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Multi-State Deployment April 25, 2026
SeniorIndex  |  Multi-State Market Deployment Report  |  Institutional Grade Intelligence
Market Deployment Report
State 1 / State 2 / State 3
2,793 facilities • 299,592 beds • Top 50 opportunities ranked • MDR-TX-FL-OH-202604
Data vintage
Staffing (PBJ)Q3 2025 (PBJ)
Health inspectionsthrough Apr 2026
Federal penaltiesthrough Apr 2026
Quality measuresthrough Apr 2026
Ownership recordsthrough Apr 2026
Fire safetythrough Apr 2026
Facility financialsFY2024 HCRIS
Local demographics2023 ACS 5-year estimates
Each layer refreshed at the fastest cadence CMS publishes. PBJ staffing is released quarterly approximately 45 days after each collection period; deficiencies, penalties, and ownership records update continuously as agencies post them.
1 Executive Summary
Multi-state market overview for staffing deployment planning
2,793
Total Facilities
299,592
Total Beds
69.9%
With Compliance Gaps
15
High Contract Dependency
Across 3 states, 2,793 nursing facilities operate 299,592 certified beds. 69.9% of facilities have at least one compliance gap heading into the industry staffing benchmarks. 15 facilities are in the HIGH or CRITICAL contract dependency tier, representing the most agency-dependent facilities across these markets. Average contract staffing utilization is 2.8%.
2 State Comparison
Side-by-side market metrics across selected states
Non-Compliance Rate by State
Contract Dependency by State
StateFacBedsAvg RatingMedicaidPrivateStability%NCContractHigh DepAvg Viol
S11,177133,5572.859.8%31.6%81.365.1%2.1%54.9
S392281,5783.245.6%47.3%82.128.8%4.8%84.1
S269484,4573.254.8%28.5%86.018.1%1.2%22.5
3 Compliance Landscape
Combined compliance status across all 3 states
833
Compliant
787
At Risk
947
Non-Compliant
197
Critical
Compliance Trend — Selected States vs National (11 Quarters)
4 County Market Rankings
Top 30 counties across selected states, ranked by facility count
Private Pay % by County (Top 15)
Contract Dependency % by County (Top 15)
CountyStateFacBedsPrivate%NCContractAvg ViolIJ (3yr)
County 1S19711,67233.2%60.8%2.1%4.2260
County 2S39310,09752.7%35.5%5.1%4.734
County 3S18210,77032.6%60.5%1.5%5.4179
County 4S1718,97235.3%62.9%1.3%5.7198
County 5S3696,66648.8%30.4%4.9%3.818
County 6S2657,48522.2%33.8%2.3%2.965
County 7S1627,67934.4%66.1%1.5%8.9118
County 8S3575,14958.7%22.8%2.9%7.521
County 9S2548,28126.5%0.0%2.1%2.529
County 10S2546,16334.8%3.7%0.4%3.914
County 11S3433,99653.1%41.9%6.0%4.715
County 12S3404,35350.6%27.5%4.4%4.44
County 13S2364,55928.6%11.8%1.3%3.336
County 14S2344,40025.7%29.4%1.1%0.96
County 15S3342,83954.8%32.4%4.2%6.314
County 16S3332,93959.3%24.2%8.4%4.211
County 17S2334,31428.4%6.1%0.6%2.52
County 18S2303,08634.8%23.3%3.3%1.627
County 19S2303,94326.6%16.7%0.5%3.016
County 20S3292,50154.5%24.1%5.5%2.88
County 21S2293,42728.7%27.6%2.8%0.86
County 22S1283,20333.8%57.1%1.5%5.075
County 23S3252,14453.7%24.0%2.4%2.24
County 24S2253,17431.2%24.0%0.1%2.727
County 25S1222,58534.4%54.5%0.2%6.632
County 26S1222,64042.9%63.6%0.4%3.916
County 27S1222,77221.2%72.7%0.3%4.738
County 28S2212,80327.6%19.0%0.5%2.629
County 29S3201,88861.9%15.0%3.3%2.07
