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Table of Contents

Executive Summary .................................................................................................................... 3

1.0 Introduction ..................................................................................................................... 8

2.0 Retention and Turnover of Nursing Staff ....................................................................... 12

3.0 Retention and Turnover of Other Nursing Facility Employees ........................................ 15

3.1 Retention and Turnover of Administrative and Management Staff ................................. 15

3.2 Retention and Turnover of Therapy Staff ....................................................................... 16

3.3 Retention and Turnover of Food Services Staff ............................................................. 17

3.4 Retention and Turnover of Housekeeping and Maintenance Staff ................................. 18

3.5 Retention and Turnover of Social Services and Activities Staff ...................................... 19

4.0 Discussion ..................................................................................................................... 20

Appendix A: Methodology ......................................................................................................... 22

Appendix B: Data Tables .......................................................................................................... 25

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EXECUTIVE SUMMARY

Key Findings in 2011

a. Retention of all employees and nursing staff improved constantly during the 2008-2011 time period;

b. Turnover of all employees and nursing staff increased in 2011 after a steady decrease from 2008 to 2010.

c. Turnover of all nursing facility employees was 45% in 2011.

d. Turnover of direct-care staff (DCS) was 53% in 2011.

The American Health Care Association (AHCA) conducted its fourth annual staffing survey collecting 2011 data to estimate the retention and turnover of all employees working in nursing facilities nationwide. More than 4,000 nursing facilities (NFs) participated in the 2011 survey. Based on data collected from survey, we estimate that 2 million people were directly employed in nursing facilities across the United States in 2011. Of these, about 1.3 million employees provided skilled nursing and nursing related care to about 1.5 million nursing facility residents.

Figure 1. Percentage Breakdown of Nursing Facility Employees by Job Category, 2011

Administrative/Management

5%

Nursing 65%

Therapy 6%

Food Services 11%

Housekeeping /Maintenance

8%

Social Activities

4%

2 million nursing facility employees

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Figure 2. Percentage Breakdown of Nursing Staff by Job Position, 2011

Dir. of Nursing1%

Admin. RN2%

Staff RN8%

Lic. Practical/ Vocational

Nurse 21%

Cert. Nurse Assist

57%

Other Nursing Staff11%

1.3 million Nursing Related Employees

Retention Rates In 2011, the retention rate for all nursing facility employees was 72.1 percent. As shown in Figure 3, retention rates ranged from 69.9 to 83.4 percent across all the major nursing facility job categories. The overall retention rate of nursing care staff (69.9 percent) was the lowest among all nursing facility employees.

Figure 3. Total Nursing Facility Employee Retention Rates (%) by Job Category, 2011

83.4

69.9

68.8

78.3

73.7

80.7

80.0

Administrative

Nursing

(Direct-Care Staff)

Therapy

Food Services

Housekeeping

Social Services & Activities

Nursing staff in direct care roles include staff registered nurses (RNs), licensed practical nurses (LPNs) and licensed vocational nurses (LVNs), and certified nursing assistants (CNAs).

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Figure 4. Nursing Staff Retention Rates (%) by Job Position, 2011

Retention rates exhibited variability across the seven nursing positions. As shown in Figure 4, retention rates were highest for MDS Coordinator (85.3 percent) and lowest among staff RNs (65.7 percent). Turnover Rates The overall turnover rate for all nursing facility employees was 45.0 percent and exhibited a high degree of variability across job categories. As shown in Figure 5, turnover rate was highest among nursing care staff (50.0 percent) and lowest for administrative staff (26.7 percent). As shown in Figure 6, turnover rates for Staff Registered Nurses (RN), Licensed Practical Nurses (LPN), and CNAs ranged from 43.1 to 62.8 percent. Turnover rates for Director of Nursing (DON) and Registered Nurses with Administrative Duties (ARN) were 23.9 and 33.7 percent, respectively.

Figure 5. Turnover Rates (%) by Nursing Facility Job Category, 2011

26.7

50.0

52.8

24.7

43.9

44.3

28.0

Administrative

Nursing

(Direct-Care Staff)

Therapy

Food Services

Housekeeping

Social Services & Activities

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Figure 6. Turnover Rates (%) by Nursing Job Position, 2011

Recent Trends in Turnover and Retention Retention rates for all employees and direct care staff (DCS) remained relatively stable over the period from 2008 through 2011. Turnover rates for all employees and DCS showed steady improvement from 2008 to 2010. In 2011, however, turnover rates increased significantly (Figures 7 and 8).

Figure 7. Turnover & Retention Trend of All Nursing Facility Employees, 2008-2011

69.0%72.9% 72.6% 72.1%

45.1% 42.0%37.0%

45.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2008 2009 2010 2011

Retention

Turnover

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Figure 8. Turnover & Retention Trend of DCS, 2008-2011

Improving Staff Stability Despite recent progress, the increase in direct care staff turnover last year is important to note. A number of factors may have contributed to the reversal including an improving economy that encourages workforce mobility and measures taken by the profession to reduce costs in the face of the significant reduction in Medicare funding in FY 2012. High quality long term and post-acute care services depend on a stable, well-trained workforce. AHCA remains committed to providing solutions to nation’s long term and post-acute care workforce issues. In order to address workforce shortage and turnover issues, AHCA/NCAL unveiled the Quality Initiative, a nation-wide campaign that sets specific, measurable targets to further improve quality of care in America’s skilled nursing centers. A core goal of the Quality Initiative is to increase staff stability by effectively reducing nursing staff turnover by 15 percent before March 2015. Go to QualityInitiative.AHCANCAL.org to learn more.

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1.0

INTRODUCTION

Since 2002, the American Health Care Association (AHCA) has conducted seven nationwide surveys to collects nursing facility staff retention and turnover information. In 2004 and 2007, the nursing staff turnover and vacancy survey collected information on six nursing staff positions including Directors of Nursing (DONs), Registered Nurses (RNs) with administrative responsibilities (ARNs), Staff RNs, Licensed Practical and Vocational Nurses (LPNs), Certified Nurse Assistants (CNAs), and non-certified nursing aides. In 2008, the Nursing Facility Staffing Survey was expanded to collect retention and turnover information for all nursing facility employees including administrative and management staff, nursing staff, therapy staff, food services staff, housekeeping and maintenance staff, and social services and activities staff. The survey questionnaire was made available for all eligible nursing facilities in the United States. More than 4,000 nursing facilities across the country (both AHCA members and non-members) participated in the 2011 survey. The detailed methodology of this study can be found in Appendix A. As a descriptive study of retention and turnover of nursing facility employees, this report presents findings at a national and state level from the AHCA 2011 Nursing Facility Staffing Survey. Detailed state level retention and turnover statistics can be found in the State Appendix. Based on the survey, an estimated 2 million employees worked at nursing facilities across the United States in 2011. A total of 1.3 million persons, including Director of Nursing (DON), Registered Nurse with Administrative Duties (ARN), Staff Registered Nurse (RN), Licensed Practical Nurse (LPN), Certified Nurse Assistant (CNA), and other nursing staff, provided nursing care to nursing facility residents. Overall, nearly two-thirds of staff is nursing staff. Of the nursing staff, the majority were Certified Nurse Assistants (57.4 percent).

