The U.S. nursing home industry, mapped.
14,710 facilities. 616 chains. 50 state markets.

The U.S. nursing home industry comprises 14,710 federally certified facilities operating across all 50 states and the District of Columbia. Roughly 616 multi-facility chains collectively operate the majority of the universe; the rest are independent operators. Bed capacity, ownership structure, payer mix, and financial position vary widely across geographies and operator types — and most of this variation is invisible in any single CMS dataset.

The financial picture is the part of the industry least understood from outside it. In fiscal year 2024, 57% of nursing home facility-years reported negative operating margins, with an average margin of −9.1%. The federal staffing mandate was repealed in December 2025, removing the most prominent compliance overhang, but the underlying margin pressure, payer mix dependencies, and ownership turnover that drive the industry's economics have not changed. Buyers, lenders, and operators evaluating the space need facility-level data, not industry averages.

Our work in this research area is to make the industry visible at facility resolution. We aggregate ownership history, HCRIS financials, payer mix breakdowns, enforcement records, and county-level demographics into a single facility-keyed dataset. See the methodology page for how the data is built, the workforce and staffing research area for the operational side of the industry, and the regulatory landscape for state-by-state enforcement context.