North Carolina PBJ Nursing Home StaffingNorth Carolina PBJ Staffing
North Carolina's statewide staffing ratio is 3.65 HPRD in Q1 2026. North Carolina's statewide staffing ratio is up (+0.06) since Q1 2025. This level is near the national ratio of 3.75 HPRD and ranks #37 out of 51 states.
- Q2 2025: 3.65
- Q3 2025: 3.67
- Q4 2025: 3.64
- Q1 2026: 3.65
North Carolina
Direct staff excludes Admin/DON. Direct staff excludes Admin/DON.
North Carolina
North Carolina
North Carolina
Explore North Carolina
PBJ320 High-risk facilities in North Carolina 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.
103 facilities flagged for staffing or quality concerns.
| Facility | City | CMS ratings | Risk flags | Total HPRD |
|---|---|---|---|---|
| Alamance Health Care CenterBurlington | Burlington | ⚠1★1★S | 3.37 HPRD | |
| Autumn Care of MarshvilleMarshville | Marshville | 1★1★S | 3.31 HPRD | |
| Autumn Care of Myrtle GroveWilmington | Wilmington | ⚠1★ | 3.78 HPRD | |
| Autumn Care of WaynesvilleWaynesville | Waynesville | 1★1★S | 3.43 HPRD | |
| Ayden Court Nursing and Rehabilitation CenterAyden | Ayden | 1★1★S | 2.99 HPRD |
Staffing snapshot
Latest state staffing metrics for North Carolina.
| Metric | North Carolina | 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 | 3.65 | 3.74+0.09 vs NC | 3.75+0.09 vs NC | #37 of 51 |
| Direct Care Nurse HPRD | 3.37 | 3.46+0.09 vs NC | 3.48+0.10 vs NC | #39 of 51 |
| RN HPRD | 0.53 | 0.61+0.07 vs NC | 0.62+0.09 vs NC | #44 of 51 |
| RN Direct Care HPRD | 0.33 | 0.41+0.08 vs NC | 0.44+0.11 vs NC | #45 of 51 |
| Nurse Aide HPRD | 2.26 | 2.26Same as NC | 2.26Same as NC | #31 of 51 |
| Contract Staff Percentage | 8.0% | 3.6%-4.4 pts vs NC | 5.3%-2.7 pts vs NC | #13 of 51 |
| Median Case-Mix HPRD (Acuity) | 3.51 | 3.67+0.16 vs NC | 3.74+0.22 vs NC | #26 of 51 |
| Rural Facilities (Share) | 29% | 29%Same as NC | 27%-1.8 pts vs NC | #27 of 51 |
State rank reflects the displayed value, not necessarily stronger or weaker performance.
Ownership groups in North Carolina
Largest organizations linked to facilities in CMS owner data.
Most facilities linked in CMS owner data (North Carolina).
Ownership changes in North Carolina
Recent CMS change-of-ownership activity.
172 ownership changes at 172 North Carolina facilities · 01/01/2016 – 02/01/2026.
Showing 10 of 40
Showing the most recent 40 of 172 indexed changes. Browse full NC 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.