This paper reports the results of a state-level comparison of the performance of nursing homes. The results were obtained by applying data envelopment analysis (DEA) to data (obtained from OSCAR, the online survey, certification and reporting database [2004]) for all the skilled nursing facilities in each of the 50 states and the District of Columbia. DEA produces an efficiency score for each state that can serve as a single comprehensive measure of its overall performance. However, two DEA models were used in the analysis reported here so that each state could be given two efficiency scores, one for each of the two aspects of their performance - quality efficiency and operating efficiency. Eleven states were identified as being 100% efficient for both quality and operating efficiency of their nursing homes. For the remaining states (i.e. those having lower scores for either quality efficiency or operating efficiency or both), DEA results include, in addition to the efficiency score, performance goals and a benchmark set of other states that could be used as models of 'best practice'.