different.
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RN staffing is the most important single metric. Only 64.71% of Washington facilities meet the 0.75 RN recommendation. Prioritize homes with strong registered nurse coverage — that's where clinical problems get caught early.
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Ask about weekends. Washington facilities drop staffing by 18.03% on weekends on average. A weekend visit may not reflect typical staffing — check the daily data.
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Look at the trend direction. A facility that's improving from C toward B may be a better choice than one declining from B toward C. Four quarters of trend data reveal the direction.
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Review the inspection history. Staffing data measures resources; inspection data measures outcomes. A facility with thin staffing and repeated citations is showing two different signals pointing the same direction.
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Use the comparison tool to evaluate finalists side by side across every metric — staffing, grades, weekend patterns, inspection history, and CMS star ratings.
Frequently Asked Questions
How are nursing homes rated in Washington?
Washington nursing homes receive CMS Five-Star ratings based on health inspections, staffing levels, and quality measures. Our analysis adds letter grades (A+ through F) based on total nursing hours per resident per day, computed from federal staffing and quality data published by CMS. Washington currently has 76 facilities earning A+ or A, and 6 earning D or F.
What is considered a good nursing home rating?
A facility with a B grade or better (3.48+ HPRD) meets the CMS benchmark standard. An A or A+ (4.10+ HPRD) meets the research recommendation for avoiding quality problems. In Washington, 86.6% of facilities reach B or better.
How many nursing homes are in Washington?
Washington has 187 Medicare and Medicaid certified nursing homes serving approximately 13,811 residents daily.
What factors affect nursing home ratings in Washington?
Key factors include total nurse staffing hours, registered nurse coverage, weekend staffing consistency, reliance on temporary agency staff, health inspection deficiency history, and clinical quality measures such as fall rates and infection rates.
How can families compare nursing homes in Washington?
Our comparison tool allows side-by-side evaluation of any two Washington facilities across staffing grades, HPRD levels, weekend drop-off, agency usage, CMS star ratings, and inspection history. You can also explore the Washington state page for county-level breakdowns and rankings.