Disclaimer: General educational research only — not legal advice. Ownership records are self-reported to Medicare; check the facility’s own listing on Medicare’s Care Compare and talk with an elder law or estate planning attorney about your situation.
Estate Planning Data & Research → Who Owns Your Parent’s Nursing Home?
When a parent needs a nursing home, families usually compare location, staffing and star ratings. Few look at who owns the building, and that information is public. Every nursing home that bills Medicare must report its owners, and the people and companies that control it, to the Centers for Medicare & Medicaid Services (CMS).
We analyzed CMS’s August 2026 ownership files for all 14,410 Medicare-enrolled skilled nursing facilities. We counted for-profit and nonprofit homes, chain affiliation, and the kinds of owners listed: individuals, trusts, holding companies, real estate investment trusts (REITs) and private equity firms.
The paperwork that protects a parent in a nursing home (a power of attorney, a health care proxy, and a will or trust) works best when it’s signed while everyone is healthy. See whether you need a will, a living trust or both.
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Cite this page URL when reusing findings. Not a substitute for official sources or professional advice.
Key findings
- Two in three nursing homes are for-profit. 67.9% of Medicare-enrolled skilled nursing facilities are proprietary, and 30.8% are nonprofit.
- Seven in ten are part of a chain. 70.2% list a chain or affiliated entity.
- One in eight lists a trust or trustee as an owner. 1,787 facilities (12.4%) report a trust or trustee holding a direct or indirect ownership or partnership interest. The share is highest in West Virginia (35.7%), Illinois (26.8%), Delaware (24.4%), South Dakota (24.1%) and Ohio (23.2%).
- One in five has a holding company in its ownership chain (19.4%). Florida leads at 42.5%.
- More than half (54.4%) name at least one individual owner. On average, each facility lists 4.5 owners with an ownership or partnership interest.
- A management company runs day-to-day operations at almost one in four (23.9%). These are management services companies reported as having operational or managerial control. The share is 55.8% in Indiana.
- REITs show up mostly as “additional disclosable parties,” not owners. 587 facilities list a REIT in some role, 557 of them as an additional disclosable party, a category that includes landlords. Only 70 list a REIT with an ownership interest.
- Self-reported private equity ownership is rare in the data: 65 facilities (0.5%). The Government Accountability Office estimated that about 5% of nursing homes had private equity owners in 2022. To reach that figure, GAO had to supplement CMS’s data with other sources.
Nursing home ownership by state
| State | Nursing homes (SNF enrollments) | For-profit (CMS flag) | Government entity | Chain-affiliated | A trust or trustee is an owner | A holding company is an owner | Management company has operational control | REIT owner (count) |
|---|---|---|---|---|---|---|---|---|
| Alabama | 222 | 83.8% | 1.4% | 73.0% | 17.1% | 22.5% | 22.5% | 1 |
| Alaska | 17 | 29.4% | 11.8% | 41.2% | 0.0% | 17.6% | 11.8% | 0 |
| Arizona | 139 | 86.3% | 1.4% | 80.6% | 10.8% | 7.9% | 28.8% | 0 |
| Arkansas | 219 | 90.4% | 1.8% | 82.6% | 6.8% | 38.8% | 15.1% | 0 |
| California | 1,134 | 85.3% | 1.7% | 74.1% | 9.8% | 20.5% | 6.3% | 0 |
| Colorado | 203 | 79.3% | 3.9% | 74.9% | 8.9% | 18.7% | 31.0% | 8 |
