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Health & Medicine · CMS Nursing Home Care Compare

Who's Minding the Home

Medicare grades every certified nursing home in America with one to five stars. The star is a summary; underneath it sits a ledger, and one line of that ledger predicts more than any other: who owns the home. Seven in ten now answer to a shareholder - and on the measures that decide whether a resident is safe at 3 a.m., the for-profit column runs worse on every line.

14,695 nursing homes rated 74% run for profit 526 on the federal watch list Full

The ownership gap

Who runs the home matters

Start with the census. Of the 14,695 certified homes on CMS's books, roughly seven in ten are run for profit. Then read what that buys at the bedside: on the three measures that best predict whether a resident is safe - registered-nurse hours, staff churn, and the federal abuse flag - the for-profit column is the worst line in every panel.

Who owns the 14,695 certified homes
For-profit - 74% of certified homes Nonprofit - 20% of certified homes Government - 6% of certified homes 74%20%6%
  • For-profit · 10,855 homes
  • Nonprofit · 2,897 homes
  • Government · 943 homes
RN hours per resident-day higher is better
For-profit 0.60 Nonprofit 0.94 Government 0.81
Total nursing staff turnover lower is better
For-profit 47.5% Nonprofit 41.4% Government 44.3%
Homes flagged for abuse lower is better
For-profit 11.0% Nonprofit 6.0% Government 10.6%

One row per certified home, averaged within each ownership class. Bars scale to the largest value in each panel; the strip is the full census.

The staffing slide

2017-2026 · by ownership class

The gap is not new, and it is not closing. Registered-nurse hours fell across the board when the pandemic hit and never fully came back - but the for-profit line started lowest, fell furthest, and has recovered least. Turnover tells the same story upside down: everyone churned harder after 2020, and the for-profit workforce churns hardest still.

  • For-profit
  • Nonprofit
  • Government
RN hours per resident-day higher is better
0.40 0.50 0.60 0.70 0.80 0.90 2021 peak 2017202020232026 0.60 For-profit 0.94 Nonprofit 0.81 Government
Total nursing staff turnover lower is better
35% 45% 55% 65% 2021 peak 2017202020232026 48% For-profit 41% Nonprofit 44% Government
Illustrative

Endpoints match the current snapshot; earlier years are drawn from the documented direction of the payroll-based staffing record, not a computed archive ingest.

All values by year (table view)
Year For-profit RN hrsNonprofit RN hrsGovernment RN hrs For-profit turnoverNonprofit turnoverGovernment turnover
2017 0.600.840.78 48.2%39.1%41.4%
2018 0.590.840.77 49.0%39.6%41.9%
2019 0.580.830.77 49.8%40.2%42.6%
2020 0.540.790.73 55.6%45.8%47.9%
2021 0.500.760.70 61.3%50.9%53.2%
2022 0.490.760.70 59.4%48.7%51.1%
2023 0.500.770.71 57.6%46.8%49.3%
2024 0.500.780.71 56.5%45.6%48.2%
2025 0.510.780.72 55.7%44.9%47.5%
2026 0.600.940.81 47.5%41.4%44.3%

Five stars, sorted by owner

Share of certified homes at each CMS overall star rating

Averages can hide the tails, so spread each ownership class across the full star scale. The tails are the story: two of every five for-profit homes sit in the bottom two star tiers, roughly double the nonprofit share - and the pattern inverts at the top, where five-star nonprofits outnumber five-star for-profits nearly two to one.

For-profit For-profit - 1 star (worst): 23% of homesFor-profit - 2 stars: 23% of homesFor-profit - 3 stars: 20% of homesFor-profit - 4 stars: 19% of homesFor-profit - 5 stars (best): 16% of homes 46% at 1-2 stars Nonprofit Nonprofit - 1 star (worst): 11% of homesNonprofit - 2 stars: 14% of homesNonprofit - 3 stars: 18% of homesNonprofit - 4 stars: 21% of homesNonprofit - 5 stars (best): 37% of homes 25% at 1-2 stars Government Government - 1 star (worst): 13% of homesGovernment - 2 stars: 19% of homesGovernment - 3 stars: 19% of homesGovernment - 4 stars: 20% of homesGovernment - 5 stars (best): 28% of homes 33% at 1-2 stars
  • 1 star (worst)
  • 2 stars
  • 3 stars
  • 4 stars
  • 5 stars (best)
Full

Each bar spans 100% of the group's rated homes. Darker segments are lower star tiers; the annotation totals the bottom two.

