Who owns America's senior care
We pulled the federal ownership records for 14,703 nursing homes and 256,242 ownership-change events. Here is who actually owns the places where America grows old, in plain numbers.
When you tour a place for your mom, the person at the front desk is warm, the hallway smells clean, and the brochure has the name of the community on it. What the brochure almost never tells you is who owns it. Not the building. The company behind the company that runs the care. And in senior care, that answer changes more often than most families realize.
We went looking for the real picture. Medicare publishes ownership records for every nursing home it certifies, along with a running log of every time an owner is added, removed, or changes their stake. We pulled all of it. What follows is what those records actually say. No opinions about which owners are good or bad, because that is not our place and a single number cannot tell you that. Just the facts, and how we counted them.
The numbers below come from 14,703 Medicare-certified nursing homes and 256,242 ownership records, covering 617 distinct parent companies. Methodology is at the bottom. These are federally reported nursing homes; assisted living and memory care are licensed by states and are not all in this dataset, so the real ownership map is even larger than what you see here.
Most of it is for-profit, and most of it belongs to a chain
The first thing the records make plain: senior care in America is mostly a business. Of the 14,703 nursing homes in the data, 73.8 percent are for-profit companies. Just under 20 percent are nonprofits, and about 6 percent are run by some level of government, usually a county or a hospital district. That is not a criticism. It is simply the shape of the industry, and it is worth knowing before anyone tells you a place is run "like a family."
The second thing: most facilities are not standalone. Just over 10,200 of them, about 69 percent, belong to a chain or ownership group. Only around 4,500 operate on their own. So when you picture a nursing home, the more accurate picture is one location inside a portfolio, sharing management, staffing decisions, and finances with dozens or hundreds of others you will never see.
- For profit: 10,848 facilities (73.8 percent)
- Nonprofit: 2,915 facilities (19.8 percent)
- Government: 940 facilities (6.4 percent)
- Part of a chain or group: about 10,200 (roughly 69 percent); independent: about 4,500
- For-profit73.8%
- Nonprofit19.8%
- Government6.4%
Share of 14,703 Medicare-certified nursing homes by ownership type. Source: CMS.
The biggest operators
Here are the largest ownership groups by number of nursing homes in the federal data. These are the companies whose names you will rarely see on a sign but whose decisions shape the care in thousands of buildings.
- The Ensign Group: 329 facilities
- PACS Group: 264 facilities
- Life Care Centers of America: 194 facilities
- Genesis Healthcare: 193 facilities
- Creative Solutions in Healthcare: 149 facilities
- Saber Healthcare Group: 126 facilities
- Trilogy Health Services: 125 facilities
- CommuniCare Health: 122 facilities
- PruittHealth: 95 facilities
- American Senior Communities: 91 facilities
Nursing homes per parent company in the CMS data. The top ten together are ~11.5% of all US nursing homes.
Put those ten together and they account for roughly 11.5 percent of all nursing homes in the country. That is real concentration, but it also means the field is more fragmented than, say, airlines or wireless carriers. There is no single giant. There are a few hundred large groups and a long tail of smaller ones, and the map is redrawn constantly, which brings us to the part families almost never see.
These places change hands. A lot.
This is the finding that surprised us most, and the one we think matters most to a family. Ownership in senior care is not stable. Across the records we counted 256,242 ownership entries, and the pace of change has been climbing steadily. In 2015 the data logged about 8,900 ownership records. By 2024 that number was 35,620, and 2025 came in even higher at 36,897.
- 2021: 18,851 ownership records
- 2022: 22,066
- 2023: 28,563
- 2024: 35,620
- 2025: 36,897
Ownership records logged per year in CMS nursing-home data (SNFs only). Roughly quadrupled since 2015.
Since the start of 2020, at least 3,584 individual nursing homes had a new owner added to their federal record. That is roughly one in four facilities in the country picking up new ownership in about six years. The typical facility in the data carries around 18 separate ownership records over its history, and some of the largest have well over a hundred owners, investors, and management entities layered into a single building's paperwork.
Why this matters for your family: the place you tour today may answer to different owners a year from now, and new owners can change staffing, budgets, and priorities without changing the sign out front. When we say Candor tracks change over time, this is exactly the kind of change we mean. A facility is not a fixed thing. It is a physical building that different companies take turns running.
Where ownership churns the most
Ownership change is not spread evenly. Since 2020, these states saw the most facilities pick up new owners. Bigger states have more facilities, so some of this is just size, but the volume in Texas and California stands out even for their scale.
- Texas: 503 facilities with new ownership since 2020
- California: 251
- Illinois: 233
- Florida: 230
- Pennsylvania: 220
- Ohio: 154
- Missouri: 127
- North Carolina: 113
Facilities with a new owner added since 2020, by state. Larger states have more facilities, but Texas and California stand out even for their scale.
What we are not telling you
We are deliberately not ranking these owners, and we never will. Whether a facility gives good care depends on the people working there, the staffing on any given shift, the residents' needs, and a dozen things a corporate ownership record cannot capture. A big chain can run a wonderful building. A small nonprofit can struggle. Ownership is one honest fact among many, not a verdict.
What we do believe is that you deserve to know it. When you are choosing a place for someone you love, knowing who owns it, whether it is part of a large portfolio, and whether it has changed hands recently is real information you can ask real questions about. That is the whole point of Candor: the plain truth, laid out so you can decide for yourself.
Methodology
Facility counts, ownership type, and chain affiliation come from the CMS Provider Information and ownership files for Medicare- and Medicaid-certified nursing homes, covering 14,703 facilities. Ownership-change history comes from the CMS Change of Ownership and ownership records, 256,242 entries in total, keyed to each facility's federal provider number (CCN). "Part of a chain" means the facility reports a parent chain name in the federal data. Year counts reflect the effective date recorded for each ownership entry. This dataset covers federally certified nursing homes; assisted living, memory care, and independent living are licensed at the state level and are not fully represented here, so the counts understate the total senior-care ownership picture. We report the numbers as the records state them and apply no scoring or quality judgment of any kind.