The weekend gap
Registered-nurse coverage falls sharply at weekends in most American nursing homes. Medicare publishes the figures. Almost nobody looks at them.
Computed from Medicare's payroll-based staffing data for Jan–Mar 2026, released in the CMS file dated 1 July 2026, covering 14,235 of 14,693 certified nursing homes (96.9%). Recalculated every time this site rebuilds.
The finding
Medicare requires nursing homes to report nurse staffing from payroll records, and it reports weekend coverage separately from weekday coverage. Comparing the two across every certified facility in the country:
| Registered-nurse coverage at weekends | Facilities | Share |
|---|---|---|
| Falls by more than 30% | 7,979 | 56.1% |
| Falls by more than 50% | 2,343 | 16.5% |
| Falls by more than 70% | 155 | 1.1% |
| Higher at weekends than weekdays | 884 | 6.2% |
The median American nursing home cuts registered-nurse coverage by 33.1% at weekends. Put plainly: for most residents, the level of skilled nursing available on a Sunday is materially lower than on a Tuesday, and that is true of the typical facility rather than a troubling minority.
Some weekend reduction is expected — planned admissions, therapy and administrative work concentrate on weekdays. What the distribution shows is that the reduction is not modest, and that it is close to universal.
Ownership
Grouping facilities by who runs them produces a result that has to be read carefully, because the obvious reading is the wrong one.
| Ownership | Weekday | Weekend | Fall | Facilities |
|---|---|---|---|---|
| Non profit | 0.87 | 0.53 | 37.1% | 2,761 |
| Government | 0.70 | 0.43 | 37.3% | 886 |
| For profit | 0.53 | 0.36 | 31.4% | 10,588 |
By percentage, for-profit facilities cut the least. Taken alone that figure would suggest they protect weekend coverage better than non-profits do. They do not. The percentage is smaller because the starting point is lower — a facility cannot fall as far from 0.53 hours as one falling from 0.87.
The comparison that survives scrutiny is the absolute one:
The median for-profit nursing home provides about as much registered-nurse coverage on a weekday as the median non-profit provides at the weekend — 0.53 hours per resident per day, either way.
This is why we publish levels beside every ratio on this site. A percentage change measured from an already-low base flatters the facilities providing least, and it is the easiest way to mislead with true numbers.
By state
States with at least 20 facilities reporting a usable comparison, ordered by the size of the weekend fall. Both the levels and the fall are shown, for the reason given above.
The ordering is not a ranking of quality, and the table shows why. Some states with the smallest weekend falls also have among the lowest coverage on both days — little changes at the weekend because there was little to begin with. Meanwhile a state near the top of the list can have a large fall from a high base and still end the weekend better staffed than a state at the bottom. Read across each row, not down the final column.
Where weekend coverage is actually lowest
Ranked by skilled nursing available at the weekend rather than by how far it fell — the measure that describes what a resident experiences on a Sunday:
Louisiana 0.15, Arkansas 0.25, Oklahoma 0.25, Missouri 0.27, Georgia 0.29 hours per resident per day.