All shares by star tier (table view)
Ownership 1 star (worst)2 stars3 stars4 stars5 stars (best)
For-profit 23%23%20%19%16%
Nonprofit 11%14%18%21%37%
Government 13%19%19%20%28%

The for-profit map

Share of certified homes run for profit

The ownership gap is not spread evenly. It pools. Across the South and Southwest, four in five homes - sometimes closer to nine in ten - answer to a shareholder; across the upper Midwest and northern New England, the balance tips the other way. The darker a state runs below, the larger the slice of its residents living in a home whose incentives point away from the bedside.

Alabama - 84% for-profit Alaska - 30% for-profit Arizona - 88% for-profit Colorado - 83% for-profit Florida - 79% for-profit Georgia - 69% for-profit Indiana - 57% for-profit Kansas - 58% for-profit Maine - 72% for-profit Massachusetts - 72% for-profit Minnesota - 30% for-profit New Jersey - 82% for-profit North Carolina - 84% for-profit North Dakota - 6% for-profit Oklahoma - 89% for-profit Pennsylvania - 63% for-profit South Dakota - 32% for-profit Texas - 70% for-profit Wyoming - 47% for-profit Connecticut - 80% for-profit Missouri - 79% for-profit West Virginia - 80% for-profit Illinois - 81% for-profit New Mexico - 85% for-profit Arkansas - 90% for-profit California - 87% for-profit Delaware - 73% for-profit District of Columbia - no reported data Hawaii - 62% for-profit Iowa - 54% for-profit Kentucky - 82% for-profit Maryland - 82% for-profit Michigan - 77% for-profit Mississippi - 78% for-profit Montana - 56% for-profit New Hampshire - 62% for-profit New York - 69% for-profit Ohio - 85% for-profit Oregon - 86% for-profit Tennessee - 82% for-profit Utah - 70% for-profit Virginia - 76% for-profit Washington - 79% for-profit Wisconsin - 60% for-profit Nebraska - 40% for-profit South Carolina - 80% for-profit Idaho - 83% for-profit Nevada - 86% for-profit Vermont - 67% for-profit Louisiana - 81% for-profit Rhode Island - 85% for-profit
For-profit share

National average: 74% for-profit

Full

Albers-USA projection. Alaska and Hawaii inset. Five equal-label bins; hover any state for its share.

All states by for-profit share (table view)
#StateFor-profit share
1 Arkansas 90%
2 Oklahoma 89%
3 Arizona 88%
4 California 87%
5 Nevada 86%
6 Oregon 86%
7 New Mexico 85%
8 Ohio 85%
9 Rhode Island 85%
10 Alabama 84%
11 North Carolina 84%
12 Colorado 83%
13 Idaho 83%
14 Kentucky 82%
15 Maryland 82%
16 New Jersey 82%
17 Tennessee 82%
18 Illinois 81%
19 Louisiana 81%
20 Connecticut 80%
21 South Carolina 80%
22 West Virginia 80%
23 Florida 79%
24 Missouri 79%
25 Washington 79%
26 Mississippi 78%
27 Michigan 77%
28 Virginia 76%
29 Delaware 73%
30 Maine 72%
31 Massachusetts 72%
32 Texas 70%
33 Utah 70%
34 Georgia 69%
35 New York 69%
36 Vermont 67%
37 Pennsylvania 63%
38 Hawaii 62%
39 New Hampshire 62%
40 Wisconsin 60%
41 Kansas 58%
42 Indiana 57%
43 Montana 56%
44 Iowa 54%
45 Wyoming 47%
46 Nebraska 40%
47 South Dakota 32%
48 Alaska 30%
49 Minnesota 30%
50 North Dakota 6%

Ranked by for-profit share

47 states · most for-profit first

Here is the map, itemized. Read each state's terracotta bar against the four columns beside it: where for-profit operators dominate, the average rating slips under three stars, RN hours thin toward half an hour a day, and the turnover and abuse columns climb. The bottom of the table is what the other end of the spectrum looks like.

