The U.S. Senior Care Data Landscape

This is the long-form deep dive. For the skim-length version, see the [executive summary](/learn/senior-care-data-landscape).

1. Executive summary

The ten things Placet should do, in priority order

The argument of this document is simple: U.S. senior care is not one market but thirteen, each regulated by different authorities, paid for by different mixes of Medicare, Medicaid, private dollars and subsidy programs, and surfaced (or hidden) by directories that almost all run on the same referral-fee conflict. No consumer product today presents the whole picture. The open lane for Placet is the one that treats transparency as a product, not a marketing claim.

1. Build the facility universe from government primary sources, not from industry aggregators. Start with CMS Provider Data Catalog, HUD Multifamily, HUD Section 202 feature service, LIHTC, USDA RD 515/538, National Housing Preservation Database, and state-level AL licensing rosters. These are public, stable, and ingestable. The referral-fee directory category — A Place for Mom, Caring, Seniorly, and SeniorAdvisor — covers only the settings whose operators enter placement-fee contracts; by the category's own economic structure, the facility universe shown to consumers is the subset of communities under contract, not the full state-licensed inventory. Treat these sources as market competitors, not as primary data vendors.

2. Explicitly disclose the referral-fee category's economic model on every relevant page. Referral-fee directories are commonly reported to charge contracted communities a placement fee in the range of one month's rent per move-in, frequently cited in industry trade press around $3,000–$5,000 [Senior Housing News, Casey letter]. On June 17, 2024, Sen. Bob Casey (D-PA), then Chair of the U.S. Senate Special Committee on Aging, sent a letter to A Place for Mom's CEO requesting information about the company's business practices [Casey press release, June 20, 2024]. That letter cited a Washington Post analysis finding that more than a third (about 37.5%) of facilities A Place for Mom recommended as "Best of Senior Living" across 28 states had been cited by state regulators for neglect or substandard care in the prior two years [Casey letter / Washington Post]. Placet's defensible brand asset is being the one consumer site that explains the category's economic model in plain language and shows the underlying regulator data for every listing.

3. Add price and payer reality on every facility page. Genworth / CareScout cost benchmarks are state-level, not per-community; Seniorly's ML-pricing estimator is the closest commercial approximation of per-community pricing; CCRC entry-fee refund math is rarely surfaced on consumer interfaces; Section 202 tenants pay 30% of adjusted income by federal statute (the actual income-based rent, not a market-rate list price). The single most common consumer frustration in senior care is "nobody would tell me what it costs." That gap is the wedge.

4. Build a unified quality view — not a single star rating — anchored in CMS Five-Star (SNF/HH/hospice/IRF/LTCH) and in state-by-state AL inspection reports. Five-Star has known limitations documented by CMS itself: the ongoing schizophrenia-coding audits, the July 30, 2025 inspection-data modernization pause, and the 2024 staffing-rule vacatur plus December 2025 repeal. Present the rating, but also the underlying components and the date-of-last-inspection. For AL, Florida, Texas, North Carolina, Oregon, Washington, and Arizona publish inspection narratives at the community level through searchable consumer portals. California's CDSS data is formally comprehensive; multiple years of ProPublica reporting (starting with "Life and Death in Assisted Living," 2013) have documented operational gaps in RCFE inspection cadence and unpaid fines, and CANHR maintains independent counter-data — present both side by side. As of April 2026, the states in which publicly-available AL inspection detail is limited to a facility roster (or available only via state public-records requests) include Louisiana, Mississippi, Arkansas, Kentucky, South Carolina, South Dakota, North Dakota, Alaska, Hawaii, New Hampshire, Utah, and Massachusetts (roster-only as of this writing; see also the 2024 Gabriel House fire follow-on reforms). Describe this observable gap on each state page.

