I'm not sure how deep the roots would grow in the wild but the pot might be a bit shallow. It's definently not dying but that might effect its shape a bit.

The soil needs to be more porous, and some direct sun, gradually applied, would be better. If it's in a warm area and gets some water 3x a month or so now, along with the light, it will start reverting to form.

I hadn't heard of this hybrid (no real surprise there) but what I've found on the Interwebus is that this isn't actually an Aloe but a Gasteraloe (Gasteria crossed with an Aloe). It should, as you know, have much more compact growth. If it is indeed Gasteraloe 'Flow', the leaves should also be shorter. I want to think that you have a correctly ID'd plant, but I don't know. Still, it doesn't look all that unhealthy, but more direct sun, with most of its light indirect, would help it be all it can be.

Thank you both so much! Yes- that is the variety - I still have the tag. "Gasteria verrucosa x aloe hybrid PPAF"

I will add some vermiculite tomorrow. I think I have some. If that is ok for this plant and check to make sure the roots are squished when I do - though I don't think its outgrown the pot yet.

I moved it to a spot that should get some direct sunlight in the afternoon.

Another thought - it's in a plastic pot. Should I change to clay??

Perlite is better than vermiculite. Vermiculite holds water because it is absorbent . Perlite doesn't. Turface, pumice, Scouria is also appropriate.

Here is a pic of mine that i got at walmart.
It is a "flow" aswell. But looks different than yours.
Mine has about 4 small pups growing under the bottom leaves

That looks good! Mine does not have the reddish color. But I think thats closer to what mine should look like (without the red)

The red comes from having lots of outdoor sunlight. Winter sun is really good at making red colors in aloes and gasteraloes. Yours might turn red if it had similar situation.

Mine is about 4inches by 4 inches and it sits in a very small dish and has moss like stuff around it as you can see in the picture. Im holding it in my hand. I first thought it was an air plant and did not know there was even soil in the dish. It was labeled as "living decor" i may repot it in the spring into an actual pot. I has to have very small roots to be able to live in such a small amount of soil. The first time i watered it (i just sprayed water on the soil) it started growing and the pups are growing too! but they are coming in a very light green color. I may need to set the dish in a window to get sun.