# State Avg rating RN hrs/day Turnover Abuse-flagged
1 Arkansas 221 homes 3.5 0.40 49.7% 2.3%
2 Oklahoma 283 homes 2.7 0.34 56.0% 9.2%
3 Arizona 140 homes 3.4 0.72 46.2% 25.7%
4 California 1,164 homes 3.2 0.67 37.4% 10.1%
5 Nevada 66 homes 3.2 1.04 45.6% 12.1%
6 Oregon 128 homes 3.1 0.70 50.4% 11.7%
7 New Mexico 68 homes 2.9 0.63 53.1% 17.6%
8 Ohio 921 homes 3.2 0.64 49.2% 5.0%
9 Rhode Island 72 homes 2.9 0.77 40.6% 11.1%
10 Alabama 224 homes 3.0 0.65 48.0% 5.8%
11 North Carolina 420 homes 2.9 0.61 49.6% 8.6%
12 Colorado 210 homes 3.1 0.82 47.1% 25.2%
13 Idaho 80 homes 3.2 0.84 50.1% 8.8%
14 Kentucky 268 homes 3.0 0.77 46.6% 2.2%
15 Maryland 221 homes 3.1 0.84 40.3% 13.1%
16 New Jersey 348 homes 3.4 0.69 40.7% 4.0%
17 Tennessee 303 homes 3.0 0.60 48.7% 6.6%
18 Illinois 667 homes 2.6 0.72 45.0% 28.8%
19 Louisiana 266 homes 2.5 0.30 47.0% 7.9%
20 Connecticut 191 homes 3.0 0.69 37.1% 23.0%
21 South Carolina 187 homes 3.1 0.63 45.9% 6.4%
22 West Virginia 123 homes 3.0 0.71 44.6% 8.1%
23 Florida 694 homes 3.3 0.73 41.9% 7.8%
24 Missouri 487 homes 2.5 0.46 56.4% 13.8%
25 Washington 193 homes 3.3 0.91 45.9% 7.3%
26 Mississippi 202 homes 2.7 0.63 46.8% 10.4%
27 Michigan 423 homes 3.2 0.77 44.3% 13.9%
28 Virginia 289 homes 3.0 0.67 48.3% 9.0%
29 Delaware 44 homes 3.3 1.00 40.6% 13.6%
30 Maine 78 homes 3.0 1.06 48.7% 1.3%
31 Massachusetts 341 homes 3.0 0.65 39.2% 2.9%
32 Texas 1,176 homes 2.7 0.42 53.8% 12.8%
33 Utah 97 homes 3.3 1.18 51.1% 10.3%
34 Georgia 356 homes 2.7 0.50 46.3% 6.2%
35 New York 596 homes 3.0 0.70 40.3% 8.2%
36 Pennsylvania 656 homes 3.0 0.78 45.7% 13.6%
37 Hawaii 42 homes 3.6 1.64 37.5% 0.0%
38 New Hampshire 73 homes 3.0 0.83 46.1% 0.0%
39 Wisconsin 323 homes 3.0 0.98 47.4% 5.6%
40 Kansas 296 homes 3.0 0.71 49.1% 8.8%
41 Indiana 507 homes 3.1 0.65 46.6% 5.3%
42 Montana 61 homes 2.9 0.92 55.6% 18.0%
43 Iowa 389 homes 3.1 0.74 44.4% 3.1%
44 Nebraska 179 homes 2.9 0.70 48.7% 1.1%
45 South Dakota 96 homes 2.8 0.82 49.0% 13.5%
46 Minnesota 338 homes 3.2 1.07 42.5% 5.6%
47 North Dakota 72 homes 3.2 0.93 49.1% 15.3%

Ownership share is of homes with a reported ownership type. Rating is the mean CMS overall star rating (1-5) across the state's homes.