5. Surface ownership — especially private equity and REIT ownership — at the chain, operator, and property level. CMS's November 2023 Ownership Transparency rule (CMS-3441-F; 88 FR 80141) exposed PE and REIT flags via the SNF All Owners dataset for the first time. Cross-reference with SEC 10-K property exhibits for publicly traded REITs (Welltower, Ventas, Omega, NHI, LTC, Sabra, CareTrust, Healthpeak) and operators (Brookdale, Ensign), with the Private Equity Stakeholder Project's named-operator lists, and with state Secretary of State LLC filings where ownership tracing is feasible (Florida's Sunbiz is the best). This is the area where NYU/Stern research (Gupta-Howell-Yannelis-Gupta, RFS 2024) has produced the strongest clinical-outcomes evidence, and it is the area where Care Compare is weakest.

6. Cover CCRC financial solvency where states publish it, and note openly where they don't. Pennsylvania, California, Florida, and Washington have the most robust publicly available actuarial and disclosure statements; Ohio, Alabama, Idaho, Wyoming, West Virginia, Montana, Arkansas, Alaska, and Hawaii are non-regulators. CCRC residents bet six-figure entrance fees on solvency. The EMMA/MSRB bond disclosure system is an underused, free, audited-financial source for nonprofit CCRCs with tax-exempt debt. Build a standardized solvency scorecard — nobody does this at consumer-product quality today.

7. Be the place subsidized senior housing is findable. Section 202, Section 8 project-based elderly designations, LIHTC age-restricted units, USDA 515/538 rural senior housing, Section 236, and elderly-designated public housing together serve more than a million low-income older adults; subsidized senior housing is not indexed on the referral-fee directories (subsidized-housing placements do not generate the category's typical contracted referral fees). The federal data (HUD Multifamily, 202 feature service, LIHTC, USDA RD, NHPD) is public and reasonable to ingest. A meaningful share of Placet's TAM is families who qualify for subsidized housing and do not know it exists.

8. Cover PACE and adult day seriously, because nobody else does. The National PACE Association's locator is a single-zip-code search with no quality data; 202 programs in 33 states serve ~92,000 dual-eligibles with zero out-of-pocket cost for people who would otherwise be Medicaid-nursing-home-bound. It is the most generous setting for the lowest-income seniors and is the most under-discovered. Adult day services (~4,600 to 7,500 depending on count) are similarly invisible.

9. Do not ingest referral-fee-directory facility rosters or reviews as primary facility coverage. Anywhere you need enrichment (photos, amenities, phone numbers), take it from primary state licensing rosters, from facility websites, or build it. Ingesting from referral-fee directories would import the category's placement-contract-based subset into Placet's facility universe.

10. Commit publicly to a transparency methodology and republish when underlying data changes. The CMS Nursing Home Compare inspection-data modernization pause (announced July 30, 2025) means some SNFs' inspection ratings have been frozen for nine months as of this writing. The federal minimum staffing rule was vacated by two federal courts in April 2025 and formally repealed by CMS on December 3, 2025 (effective February 2, 2026). NSPIRE replaced UPCS for HUD Multifamily inspections on October 1, 2024 with scoring of new affirmative requirements beginning October 1, 2025. MDS 3.0 v1.18.11 broke continuity of many SNF quality measures in October 2023. A transparency product that doesn't publish methodology and version its data is going to quietly mislead users.

The framing that ties these together

The four personas — patient, family, discharge planner, and aging life care manager — need the same data viewed through different lenses. A family needs trust signals and cost clarity; a discharge planner needs clinical capability and admit-speed; an aging life care manager needs the deep operator picture and long-run trajectory; a patient needs an honest picture of what they will feel day-to-day. The same underlying facility data, reorganized by user job-to-be-done, becomes a different product for each persona. Placet's task is the reorganization. The data is there; what's missing is the trustworthy synthesis.

2. Persona needs matrix

The purpose of this section is to say out loud what each persona is actually deciding, and what data would actually help them decide better. "Actually" is load-bearing. A lot of senior-care product design is performative — it shows what looks decision-relevant but isn't.

2.1 The patient

An older adult — 70s, 80s, 90s — contemplating where they will live next. Sometimes they are making the decision themselves; more often a family member is quietly pushing. They know their own ailments and their own preferences in ways an outside observer can only guess at. The honest answer they want is: if I move here, what will my day feel like?

