Nursing Home Industry Statistics: Facilities, Residents, and Trends in the US

The US nursing home industry is one of the largest segments of the American healthcare system, operating thousands of facilities that serve more than a million residents on any given day. The numbers behind that system — bed counts, occupancy rates, ownership structures, staffing ratios, and payer mixes — reveal how the sector functions, where it strains, and where it is quietly transforming. This page organizes those statistics by category, drawing on federal data sources, to give a clear-eyed picture of the industry's real scale and direction.

Definition and scope

A nursing home, formally classified under federal law as a Skilled Nursing Facility (SNF) or Nursing Facility (NF) depending on payer context, is a licensed residential care setting that provides 24-hour nursing supervision alongside medical, rehabilitative, or custodial services. The Centers for Medicare & Medicaid Services (CMS) maintains the primary federal registry of certified facilities, and that database defines the industry's measurable boundary.

As of CMS data published in its Nursing Home Care reporting frameworks, there are approximately 15,000 Medicare- and Medicaid-certified nursing homes operating across the United States. That figure has declined from a peak of roughly 17,000 facilities in the early 2000s, a consolidation trend driven by rural closures, acquisition activity, and the financial pressure of occupancy losses following the COVID-19 pandemic.

Collectively, these facilities hold approximately 1.7 million licensed beds (Kaiser Family Foundation), though occupancy has run well below that ceiling. The national occupancy rate, which stood near 85–87% before 2020, dropped sharply during the pandemic and has been recovering unevenly by state and facility type. Understanding the full regulatory context for nursing homes is essential to interpreting why these numbers move the way they do — licensure, certification, and reimbursement rules all shape who opens, who closes, and who stays open.

How it works

The industry's data infrastructure runs primarily through three federal channels:

  1. CMS Care Compare — the public-facing database where every certified facility's staffing levels, inspection history, and quality measures are published, updated quarterly (CMS Care Compare).
  2. The Minimum Data Set (MDS) — a standardized clinical assessment completed for every nursing home resident, submitted to CMS and used to calculate quality metrics and reimbursement under the Patient-Driven Payment Model (PDPM).
  3. The Online Survey, Certification, and Reporting System (OSCAR/CASPER) — the backend database that captures inspection deficiencies, staffing reports, and facility characteristics used in academic and policy research.

Facilities are categorized in federal data primarily by certification type. A Skilled Nursing Facility (SNF) is Medicare-certified and provides post-acute rehabilitation and complex medical care. A Nursing Facility (NF) is Medicaid-certified and typically provides long-term custodial care. Most facilities carry dual certification, appearing in both program data simultaneously.

Ownership structure is a significant variable in industry statistics. According to CMS nursing home ownership data, roughly 70% of certified nursing homes are for-profit operations, approximately 24% are nonprofit, and about 6% are government-owned. For-profit ownership is disproportionately concentrated in chain operations — a single chain may operate dozens or hundreds of facilities under a shared corporate parent, a structure with documented implications for nursing home staffing standards and quality outcomes.

Common scenarios

The resident population itself tells a layered story. At any given point, nursing home residents split broadly into two functional groups:

The resident demographic skews heavily older. More than 80% of nursing home residents are age 65 or older, and the share over age 85 — the "oldest old" — represents the fastest-growing segment of the resident population (National Center for Health Statistics, NCHS). Dementia diagnoses are present in approximately 48% of long-stay residents, making dementia care in nursing homes the dominant clinical challenge at the population level.

The payer mix across facilities shapes nearly every operational decision. Medicaid is the dominant payer for long-stay residents, funding care for approximately 62% of nursing home residents (KFF Medicaid and Long-Term Care report). Medicare covers post-acute short-stay episodes — typically up to 100 days for qualifying conditions — but its share of total resident-days is substantially smaller. Private pay and long-term care insurance together account for the remainder, a share that tends to erode as residents' assets are spent down to Medicaid eligibility.

Decision boundaries

Not every statistic about this sector describes the same population, facility type, or time window — a detail that matters enormously when comparing sources. Three classification distinctions create most of the confusion:

Certified vs. licensed facilities. State licensing databases include facilities that may not hold federal Medicare or Medicaid certification. The ~15,000 figure from CMS reflects only certified facilities; state-licensed-only homes (a smaller subset) appear in some state-level reports but not in federal tallies.

Beds vs. residents vs. resident-days. Bed counts measure physical capacity. Resident counts measure point-in-time census. Resident-days aggregate utilization over time. These three metrics diverge significantly during occupancy fluctuations — during 2020 and 2021, resident counts fell sharply while licensed bed counts remained stable, producing a misleading picture of "available" capacity.

Short-stay vs. long-stay populations. Quality metrics on CMS Care Compare are calculated separately for these two groups because their clinical profiles, risk factors, and care goals are fundamentally different. Aggregating them produces averages that accurately describe neither. The nursing home quality ratings system reflects this distinction explicitly in its five-star methodology.

A full national picture of this sector — one accurate enough to support policy, family decision-making, or facility comparison — requires holding all three distinctions simultaneously. The National Nursing Home Authority index provides a structured starting point for navigating the underlying data by topic area.

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