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Census 2025 estimates · CMS September 2026 · CDC 2020

Senior housing development in Alabama

Alabama had 428,110 residents aged 75 and older in July 2025, +21.2% since April 2020 (US +23.4%), and 102,135 aged 85 and older (+12.7%). Its 224 certified nursing homes hold 26,504 beds, 259.5 for every 1,000 people 85 and older, more than the US ratio of 222.6. Certificate of need for nursing home beds: yes; for assisted living: not listed.

Age 75+ (2025)
428,110
Growth since 2020
+21.2%
Nursing beds per 1,000 aged 85+
259.5
Assisted living beds per 1,000 aged 75+
23.8

Demand: the older population

Age groupApril 2020July 2025ChangeUS change
75 and older353,137428,110+21.2%+23.4%
85 and older90,654102,135+12.7%+11.3%

Nationally, the Census Bureau's 2023 projections have the 75+ population growing 21% from 2025 to 2030 and the 85+ population 59% from 2025 to 2035. The bureau publishes those projections for the US only, not by state.

Supply: licensed beds

SettingBedsPer 1,000 aged 75+Per 1,000 aged 85+Source
Nursing homes (Medicare or Medicaid certified)26,50461.9259.5CMS, September 2026
Residential care / assisted living10,20023.899.9CDC survey, 2020

US: 222.6 nursing beds and 170.1 assisted living beds per 1,000 aged 85+. Assisted living beds are CDC's 2020 survey estimate, its latest with state detail, set against 2025 population, so the ratio understates any supply added since.

Certificate of need

Nursing home beds
Yes
Assisted living
Not listed
Notes
Ala. Code § 22-21-260. Covers SNF, ICF and "Long-term care"

From NCSL's certificate of need table (updated April 29, 2025, covering January 2025) with later changes checked on state sites on October 24, 2026. "Not listed" means NCSL does not name assisted living, not that it is exempt. Confirm with the state health planning agency before relying on it. HUD requires a state CON for nursing home beds where the state has one (Handbook 4232.1, 2.5.EE).

Counties

The 25 counties with the most residents aged 75+, with certified nursing home beds per 1,000 aged 85+.

CountyAge 75+Since 2020Share of populationAge 85+Nursing homesBeds per 1,000 aged 85+
Jefferson County52,050+17.4%7.8%13,10634302.4
Mobile County32,663+18.5%7.9%7,86217251.2
Madison County31,237+23.9%7.2%8,39112151
Baldwin County27,748+38.5%10.4%6,0637127.3
Shelby County18,630+40.8%7.8%4,211393.1
Montgomery County17,007+18.4%7.5%4,0418267.5
Tuscaloosa County15,227+28.2%6.3%3,6256249.1
Lee County11,323+40.2%6%2,5752121.2
Morgan County10,680+15.5%8.4%2,6164242.4
Houston County10,180+20.7%9.2%2,4823201.9
Calhoun County9,855+15.0%8.5%2,4105276.8
Etowah County9,624+17.8%9.3%2,1756389.9
Lauderdale County9,448+16.9%9.7%2,3615259.2
Limestone County8,644+31.0%7%2,0432156.1
Marshall County8,203+14.9%7.9%1,9415283.4
Cullman County8,191+18.8%8.7%1,9064290.7
St. Clair County8,059+29.2%8.2%1,8254204.9
Elmore County7,125+27.8%7.8%1,5734267.6
Talladega County7,022+22.5%8.6%1,5633299.4
DeKalb County5,952+21.1%8%1,2633369
Walker County5,863+7.1%9%1,3475390.5
Colbert County5,546+16.5%9.3%1,3743219.8
Blount County5,219+16.4%8.7%1,1762189.6
Jackson County5,138+14.3%9.5%1,1213259.6
Autauga County4,834+25.5%7.8%1,2111133.8

Fastest growth in the 75+ population

  1. Shelby County: +40.8% (18,630)
  2. Lee County: +40.2% (11,323)
  3. Baldwin County: +38.5% (27,748)
  4. Henry County: +31.2% (2,092)
  5. Limestone County: +31.0% (8,644)
  6. Barbour County: +29.6% (2,541)
  7. St. Clair County: +29.2% (8,059)
  8. Tuscaloosa County: +28.2% (15,227)
  9. Cherokee County: +27.9% (2,918)
  10. Elmore County: +27.8% (7,125)

Counties with at least 2,000 residents aged 75+.

Fewest nursing beds per 1,000 aged 85+

  1. Shelby County: 93.1 (392 beds, 4,211 aged 85+)
  2. Lee County: 121.2 (312 beds, 2,575 aged 85+)
  3. Baldwin County: 127.3 (772 beds, 6,063 aged 85+)
  4. Autauga County: 133.8 (162 beds, 1,211 aged 85+)
  5. Madison County: 151 (1,267 beds, 8,391 aged 85+)
  6. Limestone County: 156.1 (319 beds, 2,043 aged 85+)
  7. Blount County: 189.6 (223 beds, 1,176 aged 85+)
  8. Houston County: 201.9 (501 beds, 2,482 aged 85+)
  9. St. Clair County: 204.9 (374 beds, 1,825 aged 85+)
  10. Colbert County: 219.8 (302 beds, 1,374 aged 85+)

Counties with at least 1,000 residents aged 85+.

HUD Section 232 construction in Alabama

Since fiscal 2001 HUD has insured 13 new construction or substantial rehabilitation loans on care facilities in Alabama (8 assisted living, 4 nursing homes), $67.6 million of original principal.

Planning a building in Alabama? Model the budget, lease-up and a HUD 232 construction loan.

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Sources: Census Bureau Vintage 2025 county population estimates; CMS Nursing Home Provider Information (September 2026); CDC/NCHS National Post-acute and Long-term Care Study (2020); HUD Office of Healthcare Programs endorsement database (data run 07/08/2026); NCSL. Absorption is operated by Janover Capital LLC and is not affiliated with any of them. Methodology.