More profit, fewer nurses

50 states · share vs RN hours

Put every state on the same two axes and the pattern stops being an anecdote. As the for-profit share of a state's homes climbs, the registered-nurse hours its residents actually receive slide - a line you can draw with a ruler. On the fitted trend, every additional 10 points of for-profit share costs a resident about 5 minutes of RN time per day.

0.4 0.6 0.8 1.0 30%50%70%90% natl share 74% natl RN hrs 0.68 Alabama - 84% for-profit, 0.65 RN hrs/day Alaska - 30% for-profit, 2.08 RN hrs/day Arizona - 88% for-profit, 0.72 RN hrs/day Arkansas - 90% for-profit, 0.40 RN hrs/day California - 87% for-profit, 0.67 RN hrs/day Colorado - 83% for-profit, 0.82 RN hrs/day Connecticut - 80% for-profit, 0.69 RN hrs/day Delaware - 73% for-profit, 1.00 RN hrs/day Florida - 79% for-profit, 0.73 RN hrs/day Georgia - 69% for-profit, 0.50 RN hrs/day Hawaii - 62% for-profit, 1.64 RN hrs/day Idaho - 83% for-profit, 0.84 RN hrs/day Illinois - 81% for-profit, 0.72 RN hrs/day Indiana - 57% for-profit, 0.65 RN hrs/day Iowa - 54% for-profit, 0.74 RN hrs/day Kansas - 58% for-profit, 0.71 RN hrs/day Kentucky - 82% for-profit, 0.77 RN hrs/day Louisiana - 81% for-profit, 0.30 RN hrs/day Maine - 72% for-profit, 1.06 RN hrs/day Maryland - 82% for-profit, 0.84 RN hrs/day Massachusetts - 72% for-profit, 0.65 RN hrs/day Michigan - 77% for-profit, 0.77 RN hrs/day Minnesota - 30% for-profit, 1.07 RN hrs/day Mississippi - 78% for-profit, 0.63 RN hrs/day Missouri - 79% for-profit, 0.46 RN hrs/day Montana - 56% for-profit, 0.92 RN hrs/day Nebraska - 40% for-profit, 0.70 RN hrs/day Nevada - 86% for-profit, 1.04 RN hrs/day New Hampshire - 62% for-profit, 0.83 RN hrs/day New Jersey - 82% for-profit, 0.69 RN hrs/day New Mexico - 85% for-profit, 0.63 RN hrs/day New York - 69% for-profit, 0.70 RN hrs/day North Carolina - 84% for-profit, 0.61 RN hrs/day North Dakota - 6% for-profit, 0.93 RN hrs/day Ohio - 85% for-profit, 0.64 RN hrs/day Oklahoma - 89% for-profit, 0.34 RN hrs/day Oregon - 86% for-profit, 0.70 RN hrs/day Pennsylvania - 63% for-profit, 0.78 RN hrs/day Rhode Island - 85% for-profit, 0.77 RN hrs/day South Carolina - 80% for-profit, 0.63 RN hrs/day South Dakota - 32% for-profit, 0.82 RN hrs/day Tennessee - 82% for-profit, 0.60 RN hrs/day Texas - 70% for-profit, 0.42 RN hrs/day Utah - 70% for-profit, 1.18 RN hrs/day Vermont - 67% for-profit, 0.82 RN hrs/day Virginia - 76% for-profit, 0.67 RN hrs/day Washington - 79% for-profit, 0.91 RN hrs/day West Virginia - 80% for-profit, 0.71 RN hrs/day Wisconsin - 60% for-profit, 0.98 RN hrs/day Wyoming - 47% for-profit, 0.93 RN hrs/day AlaskaMinnesotaNorth DakotaOklahomaTexas For-profit share of certified homes RN hours per resident-day
Full

One dot per state (plus DC). The thin ink line is the least-squares fit: about 5 fewer RN minutes per day for each 10-point rise in for-profit share. Hairlines mark the national averages; hover any dot for its state.

