So now that you’re here — thanks, Google — some bad news: this article is not exactly about 2025 nursing home staffing rankings or Top 10s or Bottom 10s. Sorry.

The thing about1 nursing home staffing rankings is: they’re kind of garbage.

Nursing home staffing is usually measured by staffing hours per resident day, or HPRD — that is, how much staff time the average resident receives in a given day at a given nursing home, as if each resident on each floor gets precisely 3 hours, 45 minutes, and 43 seconds of staff time.

HPRD is a powerful metric — I’m staking my professional career on it! — but it’s also noisy, limited, and, in the wrong hands, dangerously misleading. HPRD can be especially problematic when used for simple comparisons.

• Example 1: a 3.70 HPRD at a 50-bed nursing home in rural Pennsylvania vs. a 3.70 HPRD at a 350-bed nursing home in Brooklyn. On paper, those are the same staffing levels. But what kind of staff? RNs or nurse aides? Who are the residents? Higher-need or lower-need? What are the labor pools? What does “adequate” even mean in each setting?2

• Example 2: Delaware (4.13 HPRD, rank: 12) vs. Mississippi (4.10 HPRD, rank: 13). Basically the same staffing levels, right? But Delaware is a small, compact Mid-Atlantic state with a relatively small nursing home market. Mississippi is larger, more rural, poorer, and demographically different. Even before you get to facility-level resident needs, ownership, payer mix, and staffing composition, you are not exactly comparing two versions of the same system.

• Example 3: a California nursing home (5.28 HPRD) that’s a mainstay in the federal Special Focus Facility program for worst-performers (48 months) might be staffed more than the 5-star Alabama nursing home with a 4.10 HPRD. But is it staffed better?

⚾🥜🍇🍞 Sports x Nursing Home Crossover Alert ⚾🥜🍇🍞

In Moneyball, the Oakland Athletics are a small-market team trying to compete with the evil New York Yankees and Boston Red Sox. General manager Billy Beane (Brad Pitt) knows the A’s can’t outspend their rivals, so he stops chasing expensive stars with high batting averages — the popular stat that simply divides hits by at-bats — and starts mining the market for undervalued players with ugly girlfriends and a suspicious knack for getting on base.3

Think of HPRD as the batting average of nursing homes. In baseball, batting average treats a single, a double, and a home run the same: they all count as one ‘hit.’ HPRD can do the same thing with staffing: it treats an hour from an experienced registered nurse exactly the same as an hour from a brand-new nurse aide.

The basic number only gets you so far. Is it better to add three nurse aides or two highly trained registered nurses? Is a facility with a higher reported HPRD actually better staffed, or just differently staffed? Does the number reflect resident need, or obscure it?

In baseball, we now have better — still imperfect — ways to judge player production: On-base plus slugging (OPS), Wins Above Replacement (WAR), BORPS, SHNORPS, and whatever metric the nerds are arguing about.

Nursing home staffing deserves the same treatment. HPRD is useful, but it works best with context: staffing mix, resident acuity, day-level patterns, and longitudinal trends that compare a facility to itself over time instead of pretending every state, region, and facility belongs on one clean leaderboard.

The lesson is not that numbers are bad. It’s that familiar numbers, used too confidently, can become lazy stand-ins for what you actually care about.

Batting average became a shortcut for offensive production. HPRD has the same risk: it captures staffing time, but not the mix, context, or story behind it. Rankings can make different systems — regions, states, facilities — look directly comparable. Don’t confuse the ranking for the meaning.

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Oh, you’re still here? Well I’ve got a surprise for you! Here are the Definitive #NursingHomeStaffingRankings #Top10 #Bottom10 for #Q4 2025 staffing via the federal Payroll-Based Journal dataset (released April 29, 2026).