| Connecticut | 190 | 80.5% | 0.5% | 57.9% | 13.2% | 16.8% | 8.9% | 0 |
| Delaware | 41 | 73.2% | 4.9% | 78.0% | 24.4% | 24.4% | 24.4% | 0 |
| District of Columbia | 16 | 43.8% | 0.0% | 12.5% | 12.5% | 12.5% | 0.0% | 0 |
| Florida | 692 | 77.7% | 1.4% | 77.0% | 16.5% | 42.5% | 14.9% | 8 |
| Georgia | 350 | 69.7% | 0.6% | 69.7% | 10.0% | 36.9% | 35.7% | 2 |
| Hawaii | 43 | 53.5% | 7.0% | 48.8% | 14.0% | 23.3% | 30.2% | 0 |
| Idaho | 80 | 78.8% | 5.0% | 80.0% | 3.8% | 5.0% | 13.8% | 0 |
| Illinois | 650 | 80.8% | 1.8% | 73.5% | 26.8% | 18.6% | 15.8% | 1 |
| Indiana | 504 | 2.6% | 46.2% | 82.3% | 1.8% | 2.2% | 55.8% | 9 |
| Iowa | 374 | 53.7% | 1.1% | 59.1% | 13.9% | 19.0% | 26.2% | 1 |
| Kansas | 269 | 62.1% | 1.5% | 68.0% | 13.4% | 26.4% | 32.0% | 0 |
| Kentucky | 267 | 81.6% | 2.2% | 70.8% | 12.4% | 27.3% | 33.3% | 4 |
| Louisiana | 265 | 80.8% | 1.1% | 63.0% | 14.3% | 12.1% | 35.1% | 0 |
| Maine | 78 | 71.8% | 1.3% | 60.3% | 9.0% | 7.7% | 5.1% | 2 |
| Maryland | 219 | 78.5% | 1.8% | 74.9% | 20.5% | 23.7% | 20.5% | 1 |
| Massachusetts | 340 | 72.1% | 1.2% | 66.2% | 10.9% | 8.2% | 21.5% | 0 |
| Michigan | 421 | 75.3% | 7.6% | 73.4% | 21.9% | 26.4% | 38.5% | 4 |
| Minnesota | 329 | 30.7% | 4.9% | 58.7% | 0.9% | 3.0% | 24.6% | 0 |
| Mississippi | 183 | 82.0% | 4.9% | 65.6% | 20.2% | 22.4% | 27.3% | 0 |
| Missouri | 478 | 79.3% | 1.9% | 71.8% | 13.8% | 27.8% | 34.5% | 0 |
| Montana | 60 | 51.7% | 5.0% | 53.3% | 11.7% | 16.7% | 11.7% | 0 |
| Nebraska | 168 | 41.7% | 8.3% | 56.5% | 0.6% | 16.7% | 25.6% | 0 |
| Nevada | 63 | 85.7% | 3.2% | 77.8% | 15.9% | 30.2% | 12.7% | 1 |
| New Hampshire | 71 | 63.4% | 14.1% | 46.5% | 14.1% | 29.6% | 25.4% | 0 |
| New Jersey | 344 | 82.8% | 2.0% | 69.5% | 14.0% | 19.5% | 11.9% | 1 |
| New Mexico | 66 | 84.8% | 4.5% | 72.7% | 21.2% | 30.3% | 7.6% | 0 |
| New York | 601 | 66.7% | 4.3% | 50.6% | 0.5% | 1.3% | 1.2% | 0 |
| North Carolina | 414 | 79.5% | 1.0% | 76.6% | 19.1% | 31.2% | 30.7% | 4 |
| North Dakota | 72 | 4.2% | 1.4% | 37.5% | 0.0% | 0.0% | 11.1% | 0 |
| Ohio | 918 | 83.9% | 0.9% | 74.3% | 23.2% | 30.6% | 30.6% | 10 |
| Oklahoma | 274 | 92.3% | 0.7% | 54.7% | 10.9% | 4.0% | 10.6% | 1 |
| Oregon | 119 | 87.4% | 1.7% | 88.2% | 11.8% | 37.8% | 37.0% | 2 |
| Pennsylvania | 650 | 62.6% | 1.8% | 61.2% | 17.7% | 20.2% | 24.8% | 1 |
| Rhode Island | 71 | 84.5% | 0.0% | 46.5% | 22.5% | 5.6% | 15.5% | 0 |
| South Carolina | 186 | 79.0% | 2.2% | 69.9% | 5.4% | 23.1% | 11.3% | 1 |
| South Dakota | 83 | 37.3% | 1.2% | 59.0% | 24.1% | 9.6% | 16.9% | 0 |
| Tennessee | 298 | 79.2% | 1.0% | 75.2% | 8.1% | 20.8% | 24.5% | 0 |
| Texas | 1,160 | 28.6% | 47.8% | 80.9% | 1.1% | 2.7% | 34.9% | 5 |
| Utah | 91 | 40.7% | 53.8% | 86.8% | 12.1% | 11.0% | 45.1% | 0 |
| Vermont | 33 | 66.7% | 3.0% | 48.5% | 6.1% | 9.1% | 12.1% | 0 |
| Virginia | 279 | 78.9% | 0.7% | 76.7% | 18.3% | 30.1% | 14.3% | 0 |
| Washington | 190 | 77.9% | 1.6% | 73.7% | 13.7% | 26.3% | 29.5% | 0 |
| West Virginia | 115 | 82.6% | 0.0% | 81.7% | 35.7% | 29.6% | 38.3% | 1 |
| Wisconsin | 319 | 61.1% | 10.0% | 60.5% | 2.5% | 11.9% | 23.2% | 2 |
| Wyoming | 33 | 9.1% | 51.5% | 42.4% | 0.0% | 0.0% | 48.5% | 0 |
Source: Family Estate Guide analysis of CMS Skilled Nursing Facility Enrollments and SNF All Owners files (August 2026). “For-profit” uses CMS’s proprietary/nonprofit flag. “Government entity” uses the organization-structure field. Owner-type columns count facilities with at least one owner of that type in an ownership or partnership role, as checked by the facility. The U.S. row includes territories.