The decisions they are making: whether to move at all; whether to take a spot at a CCRC they've been on the waitlist for; whether to cash in a house for a subsidized 202 apartment; whether to stay home with a home-health aide and hospice on call; whether to move near the son in Seattle or the daughter in Phoenix. The specific facility choice is downstream. The setting choice matters more.

The data that would actually help: staffing levels on a normal Tuesday at 3pm, not the state-average full-time-equivalent number; resident turnover (a facility with 40% annual turnover tells you something meaningful); food quality (nothing systematic exists — this is a crowdsourcing opportunity); how many of the residents are cognitively intact enough to have a conversation (a question no federal dataset captures); what Medicaid, Medicare, VA benefits, and long-term care insurance will and won't cover in their specific circumstance; actual walking-distance distance to the grandchildren. Cost. Autonomy — is this an environment where the resident is a resident, or a patient, or an object?

Most of what they want is not on a CMS dataset. But some of it is: staffing from PBJ, ownership chain, complaint narrative text, five-star rating as a floor, and the full text of state inspection reports. A good product reads the PBJ tables and computes nursing minutes per resident per day; reads the deficiency narratives and extracts the type of event (fall, elopement, medication error, unexplained death); reads the ownership file and flags the private-equity chains; reads the LTCFocus dataset for resident acuity mix; and presents all of that as a picture of daily life, not a five-star icon.

2.2 The family

Almost always an adult child. Often stressed, time-boxed, choosing on someone else's behalf. Frequently does the search from a hospital bedside. Frequently feels guilty. Rarely has a coherent budget. Always wants to "talk to someone." Frequently ends up, within the first few minutes of searching, on a referral-fee directory site (A Place for Mom has the largest consumer presence in the category), and within an hour is on a call with an advisor whose compensation is structured around placements (the category's standard model, documented in Sen. Casey's June 2024 letter and in industry trade press).

The decisions they are making: which short list of facilities to tour; what questions to ask in the tour; whether Mom's income qualifies her for subsidized housing (usually they don't know this exists); whether the memory-care unit is really a memory-care unit or a marketing claim; whether the cost their parent can sustain runs out in 18 months or 8 years; whether to move Mom now or wait for the next hospitalization.

The data that would actually help: red flags, not green flags. (Any facility can show you a happy resident in a photo.) Specifically: has this facility been on the Special Focus list; has there been a recent change of ownership and, if so, to whom; are there abuse or neglect deficiencies in the last three surveys; what's the nurse staffing relative to the facility's case mix; what have other families said in sources that aren't paid by the facility; can Mom's Medicaid waiver even pay for services here. Cost transparency — not "$5,900/month average for the state" but what this specific facility will charge Mom in her first year and in her fifth year. Tour questions tailored to the setting.

Placet's single highest-value product for this persona is a trust-signal-and-red-flag page per facility that says, in plain language, what the public record shows, where it is thin, and what to ask on the tour. That page should answer "is this place likely to be OK for my mom?" not "rate this facility 1–5 stars."

2.3 The social worker / discharge planner

Hospital-side. Making placements under a 24-to-72-hour clock, often with prior-auth pressure and sometimes with bed-hold dynamics competing against the patient's best option. Talks to 30 facilities a week. Knows most of them personally. Has a whiteboard with bed availability that they update manually. Medicare rules are their religion. If the family doesn't like the first three choices, they move on; there isn't time to counsel.

The decisions they are making: which three SNFs or IRFs to put on the patient's choice form; whether this patient qualifies for LTCH admission; whether home health plus a couple of days of in-home hospice can substitute for a SNF stay; whether the memory-care unit can handle a wanderer; whether this patient's Medicaid will pay in this state at this facility.