So: read the tables. Enjoy the rankings. Notice that Alaska is #1 (5.80 HPRD), which makes sense given Alaska’s 13 reported nursing homes have an average resident count of 43 — small facilities tend to have higher staffing ratios. Notice that Illinois is last, which tells you something, though exactly what it means is for you to decide, dear Illinois readers. And then remember: you are looking at state staffing ratios — that is, the state’s total staffing hours over its total residents on an average day in Q4 2025. These numbers are indicators, but they are thin without context.

More PBJ Staffing #Rankings

Rookies, hall-of-famers, and even twins, were part of this Historic Heavening, featuring 945 feet of heaves, from Los Angeles all the way to Germany.

Yet, there is no official documentation of these 16 shots. On the official NBA box score, Stephen Curry’s 46-footer — close enough to elicit a collective “ahhh” from Chase Center — is nowhere to be found. Santi Aldama airballed two halfcourt shots yet is credited with a perfect 4-4 from three-point range. Amen Thompson’s full-court prayer is not on the Rockets-Thunder play-by-play. On NBA box scores, these bricks do not exist.

That’s because a new NBA rule, effective this season, declares that missed end-of-quarter shots from 36-plus feet are recorded as team misses rather than individual ones. In other words, these heaves don’t count.

This new rule was designed to encourage professional basketball players to shoot more basketballs, and it’s working. NBA players are heaving more — and deeper — than ever. Leaguewide attempts went up 61% while the average heave increased eight feet from last season.

We’re blessed with more glorious moments like this, this, and this. The Heavolution is here and it’s spectacular.

But the new rule comes at a cost. Players are firing away, because there’s no reason not to. Stat sheets are being sanitized and perfect bricks are being wiped from history. This is basketball erasure, and I won’t stand for it.

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Built from 16,000 Bricks

Last summer, the NBA announced a rule change allowing players to take halfcourt shots without hurting their shooting percentages. End-of-quarter attempts from at least 36 feet away now count as team shots when they don’t go in.

The more heaves the merrier, right? That’s not how I saw it. Like analysts Zach Lowe and Richard Jefferson, I thought the rule bailed out the cowards.

“Loser shit,” I texted the group chat, sitting on my porch, staring at my lawn. “Just add four more playoff teams while you’re at it.”

With my righteous indignation unreciprocated, I did what any well-adjusted person would do: spent three months building the NBA heave database.

My goal: to document what the NBA decided is not worth documenting. To remember the true Heave Heroes, those who sacrificed their percentages for the love of the shot. And to ensure that present-day heaves would not be stricken from the record.

The heave database is built from 16,000 bricks, each with a story to tell. The brick throwers are a hodgepodge of “Remember That Guys.” Andre Miller, famous for never missing games, also never turned down a heave—fully aware of what it was doing to his field goal percentage. There’s Stephen Curry of course. Jamal Crawford. Steve Blake. Earl Watson. Flip Murray.

You’re reminded that Ben Simmons, infamously afraid of normal three-pointers (and layups), was actually heave-happy when he entered the league. Meanwhile, stars like Kevin Durant, James Harden, and LeBron James often refuse them—Durant even confessed to protecting his field goal percentage.

And let’s not forget about dry heavers like DeMar DeRozan, who keep on firing. Because that 65th attempt is finally going in.

But the past is the past. This is about the present. It’s about the numbers that the league and its players don’t want you to see.

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Heave Retrieval

The NBA Heave Report database is sourced largely from the GitHub of a Western Conference analytics coordinator. The raw files contain every shot from every game spanning 2003 through last season. In total: 5 million shot attempts — coordinates, distance, time, result, etc.

But the real challenge was unlocking the 2025-26 heave data. That’s because the NBA is hiding it.

There’s no ‘heave’ category on NBA.com or ESPN.com. Basketball Reference’s half-court stat excludes Team heaves; Jamal Murray leads with 3 attempts, all makes, because his misses aren’t tracked. Post-rule change heave data, I realized, was nowhere publicly available.

At least not yet.

For days I searched for solutions, even contemplating a subscription service like Synergy or Second Spectrum. Then after digging through the Dark Basketball Web, I found what I needed: APIs.