Table 1.1. Estimated Number of Nursing Facility Employees by Job Category, 2011

Number of Employees Percentage

All Nursing Facility Employees 1,976,073 100.0%

Administrative and Management Staff 92,551 4.7%

Nursing Staff 1,300,736 65.8%

Therapy Staff 111,148 5.6%

Food Services Staff 219,009 11.1%

Housekeeping and Maintenance Staff 166,751 8.4%

Social Services and Activities Staff 85,875 4.3%

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In 2011, the retention rate for all nursing facility employees was 72.1 percent. As shown in Table 1.2, retention rates by staff category ranged from 69.9 to 83.4 percent. The retention rate of nursing staff (69.9 percent) was the lowest among all job categories. The turnover rate for all nursing facility employees was 45.0 percent. Turnover rates exhibited a high degree of variability across nursing facility job categories. As shown in table 1.2, turnover rates in nursing facilities were particularly high among nursing staff (50.0 percent) and housekeeping staff (44.3 percent), and were lowest for therapy staff (24.7 percent).

Table 1.2. Retention and Turnover Rates (%) by Nursing Facility Job Category, 2011

Retention Turnover All Nursing Facility Employees 72.1% 45.0%

Administrative and Management Staff 83.4% 26.7%

Nursing Staff 69.9% 50.0%

Therapy Staff 78.7% 24.7%

Food Services Staff 73.7% 43.9%

Housekeeping and Maintenance Staff 80.7% 44.3%

Social Services and Activities Staff 80.0% 28.0%

As shown in Figures 1.1 and 1.2, overall nursing facility retention rates are relatively stable across states, ranging from a high of 83.6 percent in Connecticut to a low of 60.5 percent in Wyoming, with most states tracking the national average of 72.1 percent. By contrast, there is substantial variation in turnover rates between states in 2011. Overall nursing facility turnover rates were below 13 percent in Hawaii and the District of Columbia and over 70 percent in Wyoming (See Figures 1.3 and 1.4)

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Figure 1.1. Retention Rates (%) of All Nursing Facility Employees by State, 2011

Figure 1.2. Retention Rates of Direct Care Staff by State, 2011

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Figure 1.3. Turnover Rates of All Nursing Facility Employees by State, 2011

Figure 1.4. Turnover Rates of Direct Care Staff by State, 2011

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2.0

RETENTION AND TURNOVER OF NURSING STAFF

In 2011, an estimated 1.3 million workers were employed as nursing staff in more than 15,000 nursing facilities nationwide. Nursing staff, including Director of Nursing (DON), Registered Nurse with Administrative Duties, Staff Registered Nurse (RN), Licensed Practical Nurse (LPN), Certified Nurse Assistant (CNA), and other nursing staff. Overall, they represented approximately 65 percent of the total nursing facility workforce. Certified Nurse Assistant constituted the largest portion of entire nursing staff (see Figure 2.1).

Figure 2.1. Percentage Breakdown of Nursing Staff by Job Position, 2011

Dir. of Nursing1%

Admin. RN2%

Staff RN8%

Lic. Practical/ Vocational

Nurse 21%

Cert. Nurse Assist

57%

Other Nursing Staff11%

Table 2.1. Estimated Number of Nursing Staff by Job Position, 2011

Number of Employees Percentage

All Nursing Staff 1,300,736 100.0%

Director of Nursing (DON) 15,424 1.2%

RN with Administrative Duties (ARN) 38,702 3.0%

Staff Registered Nurse (RN) 135,839 10.4% Licensed Practical/Vocational Nurse

(LPN/LVN) 260,755 20.0%

Certified Nurse Assistant (CNA) 747,590 57.5%

Other Nursing Staff 102,426 7.9%

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2.1 Retention of Nursing Staff In 2011, the retention rate for all nursing facility employees was 69.9 percent. The nursing staff retention rate was the lowest among all nursing facility employees. Retention rates exhibited variability across the nursing positions. As shown in Figure 2.2, retention rates were highest for the MDS Coordinator (85.3 percent) and lowest among RNs (65.7 percent).

Figure 2.2. Nursing Staff Retention Rates by Job Position, 2011

2.2 Turnover of Nursing Staff Turnover rates were high for most nursing job positions in 2011. Nationally, turnover rates exhibited a high degree of variability across nursing job positions. As shown in Figure 2.3, turnover rates in nursing facilities were particularly high among CNAs (55.3 percent), LPNs (43.1 percent), and RNs (62.8 percent). Meanwhile, the turnover rate for MDS Coordinator was low at 29.7 percent. The low level of retention and the high level of turnover among CNAs continues to be a particular concern to nursing facilities as CNAs are responsible for much of the direct, hands-on resident care.

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Figure 2.3. Nursing Staff Turnover Rates by Job Position, 2011

23.9

33.7

62.8

43.1

55.3

29.7

26.4

Director of Nursing (DON)

RN with Administrative Duties

Staff Registered Nurse (RN)

Licensed Practical Nurse (LPN/LVN)

Certified Nurse Assistant (CNA)

MDS Coordinator

Staff Development Coordinator

Figure 2.4. Turnover & Retention Trend of DCS, 2011

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3.0

RETENTION AND TURNOVER OF

OTHER NURSING FACILITY EMPLOYEES In order to measure staff stability of all nursing facility employees, the Nursing Facility Staffing Survey has been expanded to all six major nursing facility job categories – Administrative and Management, Nursing, Therapy, Food Service, Housekeeping and Maintenance, and Social Services and Activities.

3.1 Retention and Turnover of Administrative and Management Staff In 2011, an estimated 92,551 employees worked in nursing facilities nationwide as administrative and management staff, representing 4 percent of the total nursing facility workforce.

Figure 3.1. Percentage Breakdown of Administrative and Management Staff by Job Position, 2011

Administrator

18%

Manager/Controller

17%

Other Office Staff65%

In 2011, the retention rate for all administrative and management staff was 83.4 percent, the highest among all nursing facility employees. The overall turnover rate for administrative and management staff was 26.7 percent.

