Alabama PBJ Nursing Home StaffingAlabama PBJ Staffing
Alabama's statewide staffing ratio is 3.88 HPRD in Q1 2026. Alabama's statewide staffing ratio is up slightly (+0.03) since Q1 2025. This level is above the national ratio of 3.75 HPRD and ranks #21 out of 51 states.
- Q2 2025: 3.91
- Q3 2025: 3.92
- Q4 2025: 3.93
- Q1 2026: 3.88
Alabama
Direct staff excludes Admin/DON. Direct staff excludes Admin/DON.
Alabama
Alabama
Alabama
Explore Alabama
PBJ320 High-risk facilities in Alabama PBJ320 high-risk uses CMS-assigned indicators only (PBJ320 does not assign them): Special Focus Facility or SFF Candidate; abuse icon; one-star overall; one-star staffing.
48 facilities flagged for staffing or quality concerns.
| Facility | City | CMS ratings | Risk flags | Total HPRD |
|---|---|---|---|---|
| Arabella Health and Wellness of Red BayRed Bay | Red Bay | 1★1★S | 2.96 HPRD | |
| Aspire Physical Recovery Center at Cahaba RiverVestavia | Vestavia | 1★ | 4.86 HPRD | |
| Aspire Physical Recovery Center at Hoover, LlcHoover | Hoover | 1★ | 4.80 HPRD | |
| Bellway Health and Rehabilitation CenterSelma | Selma | ⚠ | 2.87 HPRD | |
| Bibb Medical Center Nursing HomeCentreville | Centreville | 1★ | 3.23 HPRD |
Staffing snapshot
Latest state staffing metrics for Alabama.
| Metric | Alabama | CMS Region 4CMS Region 4 includes Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.Regional figures are calculated from facility-level data using the same methodology as the state figures. | U.S. | State rankRanks compare the 50 states and D.C. by the displayed metric value. A higher or lower rank is not inherently positive or negative for every metric, including contract staffing share and rural-facility share. |
|---|---|---|---|---|
| Total Nurse Staffing HPRD | 3.88 | 3.74-0.14 vs AL | 3.75-0.13 vs AL | #21 of 51 |
| Direct Care Nurse HPRD | 3.60 | 3.46-0.14 vs AL | 3.48-0.13 vs AL | #22 of 51 |
| RN HPRD | 0.63 | 0.61-0.02 vs AL | 0.62Same as AL | #33 of 51 |
| RN Direct Care HPRD | 0.43 | 0.41-0.02 vs AL | 0.44Same as AL | #33 of 51 |
| Nurse Aide HPRD | 2.46 | 2.26-0.20 vs AL | 2.26-0.19 vs AL | #19 of 51 |
| Contract Staff Percentage | 0.9% | 3.6%+2.7 pts vs AL | 5.3%+4.4 pts vs AL | #51 of 51 |
| Median Case-Mix HPRD (Acuity) | 3.30 | 3.67+0.37 vs AL | 3.74+0.44 vs AL | #42 of 51 |
| Rural Facilities (Share) | 34% | 29%-4.2 pts vs AL | 27%-6.2 pts vs AL | #25 of 51 |
State rank reflects the displayed value, not necessarily stronger or weaker performance.
Ownership groups in Alabama
Largest organizations linked to facilities in CMS owner data.
Most facilities linked in CMS owner data (Alabama).
| Organization | Facilities |
|---|---|
| Phillip Cody Long | 34 |
| James Norman Estes | 33 |
| Lynn S Rasco | 33 |
| James Norman Estes Jr Tr | 30 |
| Jennifer Lee Estes Tr 031093 | 30 |
| Regions Bank | 22 |
| Brian Kohn | 19 |
| Dac Acquisition LLC | 19 |
Ownership changes in Alabama
Recent CMS change-of-ownership activity.
60 ownership changes at 60 Alabama facilities · 01/01/2016 – 02/01/2026.
Showing 10 of 40
Showing the most recent 40 of 60 indexed changes. Browse full AL ownership & CHOW search.
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Daily PBJ data, employee rosters, and facility-level analysis.
How these figures are calculatedMethods, definitions, and data sources
Staffing from CMS Payroll-Based Journal (PBJ) public files (2017–2026), plus Provider Information and chain data where shown. State staffing context via MACPAC (2022). Methodology · PBJ explained.
Metrics
- Hours Per Resident Day (HPRD): Total staff hours ÷ average residents. Example: 350 hours for 100 residents = 3.5 HPRD.
- Direct Care (excl. Admin, DON): Hours per resident day for direct care staff only (RN, LPN, CNA, NAtrn, MedAide), excluding administrative and supervisory roles.
- Contract Staff %: Share of hours provided by contract staff.
- Census: Average number of residents during the period.
Note: Some states set minimums (e.g., NJ, CA, NY at 3.5 HPRD); a federal 3.48 minimum was recently overturned (2025). A 2001 federal study linked 4.1 HPRD to better outcomes in that study. Staffing needs vary by resident acuity (case-mix), day, and shift. Estimates on PBJ Takeaway assume roughly 60% of staff are CNAs.
Data transparency
The PBJ Dashboard pulls directly from CMS data and is carefully vetted for accuracy. Still, sometimes a bug sneaks into the jelly. That could mean: a systemic CMS data reporting issue (e.g., Q2 2017 contract staffing, missing data in 2020 due to COVID) or there could be a coding error on our part. If you spot something that looks off, please let me know via the contact form so I can set things right.
Trend charts omit quarters with implausible submitted HPRD (total/direct below 0.25; RN, LPN, and aide use role floors and neighbor-quarter rules). Full criteria.
Rankings, within-state percentiles, CMS flags (including abuse icon): How metrics are calculated.