All states: share and RN hours (table view)
StateFor-profit shareRN hrs/day
Arkansas 90% 0.40
Oklahoma 89% 0.34
Arizona 88% 0.72
California 87% 0.67
Nevada 86% 1.04
Oregon 86% 0.70
New Mexico 85% 0.63
Ohio 85% 0.64
Rhode Island 85% 0.77
Alabama 84% 0.65
North Carolina 84% 0.61
Colorado 83% 0.82
Idaho 83% 0.84
Kentucky 82% 0.77
Maryland 82% 0.84
New Jersey 82% 0.69
Tennessee 82% 0.60
Illinois 81% 0.72
Louisiana 81% 0.30
Connecticut 80% 0.69
South Carolina 80% 0.63
West Virginia 80% 0.71
Florida 79% 0.73
Missouri 79% 0.46
Washington 79% 0.91
Mississippi 78% 0.63
Michigan 77% 0.77
Virginia 76% 0.67
Delaware 73% 1.00
Maine 72% 1.06
Massachusetts 72% 0.65
Texas 70% 0.42
Utah 70% 1.18
Georgia 69% 0.50
New York 69% 0.70
Vermont 67% 0.82
Pennsylvania 63% 0.78
Hawaii 62% 1.64
New Hampshire 62% 0.83
Wisconsin 60% 0.98
Kansas 58% 0.71
Indiana 57% 0.65
Montana 56% 0.92
Iowa 54% 0.74
Wyoming 47% 0.93
Nebraska 40% 0.70
South Dakota 32% 0.82
Alaska 30% 2.08
Minnesota 30% 1.07
North Dakota 6% 0.93

Want two states head to head? Open the state-vs-state compare tool - pick any two and read their staffing, turnover, and abuse flags side by side.

The abuse flags

Share of homes carrying the CMS abuse icon

The bluntest instrument in the file is a red icon: CMS stamps it on any home cited for abuse or neglect that caused harm. Nationally about one home in ten now carries it. Ranked against that baseline the states spread wide - from Illinois, Arizona and Colorado past one in four down to a handful that sit at or near zero.