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Table 3.1. Administrative and Management Staff Turnover and Retention Rates, 2011

Retention Turnover All Administrator & Management Staff 83.4% 26.7%

Administrator 86.2% 20.3%

Office Manager/Controller 90.7% 15.2%

Other Office Staff 82.7% 31.7%

3.2 Retention and Turnover of Therapy Staff In 2011, an estimated total of 11,149 employees worked in nursing facilities as therapy staff, representing 4 percent of the total nursing facility workforce. Employees of outside contractors are widely used as therapy staff at nursing facilities across the country. Contract staff was not included in this survey. In 2011, the retention rate for therapy staff was 78.3 percent. The overall turnover rate for therapy staff was 24.7 percent, the lowest among all nursing facility job categories.

Figure 3.2. Percentage Breakdown of Number of Therapy Staff by Job Position, 2011

Physical Therapist

19%

Occup. Therapist

25%

Speech Language

Pathologist12%

Physical Therapy

Aide19%

Others Therapy

Staff31%

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Table 3.2. Retention and Turnover Rates by Therapy Job Position, U.S., 2011

Retention Turnover All Therapy Staff 78.3% 24.7%

Physical Therapist 79.8% 26.2%

Occupational Therapist 78.8% 31.2%

Speech Language Pathologist 77.7% 37.8%

Physical Therapy Aide 82.0% 22.2%

Occupational Therapy Aide 76.3% 24.2%

Speech Therapy Aide 76.7% 5.4%

3.3 Retention and Turnover of Food Services Staff In 2011, an estimated 219,000 workers were employed as food services staff, representing 11 percent of the total nursing facility workforce.

Figure 3.3. Percentage Breakdown of Food Services Staff by Job Position, 2011

In 2011, the retention rate for food services staff was 73.7 percent, the second lowest and below nursing staff. The overall turnover rate for food services staff was 43.9 percent.

Table 3.3. Retention and Turnover Rates by Food Services Job Position, 2011

Retention Turnover All Food Services Staff 73.7% 43.9%

Dietician Supervisor 87.0% 20.8%

Other Food Services Staff 72.1% 47.7%

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3.4 Retention and Turnover of Housekeeping and Maintenance Staff In 2011, an estimated 166,751 employees worked in nursing facilities as housekeeping and maintenance staff, representing 8 percent of the total nursing facility workforce.

Figure 3.4. Percentage Breakdown of Housekeeping and Maintenance Staff by Job Position, 2011

In 2011, the retention rate for housekeeping and maintenance staff was 80.7 percent. The overall turnover rate for housekeeping and maintenance staff was 44.3 percent.

Table 3.4. Retention and Turnover Rates by Housekeeping and Maintenance Job Position, U.S., 2011

Retention Turnover All Housekeeping & Maintenance Staff 80.7% 44.3%

Housekeeping Staff 77.8% 36.4%

Laundry Staff 83.9% 27.1%

Maintenance Staff 85.1% 26.4%

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3.5 Retention and Turnover of Social Services and Activities Staff In 2011, there were an estimated 85,876 workers in nursing facilities employed as social services and activities staff, representing 4 percent of the total nursing facility workforce.

Figure 3.5. Percentage Breakdown of Social Services and Activities Staff by Job Position, 2011

In 2011, the retention rate for social services and activities staff was 80.0 percent, the second highest next to administrative and management staff. The overall turnover rate for social services and activities staff was 28.0 percent.

Table 3.5. Retention and Turnover Rates by Social Services and Activities Job Position, U.S., 2011

Retention Turnover All Social Services & Activities Staff 80.0% 28.0%

Activity Director 90.5% 13.8%

Activity Staff 79.6% 35.4%

Social Service Director 85.9% 20.2%

Social Service Staff 78.6% 27.3%

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4.0

DISCUSSION

The AHCA Nursing Facility Staffing Survey has provided data on turnover and retention of nursing facility employees to policy makers and public since 2002. The goal of this report is to disseminate 2011 statistics on turnover and retention for benchmarking and advocacy purposes. Since the AHCA Quality Initiative is bringing greater attention to nursing staff stability, having up-to-date, accurate, and consistent data is even more critical. AHCA conducted the 2011 Nursing Facility Staffing Survey to meet this demand. Employee turnover and retention rate are two important measures of staff stability. AHCA has committed through its Quality Agenda to focus on priority goals that will demonstrate and improve the value of services that nursing facilities provide to the elderly, frail, and intellectually disabled. Improving staff stability plays a vital role in this initiative. Staff stability is one of the most important factors to assure high quality, and cost effective care to achieve the aims of the health care reform. AHCA proposed to use staff turnover rate as one of benchmark measuring quality of service. Turnover rates of all employees and Direct-Care Staff (DCS) show a steady decrease from 2008 to 2010. However, the turnover rates increased in 2011. Retention rates of all employees and DCS remained relatively stable during this same time period. Analysis of survey data from 2008 to 2011 found that nursing facilities that participated in the staff survey each year reduced DCS turnover rates 18.8 percent from 56.4 percent in 2008 to 45.8 percent in 2011. Whereas, over the same time period, overall DCS turnover rate declined by only 3.1 percent from 54.5 percent to 52.8 percent. The economic downturn may have had an impact on staff turnover. During times of recession, workers may stay in the same job longer, re-enter the long term and post-acute care workforce and delay retirement. These factors contribute to lower turnover rates. Conversely, as the economy improves, and job opportunities and alternatives increase, turnover rates may increase as workers seek and accept more rewarding employment opportunities. This phenomenon is evident in our survey data, particularly among higher skilled DCS such as staff RNs than for lower skilled DCS such as CNAs where the increase in the turnover rate was lower. Furthermore, a simple comparison of DCS turnover data from the survey against unemployment rate data from the Bureau of Labor Statistics suggests that there is an inverse relationship between the unemployment rate and turnover rate. Additional research would be helpful in definitively understanding the impact of economic cycles on workforce turnover, and how to measure and

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adjust turnover in nursing facilities such that the efforts of the profession in reducing turnover can be disentangled from broader economic cycles.

Table 4.0. DCS Turnover versus Unemployment

Compare High and Low DCS turnover States

DCS Turnover Rate (%)

Unemployed Rate (%,

2012, Jan) 5 Low DCS Staff Turnover

State* DC 12.4 9.9

CT 28.9 8.0 NY 29.1 8.3 FL 29.2 9.6 CA 33.2 10.9

Five-State Average 26.6 9.3 5 High DCS Staff Turnover State*

WY 71.4 5.5 ID 73.7 8.1 OK 74.4 6.1 AR 75.3 7.6 TX 76.0 7.3

Five-State Average 74.2 6.9

* Continental states. High quality long term and post-acute care services depend upon a stable, well-trained workforce. Promoting sound fiscal policies, designed to strengthen America’s long term and post-acute care workforce and facilitate the continuing improvement in quality of nursing facility care, is imperative and should be a top national priority.

