North Carolina PBJ Nursing Home StaffingNorth Carolina PBJ Staffing
407 providers • 35,489 residents • 3.64 HPRD
3.64 HPRD (rank: 40)3.64 HPRD · Rk 400.52 RN HPRD8.1% contract
North Carolina's statewide staffing ratio is 3.64 HPRD in Q4 2025. North Carolina's statewide staffing ratio is down slightly (−0.02) since Q4 2024. This level is below the national ratio of 3.76 HPRD and ranks #40 out of 51 states.
North Carolina
Direct staff excludes Admin/DON. Direct staff excludes Admin/DON.
North Carolina
North Carolina
North Carolina
NC Staffing Stats
| 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 | 3.64 | 3.76+0.12 vs NC | 3.76+0.12 vs NC | #40 of 51 |
| Direct Care Nurse HPRD | 3.37 | 3.49+0.12 vs NC | 3.50+0.12 vs NC | #41 of 51 |
| RN HPRD | 0.52 | 0.60+0.08 vs NC | 0.62+0.10 vs NC | #45 of 51 |
| RN Direct Care HPRD | 0.32 | 0.41+0.09 vs NC | 0.43+0.11 vs NC | #45 of 51 |
| Nurse Aide HPRD | 2.27 | 2.28+0.02 vs NC | 2.28+0.01 vs NC | #32 of 51 |
| Contract Staff Percentage | 8.1% | 3.4%-4.7 pts vs NC | 5.3%-2.9 pts vs NC | #13 of 51 |
| Median Case-Mix HPRD (Acuity) | — | 3.70 | 3.74 | #28 of 51 |
| Rural Facilities (Share) | 29% | 29%Same as NC | 27%-1.7 pts vs NC | #27 of 51 |
PBJ320 High-Risk (104)
PBJ320 high-risk 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. nursing homes in North Carolina (104 facilities).
| Facility | Census | CMS ratings | Indicators | Total HPRD |
|---|---|---|---|---|
| Loading facilities… | ||||
Methodology
Staffing from CMS Payroll-Based Journal (PBJ) public files (2017–2025), 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.