Turns out, behind each NBA box score is an API listing full play-by-play data—shots, fouls, assists. Who did what, when, where, and how. Each player and team, identified with a unique ID. Each action — roughly 700 per game — assigned a number.

On NBA.com, the API shows “TOR Heave.” No one is responsible for the 70.82 feet at the third-quarter buzzer. Erasure!

But luckily, there’s The Worldwide Leader in Sports. ESPN’s API goes deeper — that’s where you’ll find that the TOR Heave from sequence 525 belongs to none other than Georgian-American center Sandro Mamukelashvili. This is your unlock.

So, you spend weeks learning about APIs, JSONs, and cron triggers. You discover the NBA’s advanced stats site attaches video to every Game Event (well, most of them).1

You install some questionable programs to your vibe coding environment and figure out how to convert those videos into YouTube compilations — Don’t Stop the Heavin’ — that nobody watches.

By season’s end, your Heave Detection System is finally in place, running on its own. It’s a Saturday morning in April and most every team is either tanking or resting their stars. You check your heave website — you’re one of two visitors that day — and open the April 10 daily heave report revealing a record-setting 17 heaves.

That’s one more than the sweet 16 notched twice earlier in the season and once 15 years ago.2

Everything you’ve been working for has been worth it.

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Brand New Heavers

Before the rule change, an end-of-quarter sequence might go something like this: Kevin Durant accepts an inbounds with three seconds left. Takes a few dribbles. Then just after the clock expires, he launches the prayer. It doesn’t count.3 Durant has plausible deniability and preserves his percentages.

The new rule changed the incentives. Now, players are hoarding heaves. Luka Doncic led the league with a career-high 23 attempts (zero makes). Jalen Brunson and Ayo Dosunmu heaved 12 times this season, which is 12 more than in 2024-25. Across the league, players are heaving more often and from further out.

The 2025-26 season shattered the record for most attempts from 36+ feet with 1,180, or nearly one per game.4

I’ve watched nearly all of them, from Kon Knueppel’s headshot triple to LeBron’s 81-foot Hail Mary — “Look out, first row” — that was the record-setting 17th heave on April 10. The new NBA rule is working just as Lord Silver intended.

Heaves are good, in a vacuum. But basketball is a zero-sum game. More shots for the heave cowards means less for the heave heroes like Payton Pritchard, who would take the bloody shot, percentages be damned. Less for Nikola Jokic, who kept on shooting (and occasionally making) even though his brother told him not to.5

Those players — and the teams who employ those players — ought to be rewarded for their bravery. And these glorious shots ought to be remembered. Instead, the NBA leveled the playing field by bailing out the cowards and erasing history.6 Or tried to, at least.

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I Think You Should Heave

NBA basketball is art. World-class athletes, a foot taller than us, glide and fly in unimaginable ways, all while possessing the ability to throw a round object into a small cylinder from 20+ feet away.

So skilled are these giants that we expect every shot, regardless of distance or positioning, to land precisely on its intended target. Shots that hit the wrong part of the rim — only inches off target — are memed. Swishes are merely approved.

Heaves are exempted from expectation. From long distance, players are granted permission to miss—and miss miserably. So long as they grant permission to themselves.

I’m the youngest of three boys from a family that loves shooting basketballs, maybe more than basketball itself. And so, I spent my formative basketball years blocked out of the paint and being chased outside the three-point arc. When I picked up my dribble, I had one choice: Heave it or Leave it.

And so, time and again, I launched. Sometimes it fell short. Sometimes it flew over the backboard a la Carlton Banks in Courting Disaster. Sometimes it clanked off the rim. And on rare occasions, it went in.

I didn’t amount to much as a basketball player, though not for fear of shooting. Those in the Main Line might recall the famous 2007 Friends’ Central tryout7 where I tried sandbagging my way to Third Team by launching — and inadvertently making — a handful of ill-advised four-pointers. The coaches then moved Mustafa Shakur 2.0 over to the varsity court where the magic continued. The rest is history.8

Most basketball shots can go one of only a few ways: make it, miss by a little, miss by a little more. The heave is the exception.

