This white paper analyzes the differences in nursing home usage and services across the United States. The paper presents an analysis of minimum data set (MDS) assessment records for all residents in Medicare or Medicaid-certified nursing homes on a quarterly basis to gain an understanding of how much nursing home usage varies by state and demographic characteristics. Also explored are differences in the types of assistance needed and services provided in nursing homes across the country. The findings suggest that states with higher nursing home penetration rates may have significant opportunity to reduce them, which may lower costs in long-term services and supports (LTSS) and improve patient satisfaction.