The Bill Rate Index What the hour costs, and who keeps it
11,897 nursing homes · Medicare cost reports · FY2021 to FY2025

A nursing home pays its own staff $27.72 an hour. An agency hour costs it $54.91.

The gap is wider here than in hospitals, 99% against 85%, and the people doing the work are paid far less to begin with.

Nursing homes file the same kind of wage schedule hospitals do, on a form almost nobody reads.

The median American nursing home, by year

Filings on the right. Headline figures use FY2024, the most recent year with a full set of them in.

The wage The premium
Median employed hour $27.71 What the home pays its own staff, wages only.
Median contract hour $54.91 What the same home pays for staff furnished under contract.
The gap today 99% 11,897 homes across 51 states and territories.

Every nursing home that filed the numbers

Most recent filing each, widest gap first. Search for yours, or open it to see every year.

 

Showing the first 50. Search or pick a state to narrow it.

Working a contract in one of these?

Paste what your recruiter sent you. It works out the real hourly value, separates taxed pay from stipends, and sets it beside what the facility reported paying.

Check your split Hospitals instead

Where these numbers come from

Every skilled nursing facility paid by Medicare files Form CMS-2540-10. On Worksheet S-3 Part II, line 13 is total adjusted salaries, which is what the home paid its own staff after physicians and excluded units are taken out, and line 14 is contract labour. Both carry paid hours and an hourly rate the home works out itself.

CMS Healthcare Cost Report Information System
Form CMS-2540-10, Worksheet S-3 Part II

One difference from the hospital figures

The hospital form separates contract patient care from contract management. This one does not: line 14 is titled Contract Labor: Patient Related & Management and carries both. A home that contracts out its administrator raises its own contract hourly rate here. Treat these rates as slightly generous to the agency case, and do not compare them against the hospital figures to the decimal.

What was left out

Homes reporting no contract labour, no usable wage data, or rates outside any plausible range. So are years with under 100 contract hours or 500 employed hours, where an average is noise.