For-Profit vs Non-Profit: How Ownership Type Relates to Care Quality

When choosing a nursing home, the ownership structure may matter more than many families realize. Federal data from May 2026 shows that nonprofit nursing homes affiliated with churches earn the highest average quality scores—74 out of 100—while government-run hospital district facilities score lowest at 60.8.

The 13-point gap represents a meaningful difference in care quality across America's 14,682 nursing homes tracked in this analysis. Quality scores reflect a combination of health inspections, staffing levels, and resident outcomes reported to Medicare.

While ownership type doesn't guarantee the experience at any individual facility, the patterns are striking: facilities operated by religious organizations and other nonprofits consistently outperform for-profit nursing homes across the board.

The Nonprofit Advantage

Nonprofit facilities dominate the upper tier of quality scores. Church-related nonprofits lead with 264 facilities averaging 74 points, followed closely by nonprofit corporations (2,316 facilities at 72.1 points). Among church-affiliated homes, 73 earned "excellent" ratings while only 9 were classified as "poor."

Government-run facilities show mixed results depending on their structure. City-operated nursing homes (54 facilities) score 72.1 on average, nearly matching nonprofit corporations. State facilities (156 locations) and county facilities (344 locations) also perform well, averaging 72 and 71.1 respectively. These government facilities generally post strong ratios of excellent to poor performers.

The For-Profit Picture

For-profit nursing homes tell a different story. The 10,859 for-profit facilities in this dataset—representing nearly three-quarters of all homes analyzed—average between 61 and 64.5 points depending on their corporate structure.

For-profit corporations (4,718 facilities) average 64.2 points, with 411 excellent facilities but 419 poor ones—a nearly even split. Limited liability companies, the most common ownership structure with 5,120 facilities, average just 61.1 points. This group includes 296 excellent homes but 603 poor performers, the highest count of poorly-rated facilities in any category.

Individually-owned for-profit homes (646 facilities) score 61.9 on average, with 41 excellent but 71 poor ratings. For-profit partnerships (375 facilities) perform slightly better at 64.5 points.

The Hospital District Anomaly

Government hospital districts present an unexpected finding. Despite being publicly operated, these 308 facilities score lowest overall at 60.8—below even for-profit homes. They include only 21 excellent facilities but 36 poor ones. Hospital districts often serve specialized populations or operate in challenging rural markets, which may explain their lower scores, though the data doesn't specify these circumstances.

What The Numbers Mean For Families

These ownership patterns likely reflect different operational priorities. Nonprofit and government facilities don't answer to shareholders seeking returns on investment, potentially allowing more resources to flow directly into staffing and care. Church-related facilities may benefit from mission-driven cultures and stable community support.

For-profit facilities face pressure to generate returns for investors, which can create tension with care quality—though hundreds of for-profit homes still achieve excellent ratings. The wide variation within each category means ownership type provides useful context but shouldn't be the only factor families consider.

Important context: Quality scores are calculated by Medicare using inspection results, staffing data, and health outcomes. A facility's score reflects conditions during specific inspection periods and may not capture day-to-day experiences. Families should visit facilities in person, talk with residents and staff, and review detailed inspection reports before making decisions.

Data source: Centers for Medicare & Medicaid Services (CMS). Data as of 2026-05-21.