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Appendix A

METHODOLOGY

The 2011 AHCA Nursing Facility Staffing Survey is the fourth study to collect nationwide retention and turnover information among nursing facility employees of six major job category and twenty-nine job positions (see the table below).

Nursing Facility Job Category Nursing Facility Job Position

Administrative & Management Administrator Office Manager/Controller Other Office Staff

Nursing

Director of Nursing (DON) Assistant Director of Nursing (ADON) RN with Administrative Duties Staff Registered Nurse (RN) Licensed Practical/Vocational Nurse (LPN/LVN) Certified Nurse Assistant (CNA) Non-Certified Nurse Aide, if applicable MDS Coordinator Staff Development Coordinator Other Nursing Staff - Clinical Support Unit Clerical Support

Therapy

Physical Therapist Occupational Therapist Speech Therapist/Language Pathologist Physical Therapy Aide Occupational Therapy Aide Speech Therapy Aide

Food Services Dietician Supervisor Other food Service Staff

Housekeeping & Maintenance Housekeeping Staff Laundry Staff Maintenance Staff

Social Services and Activities

Activity Director Activity Staff Social Service Director Social Service Staff

Other Others

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The survey questionnaire was used to collect four pieces of nursing facility staff information:

• Number of total current employees - the total number of persons on the payroll who worked or received pay as of December 31, 2011. All full-time, part-time, permanent, short-term, seasonal, salaried, and hourly employees were included. Employees of temporary help agencies and outside contractors will be excluded because they are counted by their employer of record, not by the nursing facility where they are working.

• Number of total vacant positions - a vacant position means that: 1) a specific full-time or

part-time position exists and there is work available for that position, 2) work could start within 30 days regardless of whether a suitable candidate is found, and 3) the employer is actively recruiting from outside the establishment to fill the position. Jobs to be filled only by internal transfers, promotions, demotions, or recall from layoffs are excluded.

• Total number of employees who had worked in the facility for 12 months or longer - should

not include employee(s) who had changed her/his job position within the same facility in the 12 months. For example, if the facility administrator left during 2011 and was replaced by the individual in the director of nursing position, the number of employees in this column would be reported as 0 for both the administrator and director of nursing positions.

• Total number of employees who had worked in the facility during calendar year 2011.

In this report, we present aggregated results for the all job categories. We also report results for selected job positions, particularly for all major nursing staff positions. Data for some job position was insufficient for analysis. Data for state of Alaska was insufficient to generate state level analysis. To ensure the reliability of the data, frequency distributions were examined and data was omitted from the analysis where individual responses were out of range or a combination of responses were deemed implausible through contingency checks. In cases where implausible or out of range data was detected, responses were omitted from analysis for the specific job position, except where noted otherwise. Calculating the Measures of Nursing Facility Staff Stability Turnover rate and retention rate are two key measures of nursing facility staff stability. AHCA defines retention as the number of employees who have worked in a nursing facility for 12 months or longer divided by the number of the total number of current employees at the end of the calendar year. Turnover is defined as the number of terminations (voluntary and involuntary) in a given year divided by the total number of current employees at the end of the calendar year.

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Turnover Rate = The number of termination* in a calendar year (12 months) X 100 The total number of current employees at the end of the calendar year

*Termination is defined as the number of all employees who worked the nursing facility in a calendar year minus the total number of current employees at the end of the calendar year.

Retention Rate =

The number of employees who have worked in a nursing facility for 12 months or longer X 100

The total number of current employees at the end of the calendar year

Population weights were calculated and applied for calculation of estimated number of nursing facility employees. The weights were calculated by dividing the number of facilities in each state by the number of responding facilities with usable data in the state. Routine data cleaning procedure applies to ensure the reliability of the data. Contingency check is applied to identify out of range/implausible responses (data):

• For each job category where the total number of CURRENT employees at the end of 2011 were greater than the total number of employees during calendar in year 2011;

• For each job category where the total number of CURRENT employees at the end of 2011 were smaller than the number of employees who had worked in the same facility for 1 YEAR or longer;

• For each job category where the total the number of employees who had worked in the same facility for 1 YEAR/or longer were greater than the total number of employees during calendar in year 2011.

For each job category, if turnover rate higher than 10 x standard deviation (SD) plus mean, this turnover will be eliminated from calculation of turnover rate of this job category.

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Appendix B

Table 1. Percentile of Turnover and Retention Rates by Job Category, 2011

Turnover Rate

Mean 10 percentile

25 percentile Median 75

percentile 90

percentile All Staff 45.0% 6.6% 26.3% 42.3% 60.4% 81.7% Administrator 20.3% 0.0% 0.0% 0.0% 0.0% 100.0% Nursing staff 50.0% 5.9% 26.8% 45.5% 67.9% 93.5% DCS 52.8% 7.5% 29.2% 47.8% 70.7% 98.1% RNs 62.8% 0.0% 14.3% 45.5% 87.5% 137.5% PNs/LVNs 43.1% 0.0% 15.4% 35.0% 60.0% 91.7% CNAs 55.3% 5.5% 27.1% 48.8% 76.0% 106.1%

Retention rate

Mean 10 percentile

25 percentile Median 75

percentile 90

percentile All Staff 72.1% 56.4% 64.7% 72.8% 80.5% 87.3% Administrator 86.2% 0.0% 100.0% 100.0% 100.0% 100.0% Nursing staff 69.9% 51.2% 61.1% 70.7% 80.0% 87.9% DCS 68.8% 50.0% 60.0% 69.3% 78.9% 87.4% RNs 65.7% 33.3% 50.0% 66.7% 85.7% 100.0% LPNs/LVNs 73.8% 48.0% 62.5% 75.8% 88.2% 100.0% CNAs 68.6% 47.1% 57.7% 69.2% 80.3% 90.0%

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Table 2. All Employees – Turnover Rate, 2008-2011, by State