| State | Weekday | Weekend | Fall | Facilities |
|---|---|---|---|---|
| Alabama | 0.71 | 0.33 | 53.4% | 220 |
| Mississippi | 0.65 | 0.31 | 52.8% | 198 |
| North Dakota | 1.05 | 0.55 | 47.1% | 70 |
| Minnesota | 1.12 | 0.58 | 46.2% | 331 |
| West Virginia | 0.63 | 0.34 | 46.0% | 120 |
| Michigan | 0.76 | 0.43 | 43.9% | 414 |
| South Dakota | 0.86 | 0.46 | 43.5% | 92 |
| Arkansas | 0.45 | 0.25 | 43.2% | 216 |
| Louisiana | 0.27 | 0.15 | 43.2% | 252 |
| Oregon | 0.68 | 0.38 | 41.1% | 122 |
| Montana | 1.03 | 0.64 | 40.8% | 58 |
| Wyoming | 0.86 | 0.57 | 40.4% | 35 |
| South Carolina | 0.56 | 0.33 | 40.3% | 184 |
| Iowa | 0.78 | 0.45 | 40.1% | 376 |
| Kansas | 0.72 | 0.44 | 39.8% | 281 |
| North Carolina | 0.53 | 0.32 | 39.2% | 404 |
| Virginia | 0.51 | 0.34 | 38.3% | 280 |
| Delaware | 0.88 | 0.49 | 38.1% | 43 |
| Nebraska | 0.67 | 0.41 | 38.0% | 170 |
| New Mexico | 0.66 | 0.41 | 37.3% | 65 |
| Idaho | 0.71 | 0.52 | 37.1% | 79 |
| Connecticut | 0.61 | 0.40 | 36.1% | 183 |
| New York | 0.57 | 0.36 | 36.1% | 582 |
| Missouri | 0.42 | 0.27 | 35.9% | 463 |
| Georgia | 0.45 | 0.29 | 34.7% | 346 |
| Vermont | 0.77 | 0.48 | 34.0% | 31 |
| Wisconsin | 0.93 | 0.62 | 33.9% | 319 |
| Maine | 1.07 | 0.73 | 33.6% | 77 |
| Oklahoma | 0.38 | 0.25 | 33.5% | 256 |
| Tennessee | 0.51 | 0.34 | 33.2% | 297 |
| Pennsylvania | 0.65 | 0.44 | 33.0% | 631 |
| Florida | 0.67 | 0.45 | 32.6% | 675 |
| New Hampshire | 0.77 | 0.52 | 32.5% | 71 |
| Rhode Island | 0.74 | 0.51 | 32.5% | 69 |
| Kentucky | 0.64 | 0.44 | 31.2% | 259 |
| Massachusetts | 0.59 | 0.40 | 30.6% | 333 |
| Colorado | 0.79 | 0.54 | 30.4% | 202 |
| Arizona | 0.59 | 0.41 | 30.3% | 135 |
| Ohio | 0.54 | 0.38 | 30.1% | 899 |
| New Jersey | 0.57 | 0.40 | 29.9% | 342 |
| Utah | 0.99 | 0.76 | 27.7% | 90 |
| Washington | 0.84 | 0.63 | 27.5% | 188 |
| Indiana | 0.56 | 0.40 | 26.7% | 501 |
| Maryland | 0.69 | 0.51 | 26.1% | 215 |
| Hawaii | 1.56 | 1.16 | 25.9% | 42 |
| Texas | 0.39 | 0.29 | 23.9% | 1,140 |
| California | 0.48 | 0.37 | 23.2% | 1,126 |
| Nevada | 0.84 | 0.67 | 21.7% | 63 |
| Illinois | 0.50 | 0.46 | 10.4% | 651 |
Why it matters
Registered nurses are the staff qualified to notice and act on clinical deterioration — a change in breathing, a wound turning, a reaction to medication. Coverage is not the only thing that determines whether that happens, and this analysis does not claim it is. But it is the thing families are least able to observe on a tour, and the thing most likely to differ on the day they are not visiting.
It also suggests a practical step, which costs nothing: visit on a weekend. A Sunday afternoon shows a facility closer to its minimum staffing than any weekday appointment will.
How this was calculated
Figures come from the Centers for Medicare & Medicaid Services' payroll-based staffing data, which facilities report from actual payroll records rather than estimates. We express the weekend difference as a share of the weekday level, and exclude facilities where either figure is missing or where the weekday figure is too small to yield a stable ratio — 96.9% of certified facilities have a usable comparison.
Medians are used throughout rather than means, because a small number of facilities with very high reported coverage would otherwise pull the averages away from the typical case. Every derivation, including the full dataset list, is set out in how we read the data.
These figures are recomputed from the current federal release every time this site rebuilds, so the numbers above are not a snapshot from a report written once.
Checking our work
The underlying files are public and the method is described above, so this is reproducible by anyone who wants to. If you find an error — in the arithmetic, the method, or the framing — we want to hear about it: corrections@wheretheycare.com. Corrections are published; see how we handle them.
Every number above is derived from one file, and you can have it: download the per-facility data (CSV). It carries every certified nursing home in the country — weekday and weekend registered-nurse hours per resident per day, the resulting change, and a link to each facility's page. Facilities excluded from the percentages are included too, each with the reason it was excluded, so the 458 exclusions can be checked rather than taken on trust. Staffing figures cover Jan–Mar 2026.
The same figures for one facility
Every certified nursing home in the country has a page here showing its own weekday and weekend coverage against its state's average, alongside inspection findings and the nearest alternatives. Start from a ZIP code to find the ones near you.