When a high-arching prayer even threatens the cylinder, everything stops. Arenas fill early just to watch Stephen Curry’s warmup heaves. LeBron once ditched his teammates to tackle a stranger who hit a halftime halfcourt shot for $75,000. Michael Jordan once bullied an insurance company to pay up on a fan’s $1 million half-court shot prize after they attempted to back out on a technicality. My eyes are glued to League Pass when Franklin the Dog fires backwards during TV timeouts.

Each heave tells a story. That’s why the misses — Joel Embiid’s full-court miracle rimming out against the Suns, Gordon Hayward’s half-court shot that nearly landed Butler a national title, my driveway heaves that broke the Rutstein’s fence — must not be forgotten.

Box scores are temporary. But the Heave Report is here to ensure that bricks are forever. Don’t stop the heavin’, wherever you are. You shouldn’t need a rule change for permission.

1

Missed heave videos are routinely “not available” on the NBA site. I guess they stop recording at the end of the quarters.

The ad follows a woman through a rehab journey filled with friends, jello shots, and O-6-7 Bingo dances. By day 30, #TheHipComeback is complete. “10 out of 10,” she says, walking out of the for-profit Wyoming facility. “This place rocks!”

Casper Mountain Rehabilitation and Care Center is one of roughly 15,000 licensed U.S. nursing homes providing care for elderly and disabled individuals. As part of Medicare and Medicaid participation requirements, the U.S. government assigns nursing homes 5-star ratings based on staffing, health inspections, and quality measures.

On these criteria, Casper Mountain is not quite the 10 out of 10 as advertised in the commercial, produced by the Denver-based Peaks Healthcare Consulting. Nor is it a 6 or 7.

Casper Mountain is a one-star nursing home and has had the lowest rating for most of the last five years. Its staffing ratio (3.00 hours per resident day) is in the bottom 10 percent of Wyoming nursing homes and it is a mainstay candidate in the government’s Special Focus Facility program for providers with repeated quality issues.

Scores are just scores. Casper Mountain might still be the right place for your 75-year-old mother’s rehab after she slipped on the ice because you forgot to shovel her driveway. It might be a good fit for your brother whose stroke left him permanently disabled. But this facility’s scores are not merely subpar; they are among the worst in the country, according to the flawed‑but‑still‑better‑than‑the‑ads government rating system.

Casper was not the only nursing home with a regional ad on the big game. Our next Super Bowl Sunday Substack subject sits in Spokane — Seattle Seahawks supporters might’ve seen the spot.

The Spokane Falls Care commercial is also from Peaks Healthcare, which “exists to make each resident feel cared for” while also pursuing “quality senior living acquisitions that fit our strategic growth plan” (and making funny Super Bowl ads).

In this ad, grandma’s wish — that the nursing home “wasn’t going to be terrible” — is granted by her granddaughter. Grandma wins Bingo, drinks jello shots, and crushes her 60-day rehab journey. At the end, it’s revealed that the employees — not the girl — have magical powers, and the camera pans to the staff waving their hands à la Dunder Mifflin’s corporate commercial.1

If there is magic in this facility, it’s not the kind that can make a bad government rating disappear. According to CMS, Spokane (part of the Caldera Care chain) has had one or two stars nearly every quarter since 2017 (stemming largely from poor health inspections). On paper, not great.

But Spokane is in good commercial company. During the 2025 Super Bowl — where the Philadelphia Eagles defeated the Kansas City Chiefs 40-22 — Peaks produced an ad for Polaris Rehabilitation and Care Center out of Cheyenne, Wyoming. The commercial features Miss Wyoming, playing as a misinformed model who thinks nursing homes are boring. But then, a resident knocks some sense into Miss Wyoming by knocking her over with an exercise ball. By the end of the ad — after more Bingo — Miss Wyoming discovers that “Actually, this place is pretty awesome.”

