ElderCareCosts Research

https://www.eldercarecosts.com/press/data/ownership-concentration/

DATA AS OF CMS NURSING HOMES, CURRENT LOAD

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Ownership Concentration in Nursing Homes, State by State

Name: Ownership Concentration in Nursing Homes, State by State
Creator: ElderCareCosts Research
License: https://www.eldercarecosts.com/editorial-standards/

How much of each state's nursing home capacity sits inside multi-facility chains.

EDITORIAL STANDARDS

The finding

10,122 of the 14,944 nursing homes in the ElderCareCosts directory, 67.7% of them, carry a CMS chain identifier, meaning federal records place them inside a multi-facility operator rather than a standalone business. Those homes sit across 611 distinct chains. The median state runs at 68.1% chain-affiliated. Of the nursing homes where CMS records an ownership type, 69.7% are recorded as for profit. A chain identifier is a corporate fact, not a judgment about care, price, or staffing, and nothing here should be read as one.

Nursing homes inside a multi-facility chain: 67.7%
10,122 of 14,944 in the directory
Distinct chains recorded: 611
counted by CMS chain identifier
Recorded as for profit: 69.7%
of the 14,922 homes where CMS records an ownership type

Cite this piece

Cite this: ElderCareCosts Research, "Ownership Concentration in Nursing Homes, State by State". Data as of CMS nursing homes, current load. https://www.eldercarecosts.com/press/data/ownership-concentration/

Reporters and researchers: reuse with attribution, no permission needed. Questions, corrections, or a cut of this data for your patch: [email protected].

How to read this

Chain affiliation is taken only from the chain identifier CMS records on the facility. We never group two facilities because their names look alike, and we never infer a corporate relationship the federal record does not state.

A nursing home with no chain identifier is counted as independent. Where CMS reporting is incomplete, that will overstate the independent share, which means the concentration shown here is a floor rather than a ceiling.

The largest chain column counts homes inside the single biggest operator in each state. It is a useful sense of how much of a state sits with one company, and it says nothing about how that company runs them.

Two chains under common ultimate ownership through separate corporate structures are counted as two. Real concentration is therefore at least as high as this table shows, never lower.

This piece covers nursing homes only, because that is the setting where CMS publishes chain affiliation. Assisted living ownership has no equivalent federal record and is not represented here.

Charts

Share of nursing homes carrying a CMS chain identifier

The fifteen states with the highest chain-affiliated share. A facility with no identifier is counted as independent, so these shares are a floor.

Unit: percent of nursing homes

Share of nursing homes carrying a CMS chain identifier
Label	Chain-affiliated share (percent of nursing homes)
Indiana	81.7% of 508
Arkansas	81.5% of 222
Utah	81.4% of 97
Oregon	81.4% of 129
Idaho	79.0% of 81
Texas	78.9% of 1,187
Arizona	78.3% of 143
Florida	75.7% of 704
North Carolina	74.8% of 425
Maryland	73.5% of 223
Ohio	73.5% of 926
Tennessee	73.4% of 305
Virginia	73.3% of 292
Nevada	73.1% of 67
West Virginia	72.3% of 130