The data that would actually help: whether the facility is accepting new admissions right now (no public dataset has this; it's phone-driven); whether the facility takes this specific insurance (Medicare Advantage plan-by-plan contracting is opaque); whether the facility is on the SFF list, on the candidate list, or excluded by the hospital's own disallow list; clinical capability for the patient's specific profile (vent, trach, wound care, dementia + behavior, dialysis on site); throughput speed — can the facility paper the transfer tonight or is it going to take 48 hours; star rating as a secondary sanity check; recent staffing trend, not just the static star rating.

Discharge planners are closer to having a usable tool today than any other persona, because CMS Care Compare is designed for them. The gap is real-time operational state (availability, insurance acceptance, capability) and the chain/PE lens on which facility is a responsible operator this quarter. Placet could build a "discharge planner view" of Care Compare that layers on the ownership data, the SFF candidate list, the PBJ last-90-days staffing trend, and — if it can build relationships with health-system partners — bed-availability signal.

2.4 The aging life care manager / geriatric care manager / aging services professional

A professional the family hires (roughly $150–$275/hour, private pay) to navigate the system. Often clinically trained (nurse, social worker). Small, expert firms; referral-driven; answerable to the paying family, not to the facility. In Ash's shorthand, "AG."

The decisions they are making: which five to ten facilities across settings are actually serious contenders for this client; whether a CCRC's financials are solid enough to entrust a refundable entry fee to; whether the operator has a consistent operating posture or has traded ownership three times in four years; how a market is priced relative to neighboring markets; how to walk a family through the difference between an assisted-living-with-memory-care and a dedicated memory care; which state regulators publish meaningful enforcement data and which do not.

The data that would actually help: the full operator/ownership graph; the chain-level quality picture (not facility-by-facility); CCRC audited financials and days-cash-on-hand; PBJ staffing and turnover over multi-year windows; state licensing violations with narrative text; long-run trajectory signals (has the facility's staffing, citations, case mix, occupancy trended well or poorly over five years); cross-setting comparison (is home-health-plus-home-care a cheaper equivalent to AL here); the list of states with meaningful CCRC financial regulation and the exceptions.

This persona is the most sophisticated and the most source-hungry. Placet will get professional-user signal and word-of-mouth trust from this persona at a rate disproportionate to their headcount — a good ALCM recommends Placet to a dozen families a month. The referral-fee directory experience is structurally mismatched for this persona because the category is lead-generation-optimized; a primary-source-anchored alternative is likely to attract disproportionate loyalty.

2.5 A note on attorneys general and regulators

Ash's brief asked whether "AG" might also mean attorneys general. It might, and the overlap is real: state AG enforcement data is exactly the ownership-plus-quality-plus-complaint dataset that an aging life care manager wants, packaged for a different use. Medicaid Fraud Control Units recovered $1.4B in FY2024 and $2B in FY2025 across the 53 state MFCUs, with ~300 open senior-living-specific investigations at any given time. The New York AG's $45M settlement with Centers for Care in November 2024 and $12M Van Duyn settlement in August 2025, along with the Massachusetts AG's $4M Next Step Healthcare settlement in 2024, are the canonical examples of facility-linked enforcement. Placet should scrape and classify state AG press feeds as an edit layer, not a primary facility signal, and should treat the regulator-as-user as a secondary persona rather than a product frame.

3. Setting-by-setting coverage landscape

Thirteen settings. For each: what it is, scale, what a searching consumer actually sees today, what quality data exists, and the gaps Placet could close.

3.1 Skilled nursing facilities (SNF) and short-term rehab

State-licensed, typically Medicare-certified and/or Medicaid-certified institutional setting providing twenty-four-hour nursing, therapy, and custodial care. Two populations share the same buildings: long-stay Medicaid-funded residents with advanced chronic illness or dementia (median age ~84, majority women, 60%+ with dementia), and short-stay Medicare-funded post-acute rehab patients admitted after a qualifying hospital stay for up to 100 days under Part A.

Scale. About 14,742 CMS-certified nursing facilities with ~1.6 million licensed beds and ~1.24 million residents as of mid-2025, per KFF aggregation of CMS Provider of Services data. The count has declined 6% since 2015. Not included in this figure: a small tier of non-Medicare/Medicaid-certified nursing facilities in a handful of states, and the VA's Community Living Centers (>100 facilities operated directly by VA, which are Title 38 and do not appear in CMS data).