Why the numbers differ
Indiana and Texas look “nonprofit,” but most of their homes have private operators. Only 2.6% of Indiana’s nursing homes carry CMS’s for-profit flag. CMS lists 233 of Indiana’s 504 homes under a government organization structure, and 55.8% report a management company with operational control. Texas has the same pattern, with 555 homes under a government structure and a 28.6% for-profit share. In both states, a public entity holds the license and a private company runs the building, so the for-profit flag alone understates private operation.
Trust ownership is a regional pattern. In West Virginia, Illinois, Ohio and Delaware, roughly a quarter to a third of homes list a trust or trustee as an owner. In New York (0.5%) and Texas (1.1%), almost none do. The data shows that an owner is a trust. It doesn’t say what kind of trust, or why the owners structured their stakes that way.
Holding companies cluster in a few states. Florida (42.5%), Ohio (30.6%) and West Virginia (29.6%) have the highest shares of homes with a holding company in the ownership chain. New York (1.3%) and Texas (2.7%) have the lowest.
Real estate often has a different owner than the operation. CMS’s 2023 rule broadened the “additional disclosable party” category. It now covers anyone that leases real property to the facility, holds 5% or more of the property, or exercises operational, financial or managerial control. That is why REITs, which usually own the building rather than the operating company, appear far more often in that role (557 facilities) than as owners (70).
The data has known gaps. Facilities report their own owners. GAO found that many nursing homes did not have all of their owners listed in CMS’s data, and that the data had no reliable way to flag private equity. The owner-type checkboxes are a floor, not a complete count.
What this means for your family
You can look up any nursing home’s owners before you choose. Medicare’s Care Compare site shows ownership details for each facility. The CMS files behind this page are free to download, too. If a facility belongs to a chain, check the chain’s other homes as well.
Don’t sign as a personal guarantor. Federal rules say a nursing home that takes Medicare or Medicaid may not require a third-party guarantee of payment as a condition of admission or continued stay. A facility may ask a representative who has legal access to the resident’s income or resources to sign. That person agrees to pay from the resident’s money, without taking on personal liability (42 CFR 483.15(a)(3)). Read admission papers closely before you sign as “responsible party.”
That legal access comes from documents your parent signs in advance. A durable financial power of attorney lets a trusted person handle a parent’s money and sign for them. A health care proxy (also called a health care power of attorney) and a living will cover medical decisions. If a parent loses capacity without these documents, the family may need a court guardianship before anyone can sign. See our essential estate documents guide.
Nursing home costs and Medicaid can reach the estate. States must try to recover certain Medicaid long-term care costs from a deceased recipient’s estate. Planning ahead (who owns the house, which accounts have beneficiaries) is easier before a crisis than during one. See Medicaid estate recovery by state and nursing home costs by state.
Related: Nursing home capacity by state · The incapacity gap · My parents are getting older
Methodology
Facilities. CMS Skilled Nursing Facility Enrollments, August 2026 release (data.cms.gov dataset 5f2c306f-3b1c-42cd-b037-187b2ce22126), 14,410 enrollment records. State is the facility’s state. Fields used: PROPRIETARY_NONPROFIT (P = for-profit, N = nonprofit; 1.3% blank), ORGANIZATION TYPE STRUCTURE (GOVERNMENT) and AFFILIATION ENTITY NAME (chain affiliation when present).