County 30S2202,17735.4%5.0%1.1%3.321
5 Top 50 Deployment Targets
Facilities ranked by SeniorIndex Staffing Need Score (0–100)
Opportunity Map: Staffing Need vs Revenue Quality
#FacilityCityStateBedsRatingRN HrsPrivateComplianceContractScore
1Facility 1City 1S3166★☆☆☆☆0.3985.0%AT RISK44.7%83
2Facility 2City 2S1222★☆☆☆☆0.3024.5%CRITICAL0.0%80
3Facility 3City 3S1214★☆☆☆☆0.1617.6%CRITICAL0.0%77
4Facility 4City 4S1180★☆☆☆☆0.2829.2%NON COMPLIANT3.9%77
5Facility 5City 5S1154★☆☆☆☆0.2225.0%CRITICAL11.8%75
6Facility 6City 2S1237★☆☆☆☆0.2117.5%CRITICAL0.0%75
7Facility 7City 6S3120★☆☆☆☆0.3362.2%NON COMPLIANT3.3%75
8Facility 8City 7S1124★☆☆☆☆0.1426.6%NON COMPLIANT0.0%73
9Facility 9City 8S1124★☆☆☆☆0.2732.7%NON COMPLIANT2.8%73
10Facility 10City 9S1172★☆☆☆☆0.3212.4%NON COMPLIANT0.0%73
11Facility 11City 10S1186★☆☆☆☆0.3335.4%NON COMPLIANT0.0%73
12Facility 12City 11S2120★☆☆☆☆0.3331.0%NON COMPLIANT0.0%73
13Facility 13City 12S3146★☆☆☆☆N/A22.1%COMPLIANT11.8%73
14Facility 14County 3S1184★☆☆☆☆0.2711.5%NON COMPLIANT0.0%71
15Facility 15City 14S1152★☆☆☆☆0.198.0%CRITICAL0.0%71
16Facility 16City 15S2103★☆☆☆☆N/A29.2%AT RISK0.0%70
17Facility 17City 16S366★☆☆☆☆0.2534.1%CRITICAL0.0%70
18Facility 18City 17S399★☆☆☆☆0.3272.1%AT RISK1.1%68
19Facility 19City 18S168★☆☆☆☆N/A41.9%NON COMPLIANT0.0%67
20Facility 20City 19S3162★☆☆☆☆0.3831.9%NON COMPLIANT0.0%65
21Facility 21City 2S1106★☆☆☆☆0.3531.2%NON COMPLIANT12.6%64
22Facility 22City 20S1155★☆☆☆☆0.3123.8%NON COMPLIANT2.6%64
23Facility 23City 21S1163★☆☆☆☆0.4034.7%NON COMPLIANT0.0%64
24Facility 24City 22S1143★☆☆☆☆0.3519.8%NON COMPLIANT0.1%63
25Facility 25City 23S1234★☆☆☆☆0.4017.4%NON COMPLIANT0.0%63
26Facility 26City 12S384★☆☆☆☆0.303.0%CRITICAL7.1%61
27Facility 27County 25S1187★☆☆☆☆0.4320.3%NON COMPLIANT0.0%60
28Facility 28City 25S1104★☆☆☆☆0.3929.7%NON COMPLIANT1.6%59
29Facility 29City 26S3110★☆☆☆☆0.4133.5%AT RISK2.1%59
30Facility 30City 27S1204★☆☆☆☆0.4723.6%NON COMPLIANT0.0%57
31Facility 31City 12S3167★☆☆☆☆0.5065.8%AT RISK0.0%57
32Facility 32City 28S399★☆☆☆☆0.5366.2%AT RISK3.3%57
33Facility 33City 29S1179★☆☆☆☆0.4730.5%NON COMPLIANT0.0%56
34Facility 34City 30S2104★☆☆☆☆0.3623.8%NON COMPLIANT0.4%56
35Facility 35City 31S2185★☆☆☆☆0.4520.1%AT RISK0.0%56
36Facility 36City 12S3130★☆☆☆☆0.6977.1%AT RISK0.0%56
37Facility 37City 32S3126★☆☆☆☆0.7380.0%COMPLIANT7.3%56
38Facility 38City 33S1122★☆☆☆☆0.3424.1%CRITICAL2.1%55
39Facility 39City 34S259★☆☆☆☆N/A15.8%NON COMPLIANT33.1%55
40Facility 40City 35S2120★☆☆☆☆0.4215.2%NON COMPLIANT0.1%54
41Facility 41City 36S3150★☆☆☆☆0.4652.9%NON COMPLIANT21.6%54
42Facility 42City 12S399★☆☆☆☆0.4458.8%AT RISK8.3%54
43Facility 43City 28S399★☆☆☆☆0.4879.5%AT RISK0.0%53
44Facility 44City 37S2180★☆☆☆☆0.4713.3%AT RISK0.0%52
45Facility 45City 38S387★☆☆☆☆1.3083.0%COMPLIANT2.1%52
46Facility 46City 39S351★☆☆☆☆0.5373.4%NON COMPLIANT4.1%51
47Facility 47City 40S3150★☆☆☆☆0.4822.4%AT RISK0.0%51
48Facility 48City 41S2240★☆☆☆☆0.7210.6%AT RISK0.0%50
49Facility 49City 42S399★☆☆☆☆0.6258.0%AT RISK8.8%49
50Facility 50City 43S1180★☆☆☆☆0.7429.4%AT RISK0.0%48
Staffing Need Score combines: Staffing Gap (30pts), Revenue Quality (25pts), Regulatory Pressure (20pts), Facility Size (15pts), and Violation Signal (10pts).
