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How Alabama nursing homes are licensed and rated

A state license, a federal certification and a five-star system that measures different things.

Quick answer

ADPH licenses every nursing home in Alabama under chapter 420-5-10 and, as the state survey agency for CMS, also inspects homes that are certified for Medicare and Medicaid against federal requirements.

Home›Alabama Rules›How Alabama nursing homes are licensed and rated
Last verified: October 2026

Who licenses nursing homes in the Birmingham area?

ADPH licenses every nursing home in Alabama under chapter 420-5-10 and, as the state survey agency for CMS, also inspects homes that are certified for Medicare and Medicaid against federal requirements.

ADPH licenses 51 nursing homes in the seven counties, 5,991 beds in all; 50 have a CMS Care Compare record, which our nursing home table shows next to each license.

That dual role means a single ADPH survey team can cite both state rules and federal tags. Federal findings are what feed Medicare's Care Compare.

What do CMS star ratings measure for Alabama nursing homes?

CMS's overall rating of one to five stars combines a health inspection rating built from the last few years of surveys, a staffing rating from payroll-based nurse hours and a quality measure rating from resident assessment data; we show each exactly as CMS publishes it.

Health inspection stars are relative to other homes in the same state, so a three-star home in Alabama is middle-of-the-pack for Alabama, not nationally. Staffing stars depend on hours per resident day, adjusted for how sick residents are. Quality measures cover things like falls with injury, pressure ulcers and antipsychotic use. A home can be strong on one and weak on another; read all three.

What does a Special Focus Facility or abuse icon mean?

CMS names a small number of homes with a persistent record of serious problems as Special Focus Facilities and inspects them more often, and it shows an abuse icon on homes cited for abuse in the past year or potential abuse in each of the last two years.

Our nursing home pages show both flags when CMS sets them. Neither is a reason to rule a home out automatically, especially if a family member is already a resident, but both are reasons to read the actual statement of deficiencies and ask hard questions.

How should Birmingham families compare nursing homes?

Compare recent deficiency counts against the local median, nurse staffing hours and turnover, whether the home takes Alabama Medicaid for long-term stays, distance from family, and whether the rehab unit and long-term hall are run differently.

Our nursing home table sorts by CMS rating, beds, inspection date and deficiencies. Each nursing home page also lists the five closest alternatives and the nearest general hospitals on ADPH's roster.

At a glance

CMS Care Compare showsCMS Care Compare does not show
RatingsOverall, inspection, staffing and quality starsAssisted living or SCALF records
InspectionsDeficiency counts and full survey textWhether a bed is open today
StaffingNurse hours per resident day and turnoverWho is on your parent's hall tonight
MoneyFines and payment denialsThe daily private-pay rate

Sources: Ala. Admin. Code chapters 420-5-4, 420-5-10 and 420-5-20; ADPH Bureau of Health Provider Standards; ADPH Health Care Facilities Directory and Deficiencies applications; Alabama DHR Adult Protective Services. See our editorial standards.

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