By Birmingham Senior Advisor Care Team · October 30, 2026
Among 50 certified nursing homes in the seven counties, none holds a five-star CMS overall rating; 18 have three stars and 16 have one. The median home reports 3.72 nurse staffing hours per resident day, 0.53 of them from RNs, and 53% nursing staff turnover. Use these medians to read any single home's numbers.
What we looked at
CMS's Care Compare Provider Information file, released October 1, 2026, covers every Medicare- or Medicaid-certified nursing home. We matched it to the 51 nursing homes the Alabama Department of Public Health licenses in Jefferson, Shelby, St. Clair, Walker, Blount, Chilton and Bibb counties; 50 have a CMS record. The one without a match is the state veterans home in Pell City, whose ADPH record lists no Medicare number to link it to CMS.
Star ratings: few top performers
CMS's overall rating runs from one to five stars. In the seven counties, no certified home holds five stars in this release. Five have four stars, 18 have three, 11 have two and 16 have one. Remember that the health inspection component is graded relative to other homes in the same state, so these ratings compare Birmingham-area homes with the rest of Alabama.
| CMS overall rating (Oct. 2026) | Homes in the seven counties |
|---|---|
| 5 stars | 0 |
| 4 stars | 5 |
| 3 stars | 18 |
| 2 stars | 11 |
| 1 star | 16 |
Staffing hours and turnover
Staffing is the measure families feel most directly. Across the 48 homes with reported staffing, total nurse staffing ranges from 2.89 to 5.25 hours per resident per day, with a median of 3.72. Registered nurse time ranges from 0.25 to 1.34 hours per resident day, median 0.53. Total nursing staff turnover runs from 30.1% to 82.1%, median 53.5%.
| CMS staffing measure | Lowest | Median | Highest |
|---|---|---|---|
| Total nurse hours per resident day | 2.89 | 3.72 | 5.25 |
| RN hours per resident day | 0.25 | 0.53 | 1.34 |
| Total nursing staff turnover | 30.1% | 53.5% | 82.1% |
| Certified beds | 30 | 116 | 259 |
Higher hours do not guarantee better care, and a home that serves sicker residents should staff more. But a home well below the local median on both total hours and RN hours, with turnover above the median, deserves pointed questions about agency staff and nights.
Inspections and penalties
The median home's most recent standard inspection cycle produced 4.5 health deficiencies, and the highest count was 15. CMS lists fines for 14 of the 50 homes within its penalty window and shows its abuse icon for four. Two homes, Magnolia Ridge Post Acute in Gardendale and Walker Rehabilitation Center in Carbon Hill, are listed as candidates for CMS's Special Focus Facility program.
Ownership is overwhelmingly private: CMS classifies 43 of the 50 as for-profit, six as nonprofit and one as government-owned. Ownership type alone predicts little; read each home's record.
How to use the numbers
Open any home on our nursing home roster and you will see its CMS ratings, staffing and turnover next to these medians, its newest-cycle deficiencies and its five nearest alternatives. Then visit, ideally twice, once on a weekend evening when staffing is thinnest.
Ask how many aides work each hall on each shift, how often agency staff fill in, who the attending physicians are and how often they round, and whether the home accepts Alabama Medicaid for long-term stays. The 2026 Medicaid income limit for nursing home care is $2,982 a month.
Reading staffing alongside inspections
Staffing and inspections tell different parts of the story. A home with low staffing hours and a high deficiency count in its newest cycle is a clearer warning than either number alone. Our nursing home pages place both next to the area medians so the comparison takes seconds.
Check also whether the home's newest standard inspection is recent. CMS shows a flag when the most recent health inspection is more than two years old, and an older inspection says less about the staff working there now.
Ask, too, how the home covers sick calls on a weekend night, and whether the director of nursing and administrator have changed recently; CMS reports the number of administrators who left in its measurement period.
What the data cannot show
CMS's staffing hours are averages from payroll data over a quarter. They do not tell you who is on your parent's hall tonight, how many of those hours were agency staff, or whether the rehab hall is staffed differently from long-term care. Ask the administrator and director of nursing directly, and visit on a weekend evening to see staffing for yourself.
Frequently asked questions
Are there five-star nursing homes around Birmingham?
Not in CMS's October 2026 release: among 50 certified homes in the seven counties, the highest overall rating is four stars, held by five homes.
What is a typical nurse staffing level?
The median home reports 3.72 total nurse staffing hours per resident per day, including 0.53 registered-nurse hours, in CMS's October 2026 data.
How common is high staff turnover?
Median total nursing staff turnover is about 53.5% among the area's certified homes, ranging from 30.1% to 82.1%.
What is a Special Focus Facility candidate?
A home CMS has identified as eligible for its program for nursing homes with a persistent record of serious quality problems. Two Birmingham-area homes carry that status.