6 Deployment Strategy Insights
Data-driven recommendations for market entry
Highest urgency market: State 1 with 65.1% non-compliance rate across 1,177 facilities. Facilities here have the widest staffing gaps and highest deployment opportunity.

Highest existing agency market: State 3 at 4.8% average contract utilization with 8 high-dependency facilities. Established demand for agency staff.

Strongest revenue market: State 3 with 47.3% average private pay. Facilities in this state have the strongest capacity to sustain premium contract rates.

Top county for deployment: County 1, TX with 97 facilities and 11,672 beds. Geographic density enables efficient multi-facility coverage from a single base.
7 Penalty Intelligence
Enforcement actions and fines across selected states
$105,718,225
Total Fines (3yr)
3,606
Penalty Actions
378
Payment Denials
1,451
Facilities Penalized
Penalty Fines by State
Enforcement intensity varies significantly across markets. States with higher penalty volumes signal active regulatory pressure, creating urgency-driven demand for contract staffing and compliance consulting.
8 Ownership Landscape
Chain operators and market consolidation across selected states
78.7%%
Chain-Affiliated
215
High-Risk Facilities
1,662
Acquisition Targets
Top Chain OperatorsFacilities (Selected States)Total NationwideAvg Rating
Chain Operator 11491492.7 ★
Chain Operator 290902.3 ★
Chain Operator 3843293.2 ★
Chain Operator 467672.8 ★
Chain Operator 563634.0 ★
Chain Operator 652522.2 ★
Chain Operator 746463.1 ★
Chain Operator 837383.1 ★
Chain Operator 9371222.8 ★
Chain Operator 10331254.0 ★
Chain-affiliated facilities often have centralized staffing contracts, while independent facilities represent direct sales opportunities for staffing agencies. Markets with high acquisition target counts signal potential ownership transitions that frequently trigger staffing contract renegotiation.
9 Financial Health by Market
CMS HCRIS Cost Reports (Form 2540-10) — Cross-State Comparison
StateAvg RevenueAvg MarginRev/DayCost/DayUnprofitable
S1$9,214,082-12.9%%$1,218,649$1,054,226633 (61%%)
S2$17,823,229-13.2%%$231,128$203,571385 (57%%)
S3$11,234,679-11.4%%$91,249$100,270502 (56%%)
Financial data from CMS HCRIS cost reports. Margin = (revenue - expenses) / revenue. National avg: -9.1% (FY2024).
Source: CMS Cost Report Filings (HCRIS, Form 2540-10)
10 Methodology & Data Sources
Report ID: MDR-TX-FL-OH-202604 • Generated April 25, 2026
This report aggregates data from CMS Provider Data Catalog (facility profiles, star ratings, quality measures), CMS Payroll-Based Journal (PBJ) daily nurse staffing records (14.5 million records across 11 quarters), facility financial filings (payer mix), and CMS health inspection and enforcement records (419,452 deficiencies).
Staffing Need Score (0–100): Staffing Gap (30pts) + Revenue Quality (25pts) + Regulatory Pressure (20pts) + Facility Size (15pts) + Violation Signal (10pts).
Staffing Assessment: COMPLIANT = meets all 3 industry benchmarks. AT_RISK = meets 2 of 3. NON_COMPLIANT = meets 0–1. CRITICAL = fails all 3 or 10+ zero-RN days.
Limitations: Proprietary analytical products. Not CMS endorsements or regulatory determinations. Compliance projections are estimates and should not be construed as legal advice.
SeniorIndex.ai
Market Intelligence for Senior Care  |  Multi-State Deployment Report  |  April 25, 2026
All data sourced from CMS public data releases. Not affiliated with CMS or HHS.
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