State 2008 2009 2010 2011 State 2008 2009 2010 2011

United States 45.1% 42.0% 37.0% 45.0% Montana 66.7% 43.8% 50.2% 43.6%

Alabama 43.5% 40.8% 40.0% 51.1% North Carolina 56.8% 49.0% 35.3% 52.3%

Arkansas 63.8% 68.6% 41.2% 59.6% North Dakota 25.8% 22.4% 18.7% 32.4%

Arizona 49.9% 54.9% 39.5% 48.7% Nebraska 42.9% 46.3% 38.0% 46.8%

California 38.9% 28.6% 24.0% 30.6% New Hampshire 37.6% 39.9% 32.2% 38.3%

Colorado 48.5% 55.4% 39.6% 55.9% New Jersey 29.6% 33.8% 30.0% 30.1%

Connecticut 19.3% 27.7% 19.2% 27.8% New Mexico 57.5% 92.4% 63.1% 58.0%

District of Columbia * 24.0% 16.8% 12.9% Nevada 63.9% 67.9% 41.8% 44.5%

Delaware 35.2% 28.9% 38.7% 38.7% New York 29.3% 20.2% 19.4% 24.1%

Florida 43.2% 30.8% 24.6% 25.9% Ohio 46.9% 34.2% 35.1% 47.1%

Georgia 39.4% 33.8% 39.9% 44.1% Oklahoma 60.3% 72.3% 59.5% 56.9%

Hawaii 26.3% 15.7% 18.4% 10.3% Oregon 45.1% 63.1% 35.3% 42.8%

Iowa 25.6% 24.4% 28.3% 29.9% Pennsylvania 38.4% 35.3% 34.3% 40.3%

Idaho 65.8% 52.0% 46.0% 62.1% Rhode Island 27.4% 34.1% 25.8% 36.1%

Illinois 38.0% 34.2% 31.4% 44.8% South Carolina 26.7% 38.8% 29.8% 53.3%

Indiana 68.2% 47.1% 42.0% 51.6% South Dakota 42.8% 41.5% 36.9% 42.7%

Kansas 64.9% 57.4% 54.6% 58.4% Tennessee 52.1% 41.2% 29.6% 48.1%

Kentucky 67.7% 59.7% 49.1% 59.6% Texas 44.2% 76.9% 65.8% 63.3%

Louisiana 45.8% 36.4% 41.9% 51.9% Utah 40.3% 54.7% 44.2% 55.3%

Massachusetts 37.0% 37.5% 26.1% 37.8% Virginia 60.3% 46.7% 33.9% 47.6%

Maryland 40.8% 37.0% 32.5% 38.1% Vermont 39.3% 34.0% 31.7% 45.3%

Maine 40.9% 34.4% 27.6% 36.9% Washington 62.7% 53.7% 46.0% 49.1%

Michigan 31.3% 29.3% 31.6% 41.1% Wisconsin 53.1% 37.0% 35.6% 45.9%

Minnesota 34.0% 35.9% 34.2% 42.7% West Virginia 47.8% 42.4% 49.3% 58.3%

Missouri 65.4% 57.5% 55.7% 58.2% Wyoming 70.0% 93.5% 44.5% 69.7%

Mississippi 26.6% 30.9% 27.5% 39.6%

* Data is insufficient for meaningful analysis.

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Table 3. All Employees – Retention Rate, 2008-2011, by State

State 2008 2009 2010 2011 State 2008 2009 2010 2011

United States 69.0% 72.9% 72.6% 72.1% Montana 63.9% 69.7% 73.8% 74.3%

Alabama 69.6% 75.7% 73.8% 72.6% North Carolina 65.4% 71.9% 70.5% 70.1%

Arkansas 63.8% 64.1% 61.6% 63.6% North Dakota 74.3% 79.6% 79.9% 73.3%

Arizona 70.4% 68.6% 68.9% 66.5% Nebraska 71.7% 69.2% 71.0% 68.1%

California 73.0% 78.1% 77.9% 77.7% New Hampshire 68.2% 77.0% 75.5% 72.9%

Colorado 65.9% 65.6% 69.4% 69.1% New Jersey 74.1% 77.8% 80.0% 82.0%

Connecticut 81.5% 82.0% 84.1% 83.6% New Mexico 61.4% 60.7% 61.2% 68.0%

District of Columbia * 90.4% 76.4% 79.4% Nevada 61.2% 65.3% 77.1% 62.7%

Delaware 69.6% 71.0% 75.1% 73.2% New York 74.8% 82.5% 82.3% 82.0%

Florida 71.4% 77.0% 75.9% 77.8% Ohio 69.3% 72.6% 73.1% 73.4%

Georgia 58.4% 75.6% 74.9% 70.9% Oklahoma 49.9% 55.9% 57.9% 63.6%

Hawaii 82.9% 83.6% 81.1% 83.4% Oregon 70.6% 73.5% 73.0% 74.4%

Iowa 80.7% 79.2% 73.5% 74.4% Pennsylvania 73.5% 75.5% 74.6% 73.3%

Idaho 63.1% 68.9% 70.3% 67.3% Rhode Island 75.2% 79.9% 78.5% 77.0%

Illinois 69.8% 71.4% 74.5% 69.0% South Carolina 78.4% 74.8% 74.0% 72.9%

Indiana 64.7% 68.2% 67.8% 72.6% South Dakota 64.3% 73.3% 70.9% 72.7%

Kansas 62.5% 63.3% 63.9% 63.9% Tennessee 67.9% 72.5% 70.6% 70.1%

Kentucky 65.3% 67.9% 69.8% 69.8% Texas 67.3% 62.8% 62.1% 64.2%

Louisiana 65.7% 65.5% 69.6% 69.2% Utah 74.4% 69.7% 66.0% 62.7%

Massachusetts 72.8% 76.8% 79.2% 77.6% Virginia 65.7% 70.6% 74.9% 71.1%

Maryland 68.4% 75.4% 75.3% 77.0% Vermont 69.0% 69.6% 65.5% 73.3%

Maine 68.5% 76.2% 77.1% 74.3% Washington 69.5% 68.1% 72.2% 69.9%

Michigan 73.0% 76.0% 75.4% 72.9% Wisconsin 70.8% 74.4% 74.7% 74.0%

Minnesota 73.4% 74.5% 72.9% 73.3% West Virginia 67.3% 76.5% 76.3% 71.7%

Missouri 61.1% 63.8% 64.3% 65.7% Wyoming 61.0% 61.5% 67.8% 60.5%

Mississippi 75.7% 76.6% 73.6% 72.6%

* Data is insufficient for meaningful analysis.

