Who owns America's nursing homes, as disclosed to CMS

The headline numbers

Of 14,690 certified nursing homes in the release, 14,215 matched a PECOS enrollment whose ownership rows can be read. An owner holds an ownership or control role (direct or indirect ownership interest, partnership interest, operational or managerial control); a party is any other disclosable party, most often the landlord. The distinction is the whole story for REITs.

• Disclose a private-equity owner650.44% of facilities · 7,404 beds
• Private equity in any role970.66% · 32 among other parties only
• Disclose a REIT owner730.5% of facilities
• REIT in any role5773.93% · 61,235 beds · mostly landlords
• For-profit74%Care Compare ownership type
• In a CMS-identified chain68.9%Browse the chains
• Changed hands in 36 months1,3999.5% · PECOS change-of-ownership file
• Care Compare 12-month change flag1130.77% of facilities

By state

Pick a layer. Each one is a share of the state's certified nursing homes in release v2026.08; the table under the map carries every layer for every state.

Quality and enforcement by disclosure group

Descriptive averages of the release columns for each disclosure group. They do not control for case mix, size, region or the reasons a facility changes hands, and the private-equity group is small (65 facilities). They describe; they do not explain.

All facilities

For-profit facilities only

The most-disclosed owners

Organizations as printed in the PECOS All Owners file, counted by the facilities that disclose them. CMS leaves the organization name blank on some rows; those are grouped as Name not published in the CMS file.

Changes of ownership

PECOS change-of-ownership records for certified nursing homes by effective year; the file is cut in the summer, so the latest year is partial. 1,399 facilities changed hands in the 36 months before the vintage (0 more than once). Care Compare's own twelve-month flag marks 113. The Care Compare ownership file is not a turnover measure: CMS relabelled its owner roles three times and the 2023 disclosure rule added new categories, so counts of "new owners" in that file mostly record reporting changes (methodology, section 9).

Where the federal files disagree

The discrepancy register lists every facility whose CMS files disagree with each other or leave a required ownership disclosure empty: 2,209 rows across six mechanical checks in release v2026.08. Each row is a statement about two federal files, never a finding about the facility.

• 475 facilities

  No PECOS enrollment matched to the CCN. The facility is certified in Care Compare but no Skilled Nursing Facility enrollment in the PECOS files carries its CCN, so none of its ownership disclosures can be read.

• 1,437 facilities

  PECOS enrollment lists no ownership-interest party. The facility's current PECOS enrollment names officers, directors, managing employees or other parties, but no direct, indirect or partnership ownership interest (role codes 34, 35, 38, 39, 85, 86). Non-profit and government facilities have no equity owners to list, so most of these rows are expected; the check matters for for-profit facilities.

• 293 facilities

  Ownership-interest owners disclosed without any ownership percentage. Every ownership-interest row on the facility's current enrollment leaves the percentage blank, so the share each owner holds cannot be read from the file.

• 3 facilities

  PE or REIT owner disclosed in PECOS, Care Compare lists individuals only. PECOS flags a private-equity company or a REIT in an ownership or control role, while the Care Compare ownership file for the same facility lists only individuals.

• 1 facilities

  Ownership changed in the last 12 months per Care Compare, no PECOS change of ownership in 36 months. Care Compare flags an ownership change in the last twelve months, but the PECOS Change of Ownership file has no record for the facility in the 36 months before the vintage.

Sources and method