Any guesses on Polaris’s 5-star rating?

This is not to pick on Polaris, Spokane, Casper, or Bingo. The care might be pretty awesome. The staff might be magical. The rehab might be a 10 out of 10. And Bingo is fun! (Shoutout, Uncle Mike).

But why, on Super Bowl Sunday, is Peaks spotlighting a select group of one-star nursing homes? Maybe these providers are critical to the portfolio in spite of their poor ratings. Or maybe they’re critical because of the poor ratings. The one-star reputation could be moving Medicare money to the four-star nursing home across town so they’re on an image rehab campaign. Of note, these facilities (Spokane: 76.6% occupancy; Casper: 69.8%; Polaris: 66%) have plenty of beds to fill.

Whatever the rationale, these ads have generated publicity for the nursing homes, even beyond the 30-second Super Bowl spotlight.

The Spokane video was shared by leaders across the industry. The American Health Care Association (AHCA) — a major industry group — wrote on Facebook that the ad is “shining a spotlight on the heart, dedication, and impact of long term care professionals.” Last year, Skilled Nursing News, an industry trade publication, highlighted the Polaris commercial as an example of “edutainment,” teaching viewers about different aspects of long-term care while being fun.2

That coverage alone might make this a positive ROI campaign. Nursing homes like Casper Mountain, Spokane Falls, and Polaris are betting they can leverage Super Bowl SEO to tell a story about themselves — one that counters both the stereotype and the regulatory data. They are selling the public on a new image in 30 seconds. In a sense, the nursing homes are just like every other Super Bowl advertiser, whether it’s AI, pharmaceuticals, or addictive snacks. Though there is one major difference: we, U.S. taxpayers, are paying for their product.

For what it’s worth, a month out from the Super Bowl, the nursing home ads are the only ones I’m still thinking about.

This was a tragedy, but federal records point to a deeper problem. Seagate Rehabilitation and Nursing Center has long been marked by chronic understaffing—one of thousands of U.S. nursing homes operating under similar conditions. In the 1,278 days since New York state implemented a staffing minimum of 3.50 hours per resident day (HPRD), Seagate has fallen below the threshold every single day, according to analysis of federal CMS Payroll-Based Journal (PBJ) data. That doesn’t prove understaffing caused what happened at the 360-bed facility, but it does reflect the kind of environment where adverse outcomes are more likely.

Seagate, one of 33 nursing homes affiliated with Excelsior Care Group, has been persistently understaffed for the better part of the last decade since CMS began collecting PBJ staffing data. Since 2017, in roughly 3,000 days, the facility has hit the 3.50 HPRD threshold just 21 days.1

Seagate’s staffing shortfall is more striking when considering resident acuity. The facility’s Staffing-to-Expected Ratio—a back-of-the-envelope metric: Reported Staffing ÷ CMS Case-Mix (expected)—indicates that Seagate residents received 63% of their total staffing case-mix and 43% of their RN case-mix in Q3 2025. That is ... not sufficient!

I’ll refrain from speculating about the impact of staffing levels on the incident or on Seagate in general,2 but research consistently links low staffing to worse outcomes such as falls, pressure ulcers, infections, and resident-to-resident incidents. This fatality is a tragic edge case that warranted national press coverage, but the conditions that allowed for it are routine, enabling adverse outcomes that go unnoticed every day—at Seagate, and across many of the 15,000+ U.S. nursing homes.

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Methodology and Notes

• Sources: CMS Payroll-Based Journal Daily Nurse Staffing, CMS Provider Information, CMS Technical Users’ Guide, New York Nursing Home Minimum Staffing

• Data archives joined via provider’s six-digit CCN.

• CMS Provider Info files, unlike PBJ files, are published monthly. Each Provider Info file was matched to a PBJ quarter by aligning the ‘reported total staffing’ metric available in Provider Info with the same metric calculated from PBJ.

• In 2024 CMS changed its staffing case-mix adjustment methodology to a model based on the Patient-Driven Payment Model (PDPM).