Owners. CMS Skilled Nursing Facility All Owners, August 2026 release. This file lists each owner and its role, with yes/no checkboxes for owner type (trust or trustee, REIT, private equity company, holding company, investment firm, management services company, chain home office). A facility counts toward an owner-type column if at least one owner with that checkbox holds a direct or indirect ownership interest or a partnership interest. Other roles, such as officers, directors, managing employees, mortgage holders and additional disclosable parties, are excluded from those columns but reported separately in the CSV download (the “_any_role” counts). “Management company has operational control” counts facilities that list a management services company in an operational/managerial control role. “Individual owner” counts facilities with at least one person (not an organization) in an ownership role.
Definitions. “Additional disclosable party” per 42 CFR 424.502, as amended by CMS’s Nov. 17, 2023 final rule (88 FR 80141). GAO private equity estimate from GAO-23-106163 (September 2023).
What this doesn’t measure. The data doesn’t measure quality, staffing or finances, and this page makes no claim about how ownership type relates to care. Owner checkboxes are self-reported and can be incomplete. One owner can hold stakes in many facilities, and this page counts facilities, not distinct owners.
Frequently asked questions
How can I find out who owns a nursing home?
Look up the facility on Medicare’s Care Compare and open its ownership details, or download CMS’s Skilled Nursing Facility All Owners file from data.cms.gov. Both come from information the facility reports to Medicare.
What share of nursing homes are for-profit?
67.9% of Medicare-enrolled skilled nursing facilities carry CMS’s for-profit flag as of August 2026. 30.8% are nonprofit.
How many nursing homes are owned by private equity?
Only 65 facilities (0.5%) self-report a private equity owner in CMS’s August 2026 data. GAO estimated about 5% in 2022 after adding other data sources. GAO also found that CMS’s data alone can’t reliably identify private equity owners.
Can a nursing home make me personally responsible for my parent’s bill?
A Medicare- or Medicaid-certified nursing home may not require a third-party guarantee of payment as a condition of admission or continued stay. It can ask a representative with legal access to the resident’s money to sign and pay from the resident’s funds, without personal liability (42 CFR 483.15(a)(3)). Have an attorney review an admission agreement if you’re unsure.
Why does a trust own a nursing home?
CMS records only that a trust or trustee holds an ownership interest. It doesn’t record the type of trust or the reason. Trusts are a common way for individuals to hold business interests.
Sources
All data is public-domain U.S. government data. Pulled Oct. 8, 2026.
- CMS, Skilled Nursing Facility Enrollments, August 2026 release. data.cms.gov dataset 5f2c306f-3b1c-42cd-b037-187b2ce22126. https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/skilled-nursing-facility-enrollments (raw: 14,410 rows)
- CMS, Skilled Nursing Facility All Owners, August 2026 release. https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/skilled-nursing-facility-all-owners (385 MB JSON held at per-facility flags in
- 42 CFR 424.502, definitions (“additional disclosable party”), via eCFR. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-H/part-424/subpart-P/section-424.502
- CMS final rule, “Disclosures of Ownership and Additional Disclosable Parties Information for Skilled Nursing Facilities and Nursing Facilities; Medicare Providers’ and Suppliers’ Disclosure of Private Equity Companies and Real Estate Investment Trusts,” 88 FR 80141 (Nov. 17, 2023), FR Doc. 2023-25408. https://www.federalregister.gov/d/2023-25408
- 42 CFR 483.15(a)(3), no third-party guarantee of payment. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.15
- GAO-23-106163, “Nursing Homes: Limitations of Using CMS Data to Identify Private Equity and Other Ownership” (September 2023). https://www.gao.gov/products/gao-23-106163
- GAO-23-104813, “Nursing Homes: CMS Should Make Ownership Information More Transparent for Consumers” (January 2023). https://www.gao.gov/products/gao-23-104813
- Medicare Care Compare (nursing homes), ownership details. https://www.medicare.gov/care-compare/
Cite this data
Family Estate Guide, “Who Owns Your Parent’s Nursing Home? Ownership of 14,410 Facilities, State by State,” October 2026. https://familyestateguide.com/estate-planning-data/who-owns-nursing-homes/
You’re welcome to reuse the table or map with a link back to this page. CMS data is public domain.
Published October 8, 2026 by Family Estate Guide. Data vintage: CMS SNF Enrollments and SNF All Owners, August 2026 release (pulled Oct. 8, 2026). Regulations checked Oct. 8, 2026. Editorial standards.