Missouri PBJ Nursing Home StaffingMissouri PBJ Staffing
Missouri's statewide staffing ratio is 3.34 HPRD in Q1 2026. Missouri's statewide staffing ratio is up slightly (+0.04) since Q1 2025. This level is below the national ratio of 3.75 HPRD and ranks #49 out of 51 states.
- Q2 2025: 3.39
- Q3 2025: 3.39
- Q4 2025: 3.36
- Q1 2026: 3.34
Missouri
Direct staff excludes Admin/DON. Direct staff excludes Admin/DON.
Missouri
Missouri
Missouri
Explore Missouri
PBJ320 High-risk facilities in Missouri 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.
179 facilities flagged for staffing or quality concerns.
| Facility | City | CMS ratings | Risk flags | Total HPRD |
|---|---|---|---|---|
| Abbey Senior HealthO Fallon | O Fallon | ⚠ | 4.74 HPRD | |
| Abode Health and Wellness CenterIndependence | Independence | SFF cand.c.⚠1★1★S | 4.21 HPRD | |
| Advanced Care of St JosephSaint Joseph | Saint Joseph | 1★1★S | 2.48 HPRD | |
| Aegis Health and RehabilitationWildwood | Wildwood | 1★1★S | 3.41 HPRD | |
| Alpine Breeze Health and WellnessRaytown | Raytown | ⚠1★S | 2.40 HPRD |
Staffing snapshot
Latest state staffing metrics for Missouri.
| Metric | Missouri | CMS Region 7CMS Region 7 includes Iowa, Kansas, Missouri, and Nebraska.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 | 3.34 | 3.66+0.32 vs MO | 3.75+0.41 vs MO | #49 of 51 |
| Direct Care Nurse HPRD | 3.13 | 3.41+0.28 vs MO | 3.48+0.35 vs MO | #49 of 51 |
| RN HPRD | 0.40 | 0.56+0.16 vs MO | 0.62+0.22 vs MO | #48 of 51 |
| RN Direct Care HPRD | 0.27 | 0.38+0.11 vs MO | 0.44+0.17 vs MO | #48 of 51 |
| Nurse Aide HPRD | 2.27 | 2.45+0.19 vs MO | 2.26Same as MO | #29 of 51 |
| Contract Staff Percentage | 3.9% | 4.7%+0.8 pts vs MO | 5.3%+1.4 pts vs MO | #36 of 51 |
| Median Case-Mix HPRD (Acuity) | 3.32 | 3.42+0.10 vs MO | 3.74+0.42 vs MO | #29 of 51 |
| Rural Facilities (Share) | 41% | 52%+11.0 pts vs MO | 27%-13.4 pts vs MO | #20 of 51 |
State rank reflects the displayed value, not necessarily stronger or weaker performance.
Ownership groups in Missouri
Largest organizations linked to facilities in CMS owner data.
Most facilities linked in CMS owner data (Missouri).
| Organization | Facilities |
|---|---|
| Forvis Mazars LLP | 83 |
| James C Lincoln | 54 |
| Judy L Lincoln | 53 |
| Ltc Management Services LLC | 35 |
| AGH1 LLC | 33 |
| Donald B Bedell | 33 |
| Fg LLC | 33 |
| MID States Inc | 33 |
Ownership changes in Missouri
Recent CMS change-of-ownership activity.
147 ownership changes at 147 Missouri facilities · 01/01/2016 – 02/01/2026.
Showing 10 of 40
Showing the most recent 40 of 147 indexed changes. Browse full MO ownership & CHOW search.
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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.