Ohio has the largest skilled nursing facility market in the Midwest — nearly 1,000 facilities across 88 counties. With 4.82% average contract staffing dependency and $21.26M in federal penalties over three years, Ohio presents one of the most active markets for staffing agencies and acquisition-focused investors in the country.
Ohio sets no minimum hours per resident day at the state level. Facilities determine their own staffing ratios, measured only against the federal RN presence requirement.
Ohio recorded 721 CMS penalty actions over three years, including 61 penalties of $100,000 or more. Active enforcement signals ongoing survey pressure across the state.
Ohio’s average contract staffing rate of 4.82% is the highest among Midwest states we track — indicating strong existing demand for agency staff and an established market for staffing providers.
| County | Facilities | Avg HPRD | RN HPRD | Below 3.48 | Below 0.55 RN | Zero-RN Days | Stability Score |
|---|---|---|---|---|---|---|---|
| Cuyahoga | 93 | 3.74 | 0.586 | 42 (45%) | 49 (53%) | 0.8 | 80.7 |
| Hamilton | 69 | 3.88 | 0.612 | 26 (38%) | 33 (48%) | 0.2 | 83.5 |
| Franklin | 57 | 3.99 | 0.799 | 19 (33%) | 14 (25%) | 0.1 | 84.1 |
| Summit | 43 | 3.61 | 0.547 | 23 (53%) | 23 (53%) | 0.2 | 82.1 |
| Montgomery | 40 | 3.69 | 0.622 | 16 (40%) | 17 (43%) | 0.3 | 82.7 |
| Lucas | 34 | 3.73 | 0.565 | 10 (29%) | 21 (62%) | 0.4 | 81.8 |
| Stark | 33 | 3.78 | 0.598 | 12 (36%) | 16 (48%) | 0.0 | 81.5 |
| Mahoning | 29 | 3.76 | 0.63 | 10 (34%) | 11 (38%) | 0.3 | 81.1 |
| Butler | 25 | 3.94 | 0.571 | 6 (24%) | 10 (40%) | 2.4 | 82.4 |
| Lorain | 19 | 3.69 | 0.613 | 4 (21%) | 8 (42%) | 0.1 | 84.2 |
| Trumbull | 17 | 3.73 | 0.596 | 7 (41%) | 8 (47%) | 0.8 | 80.4 |
| Warren | 16 | 4.07 | 0.62 | 2 (13%) | 7 (44%) | 0.3 | 82.8 |
| Clermont | 15 | 4.03 | 0.728 | 3 (20%) | 2 (13%) | 0.2 | 82.6 |
| Wayne | 14 | 3.79 | 0.648 | 6 (43%) | 10 (71%) | 2.4 | 77.7 |
| Lake | 14 | 3.51 | 0.561 | 8 (57%) | 7 (50%) | 0.0 | 82.7 |
Ohio’s 4.82% contract dependency is the highest in the Midwest. The market already relies on agency staff — the opportunity is to identify which of the 389 facilities below RN benchmark are actively sourcing.
With 919 facilities, $21M in recent penalties, and 371 below the 3.48 benchmark, Ohio offers a deep acquisition screening opportunity. Distressed assets are concentrated in Cuyahoga, Summit, and Ashtabula counties.
Ohio operators need county-level benchmarks to understand how their facilities compare to local peers. Our data covers every county from Cuyahoga to rural Appalachian Ohio.
