Accura Healthcare of Creston
Creston, IA • 4.43 HPRD • 24 residents • For Profit • Entity: Arboreta HealthcareCreston, IA • 4.43 HPRD • 24 residentsFor Profit • Arboreta Healthcare
Accura Healthcare of Creston reported 4.43 HPRD (≈ 5.4 residents per total staff) in Q3 2025. This level is above its case-mix (acuity) 3.75 HPRD and in the top 15% of nursing homes in Iowa (3.81 HPRD).
Put another way… On a typical 30-bed floor at Accura Healthcare of Creston you’d see about 5.5 staff, including 3.3 nurse aides. For the entire 24-resident facility, that’s about 4.4 total staff, including 2.7 nurse aides.
Case-mix is a CMS metric based on resident acuity.
Reported HPRD (4.43) is 118.0% of case-mix (3.75).
Direct staff excludes Admin/DON. State minimums via MACPAC (2022) may reflect calculated HPRD equivalents. Direct staff excludes Admin/DON. State minimums via MACPAC may reflect calculated HPRD equivalents.
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Methodology
This dashboard uses CMS Payroll-Based Journal (PBJ) data (2017–2025), along with other public datasets (Provider Information, Affiliated Entity). State staffing standards via MACPAC (2022).
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.