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Table 4. Nursing Staff – Turnover Rate, 2008-2011, by State

State 2008 2009 2010 2011 State 2008 2009 2010 2011

United States 50.7% 46.9% 41.6% 50.0% Montana 64.8% 47.9% 51.1% 41.7%

Alabama 49.6% 47.5% 46.5% 56.9% North Carolina 64.8% 58.1% 41.0% 59.7%

Arkansas 70.0% 75.0% 48.5% 68.4% North Dakota 30.4% 24.3% 20.7% 37.7%

Arizona 54.9% 62.2% 43.9% 52.9% Nebraska 44.3% 49.0% 39.7% 47.9%

California 42.3% 30.7% 26.7% 32.7% New Hampshire 38.4% 42.0% 34.9% 39.7%

Colorado 49.9% 57.9% 44.0% 56.3% New Jersey 31.3% 36.5% 32.7% 32.8%

Connecticut 21.0% 30.8% 20.5% 28.0% New Mexico 57.1% 98.9% 68.8% 63.4%

District of Columbia * 28.0% 18.0% 14.8% Nevada 76.4% 74.8% 44.3% 48.0%

Delaware 38.1% 28.8% 39.5% 41.2% New York 34.8% 24.2% 23.1% 30.1%

Florida 49.9% 30.9% 27.1% 28.0% Ohio 59.5% 40.8% 39.7% 53.7%

Georgia 43.4% 39.2% 44.6% 51.1% Oklahoma 64.5% 83.4% 64.2% 64.8%

Hawaii 30.7% 18.4% 20.4% 11.2% Oregon 53.2% 67.1% 38.7% 46.5%

Iowa 27.7% 28.5% 32.4% 33.1% Pennsylvania 43.7% 39.2% 37.8% 44.0%

Idaho 69.5% 58.0% 51.0% 65.7% Rhode Island 30.4% 36.4% 28.5% 39.4%

Illinois 49.6% 40.7% 36.3% 52.8% South Carolina 29.9% 39.7% 34.1% 52.6%

Indiana 78.8% 54.0% 46.5% 58.1% South Dakota 46.9% 44.7% 42.1% 48.5%

Kansas 70.9% 64.2% 62.2% 65.0% Tennessee 61.9% 50.9% 36.2% 56.8%

Kentucky 78.4% 67.4% 53.6% 64.7% Texas 50.0% 79.8% 74.1% 71.5%

Louisiana 47.6% 41.2% 47.7% 57.7% Utah 48.2% 58.3% 49.7% 63.4%

Massachusetts 37.9% 39.7% 27.3% 38.5% Virginia 69.9% 55.0% 39.8% 52.5%

Maryland 44.0% 41.4% 34.3% 40.0% Vermont 40.9% 40.9% 37.5% 47.0%

Maine 43.0% 39.1% 34.0% 41.2% Washington 74.4% 59.7% 53.2% 53.9%

Michigan 37.6% 35.9% 35.6% 45.8% Wisconsin 60.5% 41.7% 39.4% 52.5%

Minnesota 37.7% 41.7% 39.5% 48.4% West Virginia 55.5% 46.1% 54.2% 66.8%

Missouri 72.1% 67.6% 66.9% 67.6% Wyoming 72.8% 91.7% 53.3% 73.4%

Mississippi 28.6% 35.0% 31.4% 46.0% * Data is insufficient for meaningful analysis.

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Table 5. Nursing Staff – Retention Rate, 2008-2011, by State

State 2008 2009 2010 2011 State 2008 2009 2010 2011

United States 66.9% 70.4% 70.3% 69.9% Montana 63.1% 69.9% 72.6% 73.5%

Alabama 65.9% 72.3% 70.1% 69.1% North Carolina 62.4% 68.6% 67.6% 67.9%

Arkansas 61.3% 61.8% 59.8% 59.5% North Dakota 72.0% 77.6% 78.3% 71.0%

Arizona 68.6% 65.6% 66.7% 65.6% Nebraska 70.6% 67.2% 70.0% 67.0%

California 72.0% 76.6% 76.6% 76.4% New Hampshire 67.3% 75.8% 74.3% 71.5%

Colorado 65.8% 63.5% 66.8% 67.3% New Jersey 73.1% 77.4% 80.4% 81.9%

Connecticut 80.8% 81.0% 83.8% 83.7% New Mexico 59.5% 58.9% 59.1% 65.6%

District of Columbia * 88.4% 77.1% 76.4% Nevada 55.9% 60.4% 74.9% 58.4%

Delaware 68.4% 70.1% 75.2% 71.6% New York 74.3% 80.3% 80.5% 80.5%

Florida 70.9% 75.5% 74.6% 77.3% Ohio 69.0% 69.4% 70.6% 71.0%

Georgia 55.0% 73.1% 72.5% 68.2% Oklahoma 50.3% 51.4% 51.5% 59.9%

Hawaii 86.1% 82.1% 81.1% 82.8% Oregon 66.5% 69.1% 69.2% 72.6%

Iowa 77.2% 76.9% 70.9% 71.5% Pennsylvania 72.3% 74.0% 73.2% 71.7%

Idaho 61.1% 64.1% 67.0% 65.6% Rhode Island 74.9% 78.2% 78.0% 76.8%

Illinois 66.1% 67.1% 70.9% 65.8% South Carolina 75.3% 73.1% 72.6% 70.1%

Indiana 61.9% 63.9% 65.6% 71.2% South Dakota 60.9% 70.2% 68.1% 71.0%

Kansas 60.5% 59.0% 58.8% 60.3% Tennessee 63.7% 69.1% 66.9% 65.7%

Kentucky 62.0% 64.6% 66.9% 67.2% Texas 63.6% 61.3% 59.2% 60.9%

Louisiana 62.6% 60.4% 66.5% 67.1% Utah 72.9% 66.4% 63.0% 57.9%

Massachusetts 73.1% 76.3% 78.9% 77.0% Virginia 63.4% 68.3% 72.0% 68.9%

Maryland 67.8% 74.2% 74.3% 76.8% Vermont 67.8% 69.4% 63.1% 72.4%

Maine 66.2% 74.1% 76.6% 71.2% Washington 67.0% 64.8% 70.2% 68.9%

Michigan 70.0% 73.0% 72.7% 70.5% Wisconsin 68.0% 72.6% 73.2% 71.6%

Minnesota 71.0% 71.3% 70.5% 71.8% West Virginia 65.1% 75.2% 74.7% 68.9%

Missouri 56.7% 59.1% 59.4% 61.3% Wyoming 61.3% 60.5% 62.9% 57.7%

Mississippi 74.1% 72.4% 70.4% 69.6%

* Data is insufficient for meaningful analysis.