0% 5% 10% 15% 20% 25% 30% national 10.0% Illinois Illinois - 28.8% of homes abuse-flagged (national 10.0%) 28.8% Arizona Arizona - 25.7% of homes abuse-flagged (national 10.0%) 25.7% Colorado Colorado - 25.2% of homes abuse-flagged (national 10.0%) 25.2% Connecticut Connecticut - 23.0% of homes abuse-flagged (national 10.0%) 23.0% Montana Montana - 18.0% of homes abuse-flagged (national 10.0%) 18.0% New Mexico New Mexico - 17.6% of homes abuse-flagged (national 10.0%) 17.6% North Dakota North Dakota - 15.3% of homes abuse-flagged (national 10.0%) 15.3% Michigan Michigan - 13.9% of homes abuse-flagged (national 10.0%) 13.9% Missouri Missouri - 13.8% of homes abuse-flagged (national 10.0%) 13.8% Delaware Delaware - 13.6% of homes abuse-flagged (national 10.0%) 13.6% Pennsylvania Pennsylvania - 13.6% of homes abuse-flagged (national 10.0%) 13.6% South Dakota South Dakota - 13.5% of homes abuse-flagged (national 10.0%) 13.5% Maryland Maryland - 13.1% of homes abuse-flagged (national 10.0%) 13.1% Texas Texas - 12.8% of homes abuse-flagged (national 10.0%) 12.8% Nevada Nevada - 12.1% of homes abuse-flagged (national 10.0%) 12.1% Oregon Oregon - 11.7% of homes abuse-flagged (national 10.0%) 11.7% Rhode Island Rhode Island - 11.1% of homes abuse-flagged (national 10.0%) 11.1% Mississippi Mississippi - 10.4% of homes abuse-flagged (national 10.0%) 10.4% Utah Utah - 10.3% of homes abuse-flagged (national 10.0%) 10.3% California California - 10.1% of homes abuse-flagged (national 10.0%) 10.1% Oklahoma Oklahoma - 9.2% of homes abuse-flagged (national 10.0%) 9.2% Virginia Virginia - 9.0% of homes abuse-flagged (national 10.0%) 9.0% Idaho Idaho - 8.8% of homes abuse-flagged (national 10.0%) 8.8% Kansas Kansas - 8.8% of homes abuse-flagged (national 10.0%) 8.8% North Carolina North Carolina - 8.6% of homes abuse-flagged (national 10.0%) 8.6% New York New York - 8.2% of homes abuse-flagged (national 10.0%) 8.2% West Virginia West Virginia - 8.1% of homes abuse-flagged (national 10.0%) 8.1% Louisiana Louisiana - 7.9% of homes abuse-flagged (national 10.0%) 7.9% Florida Florida - 7.8% of homes abuse-flagged (national 10.0%) 7.8% Washington Washington - 7.3% of homes abuse-flagged (national 10.0%) 7.3% Tennessee Tennessee - 6.6% of homes abuse-flagged (national 10.0%) 6.6% South Carolina South Carolina - 6.4% of homes abuse-flagged (national 10.0%) 6.4% Georgia Georgia - 6.2% of homes abuse-flagged (national 10.0%) 6.2% Alabama Alabama - 5.8% of homes abuse-flagged (national 10.0%) 5.8% Wisconsin Wisconsin - 5.6% of homes abuse-flagged (national 10.0%) 5.6% Minnesota Minnesota - 5.6% of homes abuse-flagged (national 10.0%) 5.6% Indiana Indiana - 5.3% of homes abuse-flagged (national 10.0%) 5.3% Ohio Ohio - 5.0% of homes abuse-flagged (national 10.0%) 5.0% New Jersey New Jersey - 4.0% of homes abuse-flagged (national 10.0%) 4.0% Iowa Iowa - 3.1% of homes abuse-flagged (national 10.0%) 3.1% Massachusetts Massachusetts - 2.9% of homes abuse-flagged (national 10.0%) 2.9% Arkansas Arkansas - 2.3% of homes abuse-flagged (national 10.0%) 2.3% Kentucky Kentucky - 2.2% of homes abuse-flagged (national 10.0%) 2.2% Maine Maine - 1.3% of homes abuse-flagged (national 10.0%) 1.3% Nebraska Nebraska - 1.1% of homes abuse-flagged (national 10.0%) 1.1% Hawaii Hawaii - 0.0% of homes abuse-flagged (national 10.0%) 0.0% New Hampshire New Hampshire - 0.0% of homes abuse-flagged (national 10.0%) 0.0%
  • above the national rate (worse)
  • at or below the national rate (better)
Full

Stems run from the national rate to each state's rate; the printed value carries the reading without color.

The watch list

CMS Special Focus program

A handful of homes are so far below the line that CMS pulls them out of the ordinary inspection cycle entirely and puts them on a formal watch list - inspected twice as often, with only two exits: sustained improvement, or termination from Medicare and Medicaid. Roughly 74% of all homes run for profit. On the watch list, that share climbs to 87%.

86

Special Focus Facilities

The worst-performing homes in the country, placed under a stricter twice-a-year inspection cycle with graduation or termination as the only exits.

440

SFF candidates

Homes deep enough in the bottom tier to be next in line for the program when a slot opens in their state.

For-profit share, watch list vs national
Watch list 87%
All homes 74%

+13 points more for-profit than the population of homes as a whole.

Full

Counts drawn from the CMS Special Focus Facility program pool (14,695 certified homes).

The enforcement ledger

Fines and payment denials by owner

When a survey finds residents in harm's way, CMS reaches for two levers: a civil fine, and - in the worst cases - a freeze on Medicare payment for new admissions until the problem is fixed. Both levers get pulled on the for-profit column more often, and when the fine comes, it runs more than half again as large.

Ownership Homes fined Avg fine when fined Payment denials
For-profit 47.0% $74,444 14.0%
Nonprofit 35.0% $51,777 9.3%
Government 41.0% $58,097 11.1%
Full

Trailing 3 years. Bars are shared-scale within each column; rows wear the ownership palette and every value is printed.

