A study published in March 2026 that was designed to examine relationships between facility and resident characteristics to ownership change in U.S. nursing homes during the COVID-19 pandemic (i.e., between March 2020 to March 2023) reported that of the 9,256 for-profit nursing homes with an organization owner that completed two or more semi-annual surveys, 62.8% had an ownership change. Among government (745) and non-profit (2,555) nursing homes with an organization owner, the incidence proportion of ownership change was 48.6% and 42.7%, respectively. Approximately 22.7% of government nursing homes converted to for-profit ownership. Factors associated with a change in ownership were related to several care quality metrics, suggesting that ownership change was driven by poorer care quality.
There was an average of 907,666 nursing home residents among an average of 1,234,563 beds in certified facilities as counted by the CMS between March 2020 to March 2023. Of these 12,556 facilities, 7,263 (57.8%) had an ownership
change from baseline survey. For-profit – Corporation was the most prevalent ownership type among nursing homes at baseline survey, comprising 6,838 facilities that had an average of 501,857 residents among an average of 680,841 certified beds. Of these 6,838 facilities, 4,126 (60.3%) had an ownership change from baseline survey. Ownership change was highest (76.9%) among facilities having Government – Federal ownership type at baseline survey; it was lowest (28.6%) among facilities having Government – State ownership type at baseline survey.
By predominant ownership type, 5,811 (62.8%) of the 9,256 for-profit nursing homes had an ownership change. This compares to 362 (48.6%) of the 746 government, and 1,090 (42.7%) of the 2,555 non-profit nursing homes, respectively. Overall, 4,571 (62.9%) of the 7,263 nursing homes with an ownership change had a change in names of organizational owners; this proportion varied from a low of 35.4% among government facilities to a high of 66.7% among for-profit facilities. Non-profit – corporation facilities had the lowest incidence proportion of ownership change, at 38.0%. Government – city/county facilities had the highest incidence proportion of ownership change (74.5%).
Years of ownership by provider was lower for nursing homes that experienced an ownership change during the COVID-19 pandemic, regardless of predominant ownership type at baseline survey. Occupancy ratio was higher among for-profit nursing homes with an ownership change, in comparison to being lower among government and non-profit facilities that had an ownership change.
Across all ownership types, the majority (57.8%) of American nursing homes had an ownership change. Disparities were observed in ownership change and predominant ownership type among facility and resident measures. In addition to ownership change, predominant ownership type was dynamic. Approximately 22.7% of government nursing homes in the United States converted to for-profit ownership during the pandemic, and 7.1% became non-profit. This compares to 1.3% of for-profit nursing homes becoming government owned, and 1.4% non-profit. Among non-profit facilities,11.1% assumed for-profit and 1.7% government ownership. Government nursing homes with an ownership change experienced a decrease in case-mix adjusted total nurse staffing throughout the pandemic, converging to similar staffing levels as for-profit facilities toward the pandemic’s end. Decreases in nurse staffing after ownership acquisition, especially among RNs, has been observed in other studies (Harrington et al., 2015)
Roughly a fifth of COVID-19 deaths in the United States were among nursing home residents during the first year and a half of the pandemic. Overall, nursing homes with an ownership change from baseline survey had more care deficiencies than nursing homes without an ownership change, as denoted by total weighted health inspection score.
If you or a loved one may have been injured (or worse) in a nursing home in the United States due to nursing home staff shortage, nursing home understaffing, nursing home pressure ulcer (nursing home bedsore) negligence, a nursing home infection, nursing home fall, nursing home aspiration, nursing home neglect, nursing home negligence, nursing home abuse, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home malpractice lawyer who may investigate your nursing home malpractice claim for you and represent you or your loved one in a nursing home malpractice case, if appropriate.
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