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Table 6. DCS – Turnover Rate, 2008-2011, by State

State 2008 2009 2010 2011 State 2008 2009 2010 2011

United States 54.5% 49.4% 44.9% 52.8% Montana 76.7% 46.8% 61.0% 42.2%

Alabama 56.1% 49.3% 49.9% 57.5% North Carolina 67.2% 60.0% 44.5% 61.7%

Arkansas 81.5% 75.2% 44.5% 75.3% North Dakota 28.9% 27.7% 23.7% 43.4%

Arizona 53.2% 61.2% 44.9% 54.3% Nebraska 55.8% 52.8% 44.9% 53.2%

California 43.6% 31.6% 27.8% 33.2% New Hampshire 39.4% 45.7% 36.2% 41.7%

Colorado 52.3% 57.7% 49.2% 57.7% New Jersey 31.5% 39.1% 31.7% 32.4%

Connecticut 21.0% 33.9% 20.9% 28.9% New Mexico 59.4% 88.6% 66.3% 65.7%

District of Columbia * 30.5% 22.8% 12.4% Nevada 103.5% 74.4% 44.4% 52.1%

Delaware 43.1% 32.1% 44.2% 45.7% New York 37.7% 27.3% 23.8% 29.1%

Florida 50.2% 34.4% 28.3% 29.2% Ohio 65.6% 43.6% 41.9% 57.2%

Georgia 44.5% 40.3% 46.9% 55.5% Oklahoma 62.5% 92.5% 73.4% 74.4%

Hawaii 32.0% 19.2% 22.0% 12.5% Oregon 60.8% 77.3% 39.8% 49.8%

Iowa 31.9% 28.9% 33.5% 35.4% Pennsylvania 47.3% 41.2% 38.8% 45.9%

Idaho 69.6% 55.5% 53.9% 73.7% Rhode Island 32.1% 42.3% 32.0% 44.9%

Illinois 39.5% 42.8% 41.2% 56.1% South Carolina 31.2% 44.4% 37.2% 57.6%

Indiana 84.8% 57.0% 51.0% 61.0% South Dakota 51.0% 47.6% 48.4% 56.8%

Kansas 77.3% 70.8% 71.2% 69.0% Tennessee 65.4% 54.3% 37.1% 60.7%

Kentucky 81.4% 72.2% 60.3% 67.7% Texas 56.1% 86.9% 77.5% 76.0%

Louisiana 50.6% 41.4% 53.0% 60.5% Utah 50.9% 58.7% 53.6% 67.0%

Massachusetts 39.8% 40.5% 30.1% 38.9% Virginia 77.8% 63.2% 43.2% 53.2%

Maryland 42.4% 43.4% 38.5% 41.1% Vermont 50.8% 46.3% 41.1% 64.2%

Maine 46.2% 41.5% 37.5% 46.3% Washington 75.5% 62.2% 54.3% 56.4%

Michigan 40.0% 39.0% 39.7% 47.8% Wisconsin 65.4% 43.0% 41.3% 52.3%

Minnesota 43.0% 46.3% 44.1% 51.2% West Virginia 58.1% 50.7% 58.8% 70.9%

Missouri 76.9% 67.0% 71.4% 67.7% Wyoming 79.8% 71.8% 64.4% 71.4%

Mississippi 29.3% 34.8% 32.9% 47.6%

* Data is insufficient for meaningful analysis.

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Table 7. DCS – Retention Rate, 2008-2011, by State

State 2008 2009 2010 2011 State 2008 2009 2010 2011

United States 65.6% 68.8% 69.0% 68.8% Montana 55.3% 68.2% 70.6% 71.9%

Alabama 64.0% 72.2% 69.2% 67.9% North Carolina 62.6% 68.2% 65.8% 66.5%

Arkansas 57.2% 58.3% 55.2% 56.5% North Dakota 68.8% 76.6% 78.9% 67.3%

Arizona 70.9% 62.1% 67.3% 63.6% Nebraska 62.7% 63.0% 67.0% 64.9%

California 71.7% 75.6% 75.4% 76.7% New Hampshire 66.9% 74.2% 73.7% 70.1%

Colorado 63.0% 62.6% 64.7% 65.9% New Jersey 73.5% 76.2% 79.4% 82.8%

Connecticut 82.3% 79.6% 82.6% 83.5% New Mexico 58.1% 58.9% 59.3% 63.5%

District of Columbia * 87.2% 78.6% 72.1% Nevada 46.3% 59.2% 75.4% 58.0%

Delaware 66.2% 63.5% 73.5% 72.0% New York 73.5% 77.8% 79.6% 80.3%

Florida 70.6% 73.2% 73.7% 76.9% Ohio 67.4% 68.1% 70.0% 69.9%

Georgia 51.8% 72.6% 72.1% 67.4% Oklahoma 47.4% 48.5% 49.8% 58.2%

Hawaii 85.9% 80.5% 78.7% 81.5% Oregon 65.4% 65.6% 63.6% 72.8%

Iowa 76.0% 73.5% 70.4% 69.1% Pennsylvania 72.4% 73.7% 73.5% 71.4%

Idaho 63.1% 63.3% 66.4% 62.2% Rhode Island 74.1% 73.1% 74.8% 74.5%

Illinois 64.5% 66.6% 69.1% 64.5% South Carolina 72.5% 71.8% 71.8% 68.1%

Indiana 62.3% 62.2% 63.3% 70.6% South Dakota 58.6% 68.7% 65.0% 67.7%

Kansas 57.2% 57.2% 54.1% 57.7% Tennessee 63.9% 67.8% 66.9% 64.8%

Kentucky 62.1% 63.4% 65.7% 65.6% Texas 59.5% 56.4% 57.6% 58.5%

Louisiana 63.8% 58.4% 64.7% 64.1% Utah 73.2% 66.4% 60.8% 57.1%

Massachusetts 72.3% 75.4% 78.3% 76.4% Virginia 60.8% 64.6% 70.0% 68.0%

Maryland 68.5% 73.4% 74.7% 76.7% Vermont 61.1% 69.5% 65.2% 72.8%

Maine 64.1% 70.5% 74.5% 69.0% Washington 67.9% 62.9% 70.5% 68.3%

Michigan 68.5% 69.9% 71.9% 70.1% Wisconsin 66.6% 71.7% 71.5% 70.6%

Minnesota 69.2% 69.8% 69.1% 70.8% West Virginia 64.5% 73.1% 74.3% 68.4%

Missouri 54.7% 57.7% 58.1% 60.4% Wyoming 64.3% 62.0% 60.8% 56.8%

Mississippi 71.5% 74.6% 69.1% 68.9%

* Data is insufficient for meaningful analysis.