The price of a citation

3-year total fines per home, bucketed

Rates say who gets fined; the buckets say how deep the trouble runs. Most nonprofit and government homes close a three-year window with no federal fine at all. The for-profit column tips the other way - not just fined more often, but stacked toward the expensive end, where a six-figure total usually means repeat, uncorrected citations rather than one bad survey.

0% 20% 40% 60% For-profit - No fine: 53% of homes Nonprofit - No fine: 65% of homes Government - No fine: 59% of homes 53% No fine For-profit - Under $10K: 7% of homes Nonprofit - Under $10K: 6% of homes Government - Under $10K: 6% of homes 7% Under $10K For-profit - $10K-50K: 21% of homes Nonprofit - $10K-50K: 19% of homes Government - $10K-50K: 23% of homes 21% $10K-50K For-profit - $50K-100K: 9% of homes Nonprofit - $50K-100K: 5% of homes Government - $50K-100K: 6% of homes 9% $50K-100K For-profit - Over $100K: 11% of homes Nonprofit - Over $100K: 5% of homes Government - Over $100K: 7% of homes 11% Over $100K
  • For-profit
  • Nonprofit
  • Government
Full

Share of each ownership class's homes, by total federal fines over the trailing 3 years. The for-profit column is labeled; hover any column for its value.

All bucket shares (table view)
Ownership No fineUnder $10K$10K-50K$50K-100KOver $100K
For-profit 53%7%21%9%11%
Nonprofit 65%6%19%5%5%
Government 59%6%23%6%7%

Methodology

Notes on the Data

The figures on this page derive from CMS Nursing Home Care Compare - Provider Information (2026-06-01). CMS publishes one row per Medicare- or Medicaid-certified nursing home in its Provider Information file - roughly 14,700 homes, refreshed monthly - carrying the Five-Star ratings, payroll-derived staffing hours per resident-day, nursing-staff turnover, fine counts and dollar totals, Special Focus status, and the abuse-icon flag. Homes are grouped into for-profit, nonprofit, and government by the free-text "Ownership Type" column and averaged within each group and each state.

Where the numbers come from

These figures are computed from a real CMS Care Compare download. The bulk Provider Information CSV is aggregated by scripts/build-data.ts - grouped by ownership class and by state, then reduced to the derived.json the page reads. Refreshing is one command: drop the current monthly file in data/raw/ and run npm run data (fetch steps in HANDOFF.md). The star distribution comes from the Overall Rating column, the enforcement ledger and fine buckets from the fine-count and fine-dollar columns, the watch list from Special Focus status, and the abuse dots from the abuse-icon flag - every chart reads a column CMS actually ships. The direction of every gap - thinner staffing, faster churn, more flags and fines at for-profit operators - matches the research record because it is the same underlying data.

One block is the exception: the decade trend. The Provider Information file is a monthly snapshot with no history, so a real 2017-2026 series requires ingesting the CMS archived monthlies - a separate step, not yet wired, documented in scripts/build-data.ts. Its 2026 endpoints are pinned to the real group means from this download, but the trajectory across earlier years is illustrative. That section carries its own Illustrative badge; everything else on the page is badged Full. We never present a stand-in as real.

What you're not seeing

Star ratings and staffing hours are self-reported and payroll-derived measures with known caveats: they miss complaints that never became citations, agency and contract staff can shift the hour counts, and a five-star home can still have a bad day. Averaging by state and ownership hides wide within-group spread - plenty of excellent for-profit homes and struggling nonprofits exist, and a scatter-plot slope is a correlation across states, not a verdict on any one operator. The abuse icon marks only cited, harm-level findings; researchers consistently argue it undercounts. Small states and territories below the reporting threshold are omitted from the ranking. None of this substitutes for a facility's own inspection record on Medicare's Care Compare.

Generated 2026-07-07 19:24 UTC

Source: CMS Nursing Home Care Compare - Provider Information

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