When families compare nursing homes, almost no one asks who owns the place. Yet ownership turns out to be one of the clearest patterns in the entire dataset. We scored 14,696 Medicare-certified nursing homes using CMS Care Compare data — inspections, staffing, penalties, and complaints — and then grouped them by how they’re owned. The differences are large and consistent.
Before the numbers, one principle guides this whole piece: ownership type is a signal, not a verdict. It shifts the odds, but it does not decide whether any one home is good. Many for-profit homes are excellent; some nonprofits are not. Use ownership to know what questions to ask — never to accept or reject a home on its own.
Who actually owns America’s nursing homes?
Most people assume nursing homes are run by hospitals or charities. The reality is the opposite. Of the 14,696 facilities we scored:
- For-profit — 73.8% (10,849 homes): owned by companies, partnerships, or individual operators.
- Nonprofit — 19.8% (2,907 homes): run by religious, community, or hospital-affiliated organizations.
- Government — 6.4% (940 homes): county, city, state, hospital-district, or federal.
So nearly three out of four nursing homes are for-profit businesses. That isn’t a scandal in itself — but it means the “average” nursing home experience in the U.S. is shaped overwhelmingly by for-profit operators.
The data: safety score by ownership type
Here’s how the three groups compare on our 0–100 safety score and the measures behind it. Higher is better on every column except the last two.
| Ownership | Homes | Avg score | Median score | Staffing sub-score | Good or excellent | Abuse-flagged |
|---|---|---|---|---|---|---|
| Nonprofit | 2,907 | 71.9 | 74 | 69.6 | 61.2% | 6.1% |
| Government | 940 | 67.9 | 70 | 60.6 | 50.2% | 11.0% |
| For-profit | 10,849 | 62.6 | 64 | 51.2 | 39.1% | 11.1% |
The pattern is hard to miss. Nonprofit homes average about 9 points higher than for-profit homes, and the median tells the same story (74 vs. 64), so this isn’t a handful of outliers dragging the average. Nonprofit homes are more than 1.5x as likely to land in our “good or excellent” tier (61% vs. 39%), and far less likely to be in the “poor” tier (3.2% vs. 10.4%) or in the federal Special Focus program for the worst performers (1.6% vs. 4.2%).
Where the gap really comes from: staffing
If you trace the difference to a single cause, it’s staffing — the factor most tightly linked to day-to-day care. Nonprofit homes post a staffing sub-score of 69.6 versus 51.2 for for-profit homes, an 18-point gulf. More nurse and aide hours per resident mean call lights answered faster, more help with eating and mobility, and fewer falls and pressure injuries.
This is also the most observable difference for families. You can feel understaffing on a tour — long waits, frazzled aides, residents left unattended in hallways. Our guide to the red flags families miss on a visit walks through exactly what to watch for.
An honest nuance: it’s not a clean sweep
A trustworthy comparison shows the whole picture. For-profit homes actually scored higher on the clinical quality measures sub-score (69.6 vs. 58.0 for nonprofits). Those measures come largely from facility-reported clinical data — things like vaccination rates and certain condition rates.
So the fair summary is this: nonprofits lead decisively on staffing and inspections — the things families can observe and verify — while for-profits sometimes edge ahead on self-reported clinical measures. Because staffing and inspection results are harder to game and easier to confirm, we weight them heavily. But you should know both sides exist, and not treat any single number as the whole story.
How we analyzed this
So you can judge the findings for yourself:
- Source: CMS Care Compare / official nursing home datasets, the same data Medicare publishes.
- Scope: all 14,696 Medicare-certified nursing homes with a current safety score.
- Method: facility-level, unweighted averages and medians by ownership category.
- Important limits: these numbers are not adjusted for facility size, state, resident acuity, or payer mix, all of which can differ by ownership. They show a real association — they do not prove ownership causes the difference. Treat them as a strong signal, then verify the specific home.
Looking for nonprofit nursing homes near you?
Nonprofit homes are only about a fifth of the market, so they aren’t always easy to spot — the name rarely tells you. The ownership type for every facility is on file with CMS, and we show it on each home’s profile under “Ownership & Chain.” The simplest approach:
- Look up nursing homes by name or location and check each one’s ownership type alongside its safety score.
- Shortlist a few candidates — including nonprofits if available locally — and compare their staffing and inspection history side by side.
- Tour your top choices in person using a list of questions to ask.
Who owns this home? Chains and investment groups
Beyond the for-profit/nonprofit label, many homes belong to larger chains or are backed by investment groups, including private equity. CMS ownership records can help you see the listed owners and chain affiliation, though they don’t always reveal every layer of control.
Being part of a chain isn’t automatically a problem — but it’s a good reason to look closely rather than assume a recognizable brand means quality. The same questions apply regardless of who’s behind the home: How many nursing hours per resident? What did the last inspection find? Any abuse flags or recent complaints? You can answer all three from a home’s Care Safety Check profile, and learn to read the inspection record with our plain-English guide to inspection reports.
The bottom line for your family
Ownership type genuinely shifts the odds: as a group, nonprofit homes staff better and inspect better, and for-profit homes — three-quarters of the market — score lower on average. That’s worth knowing. But it is a starting point, not an answer.
Don’t choose or reject a home on ownership alone. Use it to sharpen your questions, then check the one number that matters most — the actual record of the specific home you’re considering.
- ☐ Look up any home’s safety score, staffing, ownership, and inspection history »
- ☐ Learn the red flags families miss on a tour.
- ☐ Know how to speak up if something isn’t right — it’s free and protected by law.
Planning ahead for a parent? Our free Before the Crisis family planning guide is a printable workbook that walks you through the conversations, documents, and decisions step by step — so a sudden health change never catches your family flat-footed.
Frequently asked questions
Are nonprofit nursing homes better than for-profit ones?
On average, yes — but it’s a tendency, not a guarantee. Across 14,696 CMS-listed facilities we scored, nonprofit homes averaged 71.9 out of 100 versus 62.6 for for-profit homes, and the gap is widest on staffing. But plenty of for-profit homes score well and some nonprofits score poorly, so ownership should guide your questions, not decide your choice.
What does it mean when a nursing home is nonprofit?
A nonprofit nursing home is run by an organization — often religious, community, or hospital-affiliated — that reinvests any surplus into operations rather than paying it out to investors. In our data these homes tend to staff at higher levels. Nonprofits make up about 20% of U.S. nursing homes.
How do I find out who owns a nursing home?
Every Medicare-certified nursing home has its ownership type and listed ownership/chain information on file with CMS. You can see the ownership type for any facility on its Care Safety Check profile under “Ownership & Chain,” alongside its safety score, staffing, and inspection history.
Are for-profit nursing homes less safe?
In aggregate they score lower on our safety measure — driven mainly by thinner staffing and weaker inspection records — and they are flagged for abuse and placed in the Special Focus program at higher rates. But for-profit homes are 74% of all U.S. facilities and many are excellent. Judge each home on its own record, not its tax status.
What are private equity nursing homes?
Some nursing homes are owned by larger chains or investment groups, including private equity firms, rather than a single local operator. CMS ownership records can help you see the listed owners and chain affiliation, though they may not reveal every layer of control. Knowing a home is part of a chain is a reason to look closely at its staffing and inspection history — not an automatic red flag.
Should ownership type determine which nursing home I choose?
No. Ownership is one useful signal among several. Always check the home’s actual staffing levels, recent inspection results, abuse flags, and Special Focus status, and tour in person. A specific home’s record matters far more than the category it falls into.
Continue your nursing home research
Use the same CMS inspection, staffing, enforcement, and quality data behind this article to compare facilities near you.