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Table 8. Estimated Number of Total Employees by State and Job Category, 2011

State All Staff Admini- strative Nursing Therapy Food

Service House- keeping Activity

United States 1,976,073 92,551 1,300,737 111,149 219,009 166,751 85,876 Alabama 29,000 1,225 20,452 734 2,942 2,662 985 Arkansas 24,505 854 16,791 1,215 2,295 2,753 597 Arizona 19,720 1,106 13,035 1,460 1,815 1,513 792 California 147,358 8,208 100,668 7,019 14,949 10,058 6,457 Colorado 24,401 1,217 15,333 1,820 2,682 2,028 1,322 Connecticut 41,590 2,072 27,272 2,271 5,069 3,104 1,801 District of Columbia 4,137 174 2,541 198 399 675 150 Delaware 8,074 455 5,040 614 919 753 293 Florida 111,183 4,694 75,210 7,203 10,168 10,496 3,412 Georgia 39,377 1,544 27,125 1,124 4,216 3,925 1,443 Hawaii 9,161 499 5,845 182 995 1,085 555 Iowa 39,346 1,761 24,053 1,442 5,954 4,286 1,849 Idaho 7,103 342 4,890 252 890 344 385 Illinois 111,002 5,459 66,194 9,894 12,819 10,835 5,801 Indiana 60,458 2,964 39,906 4,165 6,573 4,048 2,802 Kansas 27,130 1,269 17,290 1,152 3,394 2,643 1,382 Kentucky 32,584 1,426 21,857 2,416 3,532 2,195 1,158 Louisiana 29,085 1,425 20,437 499 3,136 2,666 922 Massachusetts 60,588 2,414 41,109 2,715 7,215 4,088 3,047 Maryland 37,702 2,361 23,951 2,723 3,906 3,150 1,611 Maine 14,309 421 9,117 814 1,783 1,512 663 Michigan 62,429 2,487 39,930 6,184 6,395 4,562 2,871 Minnesota 44,381 1,602 30,524 805 5,997 2,814 2,640 Missouri 48,797 2,165 31,660 1,348 6,460 5,063 2,101 Mississippi 24,128 989 16,643 232 2,696 2,756 812 Montana 8,220 384 5,478 145 1,056 685 473 North Carolina 49,083 2,341 33,483 3,145 5,079 3,374 1,660 North Dakota 14,404 512 9,395 481 2,063 1,276 676 Nebraska 21,377 889 14,945 222 2,751 1,528 1,043 New Hampshire 10,691 463 7,131 434 1,406 732 525 New Jersey 67,311 3,404 42,581 3,401 7,633 6,400 3,892 New Mexico 7,808 490 5,029 463 886 575 366 Nevada 7,976 559 4,856 650 708 866 337 New York 133,073 6,619 84,311 6,651 16,103 13,334 6,056 Ohio 126,021 5,724 82,211 7,866 14,469 10,163 5,588 Oklahoma 27,117 1,135 17,970 913 3,233 2,705 1,161 Oregon 13,458 595 9,811 32 1,497 745 779 Pennsylvania 112,573 5,194 74,091 7,883 12,743 7,488 5,174 Rhode Island 12,517 555 8,254 567 1,437 1,073 632 South Carolina 24,538 977 15,956 1,728 2,311 2,607 958 South Dakota 9,177 426 5,975 85 1,333 841 518 Tennessee 43,303 2,033 27,706 3,702 4,112 4,237 1,513 Texas 123,512 7,004 80,567 7,597 12,580 11,936 3,829 Utah 10,140 566 6,317 1,021 1,058 698 479 Virginia 39,982 2,177 26,238 1,580 4,875 3,591 1,522 Vermont 5,200 178 3,309 326 620 525 242 Washington 27,675 1,330 18,336 1,863 3,162 1,631 1,353 Wisconsin 45,021 1,879 30,439 1,934 5,602 2,808 2,360 West Virginia 8,753 363 5,536 584 907 945 419 Wyoming 4,240 253 2,683 191 433 483 197

Note: May not sum to total due to rounding.

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Table 9. Estimated Number of Nursing Staff by State, 2011

State All Nursing Staff Direct Care Staff RNs LPNs CNAs United States 1,300,737 1,144,185 135,839 260,755 747,590 Alabama 20,452 18,142 1,103 4,716 12,322 Arkansas 16,791 15,328 729 3,517 11,082 Arizona 13,035 11,799 1,540 2,752 7,507 California 100,668 89,995 11,313 18,099 60,583 Colorado 15,333 13,635 2,102 2,881 8,651 Connecticut 27,272 23,923 3,590 5,162 15,171 District of Columbia 2,541 2,153 193 671 1,289 Delaware 5,040 4,461 873 933 2,655 Florida 75,210 68,730 6,102 16,986 45,643 Georgia 27,125 24,186 1,674 7,326 15,186 Hawaii 5,845 5,218 960 562 3,696 Iowa 24,053 21,499 2,503 3,831 15,165 Idaho 4,890 4,329 588 824 2,917 Illinois 66,194 59,682 11,309 11,209 37,164 Indiana 39,906 34,961 3,142 10,005 21,814 Kansas 17,290 13,963 1,623 2,569 9,770 Kentucky 21,857 19,218 1,850 4,699 12,669 Louisiana 20,437 18,451 912 5,245 12,294 Massachusetts 41,109 36,420 5,525 8,133 22,763 Maryland 23,951 20,565 3,315 5,063 12,188 Maine 9,117 8,060 1,595 784 5,682 Michigan 39,930 35,452 4,705 7,129 23,618 Minnesota 30,524 26,479 3,050 5,392 18,037 Missouri 31,660 26,876 1,699 6,395 18,782 Mississippi 16,643 14,693 939 4,282 9,472 Montana 5,478 4,831 689 756 3,386 North Carolina 33,483 29,643 3,221 6,989 19,434 North Dakota 9,395 8,546 931 1,333 6,282 Nebraska 14,945 12,713 1,237 2,467 9,008 New Hampshire 7,131 6,451 1,216 1,105 4,130 New Jersey 42,581 37,321 7,809 7,246 22,266 New Mexico 5,029 4,402 512 840 3,050 Nevada 4,856 4,317 708 1,037 2,573 New York 84,311 73,050 6,684 16,798 49,569 Ohio 82,211 74,532 8,637 18,536 47,359 Oklahoma 17,970 16,096 1,086 3,838 11,172 Oregon 9,811 7,475 933 1,173 5,369 Pennsylvania 74,091 63,601 9,115 14,354 40,132 Rhode Island 8,254 7,388 1,434 814 5,141 South Carolina 15,956 14,381 1,527 3,687 9,167 South Dakota 5,975 4,806 431 617 3,758 Tennessee 27,706 23,388 1,687 6,779 14,922 Texas 80,567 68,433 6,028 19,608 42,797 Utah 6,317 5,590 1,189 685 3,716 Virginia 26,238 23,089 1,610 6,703 14,775 Vermont 3,309 2,872 456 587 1,829 Washington 18,336 16,030 2,619 2,985 10,427 Wisconsin 30,439 26,507 3,896 4,244 18,367 West Virginia 5,536 4,688 572 1,112 3,003 Wyoming 2,683 2,341 438 327 1,576

Note: May not sum to total due to rounding.