Full data

Nursing home chain affiliation and ownership type, by state
State	Nursing homes	Chain share	Chains	Largest chain	For profit	Nonprofit	Government
Indiana	508	81.7%	40	90	72	428	8
Arkansas	222	81.5%	15	35	200	14	8
Utah	97	81.4%	12	21	41	46	10
Oregon	129	81.4%	17	18	112	12	5
Idaho	81	79.0%	10	25	64	9	8
Texas	1,187	78.9%	61	149	475	661	51
Arizona	143	78.3%	21	40	122	15	6
Florida	704	75.7%	62	50	567	114	23
North Carolina	425	74.8%	38	37	356	56	13
Maryland	223	73.5%	32	37	178	39	6
Ohio	926	73.5%	77	64	780	132	14
Tennessee	305	73.4%	34	37	261	32	12
Virginia	292	73.3%	33	35	226	55	11
Nevada	67	73.1%	19	6	55	4	8
West Virginia	130	72.3%	9	41	99	21	10
Michigan	428	72.2%	32	53	312	70	24
Colorado	213	71.8%	27	31	175	25	13
California	1,179	71.2%	63	133	1,012	124	43
Delaware	45	71.1%	14	5	32	10	3
Washington	197	71.1%	21	17	154	28	15
Kentucky	269	70.3%	29	38	221	42	6
Illinois	683	70.0%	62	41	555	102	26
New Mexico	69	69.6%	6	23	58	6	5
Alabama	233	69.5%	26	33	188	32	13
South Carolina	188	69.1%	24	25	151	26	11
New Jersey	349	68.8%	37	43	289	52	8
Missouri	504	68.1%	42	54	387	82	35
Georgia	363	67.2%	28	59	248	95	20
Massachusetts	344	65.4%	36	19	250	87	7
Louisiana	268	62.7%	18	24	231	25	12
Kansas	300	61.0%	29	27	186	93	21
Pennsylvania	671	59.3%	70	37	427	215	29
Wisconsin	327	59.0%	37	53	210	83	34
Maine	81	58.0%	7	11	56	16	9
Connecticut	192	57.3%	18	24	155	34	3
Iowa	391	56.8%	32	43	212	168	11
Mississippi	213	56.3%	15	24	160	22	31
Minnesota	346	56.1%	30	45	114	210	22
Montana	63	50.8%	8	7	31	23	9
Oklahoma	296	50.7%	19	33	264	15	17
New York	607	50.1%	46	34	416	156	35
Nebraska	191	49.7%	19	21	78	88	25
Vermont	33	48.5%	8	4	24	8	1
South Dakota	102	48.0%	8	13	33	61	8
Hawaii	45	46.7%	7	7	26	14	5
Rhode Island	74	45.9%	13	7	61	11	2
New Hampshire	77	42.9%	8	15	47	17	13
North Dakota	73	37.0%	8	10	5	65	3
Wyoming	38	36.8%	4	8	14	10	14
Alaska	22	31.8%	4	2	6	10	6
District of Columbia	18	11.1%	2	1	7	10	1
GU	1	0.0%	0	0	0	0	1
PR	12	0.0%	0	0	5	4	3

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Every row above is in the download. Download the full dataset as CSV.

Methodology

Chain affiliation comes from the CMS chain identifier carried on each nursing home record. A facility is chain-affiliated when CMS records a chain for it, and independent when CMS records none. We never infer a chain from a facility's name, and we never group two facilities because their names look similar.

For each state we publish the count of nursing homes, how many are chain-affiliated, how many distinct chains operate there, and what share of the state's chain-affiliated homes sit inside its single largest chain.

Ownership type, where CMS records one, is reported in buckets: for profit, nonprofit, government, and not classified. Buckets are used rather than raw labels because the raw values are not consistently spelled across source files.

States with very few nursing homes are still published, with their counts visible, rather than hidden behind a threshold that would quietly remove them from the picture.

Sitewide cost and data method: Methodology · Data sources · Corrections

Source: CMS Nursing Home Provider Information · Updated CMS nursing homes, current load

What this cannot tell you

A chain identifier is a corporate affiliation recorded by CMS, not a statement about care, staffing, or price. Chain-affiliated is not a synonym for worse, and independent is not a synonym for better. This piece takes no position on either.

Not every nursing home carries a chain identifier in the CMS record. A facility with no identifier is counted as independent, which will overstate the independent share wherever CMS reporting is incomplete.

Ownership structures change hands, and the record reflects the file we last loaded. A sale completed after that load is not here.

Chains are counted by CMS identifier, so two chains under common ultimate ownership through separate corporate structures are counted separately. Real concentration is therefore at least as high as this shows, never lower.

This piece covers nursing homes only, because that is the setting where CMS publishes chain affiliation. Assisted living ownership is not published federally and is not represented here at all.

Sources

CMS Nursing Home Provider Information: Nursing home records, ownership type, and chain identifiers
CMS Skilled Nursing Facility All Owners: Structured ownership disclosures behind parent organization links
ElderCareCosts licensed provider directory: Licensed provider records built from state licensing registries and CMS files, with the source and load date recorded on every row

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