Consumer experience today. Medicare Care Compare is the authoritative consumer starting point — Five-Star overall plus health inspection, staffing, and quality-measure sub-ratings; PBJ-derived nurse hours per resident day; three years of inspection/enforcement history (distributed across PDF survey narratives); and the recently expanded ownership file. What it doesn't show: any price (private-pay daily rates are never surfaced; Medicaid rates are publicly available from most states but never integrated here); real-time bed availability; the PE/REIT overlay in a meaningful consumer-usable form; the operator chain. A Place for Mom historically did not cover SNF; in September 2023 it launched Nursinghomes.com (per Senior Housing News coverage of the launch). Caring.com lists SNFs with user reviews. Seniorly does not treat SNF as a primary product category.

Quality data available. CMS Care Compare and the Provider Data Catalog (monthly refresh via data.cms.gov/provider-data/; Nursing Home datasets include NH_ProviderInfo, NH_Ownership, NH_HealthCitations, NH_FireSafetyCitations, NH_Penalties, NH_QualityMsr_Claims, NH_QualityMsr_MDS, and more). PBJ quarterly staffing releases at facility-day grain. HCRIS cost reports for facility financial picture (quarterly releases, ~2-year lag to finalization). LTCFocus.org aggregates annually with 70+ measures across 17+ years at facility, county, and state levels; the single best academic counterweight to Care Compare. ProPublica's Nursing Home Inspect keeps a searchable interface over CMS deficiency narratives.

Gaps. No price transparency for either private pay or Medicaid. No bed availability. PE and REIT ownership is captured but not surfaced to consumers. Complaint narratives are in PDFs, not structured. Staffing stars penalize higher-acuity facilities. Short-stay rehab quality (rehospitalization, discharge-to-community) is on Care Compare but presented in ways families don't parse. The 2024 federal minimum staffing rule provided a clean comparison benchmark for ten months and has since been vacated (April 2025) and repealed (December 2025); comparison to a known standard is no longer available at the federal level.

3.2 Inpatient rehabilitation facilities (IRFs)

Medicare Part A intensive rehab — stroke, TBI, spinal cord injury, hip fracture, complex ortho — at freestanding rehab hospitals or distinct-part units inside acute-care hospitals. The "three-hour rule" governs eligibility. Average length of stay around 13 days. Roughly 70% of admissions are 65+.

Scale. Approximately 1,180 IRFs participate in Medicare (MedPAC Payment Basics 2024 and March 2025 Report to Congress) — roughly 300 freestanding and 880 hospital-based units — accounting for approximately 395,000 Medicare fee-for-service stays per year. Encompass Health is the largest IRF operator by facility count (approximately 165 facilities, per the company's own SEC filings); Kindred and Select Medical also operate meaningful IRF footprints, per MedPAC.

Consumer experience. Care Compare's IRF tab shows IRF-QRP measures (discharge to community, functional improvement, pressure ulcers, falls with major injury, all-cause unplanned readmission) but has no overall star rating. APFM, Caring, Seniorly do not list IRFs. Consumers arrive at IRFs through hospital case-manager-generated choice forms, not through online search.

Quality data. IRF-QRP via CMS; CARF accreditation; Leapfrog ratings for hospital-based units.

Gaps. Essentially no consumer-facing comparison. Medicare Advantage prior-auth denials for IRF are opaque and growing. Chain ownership is not flagged.

3.3 Long-term care hospitals (LTCHs)

Medicare-certified acute-care hospitals for medically complex patients with prolonged hospital-level needs — typically ventilator weaning, complex wounds, multi-organ failure recovery, severe sepsis follow-up. Statutorily require a >25-day average length of stay. Medicare beneficiaries (most 65+) represent ~65% of admissions.

Scale. About 340 LTCHs as of 2024, down from a peak of 435 in 2012 following the dual-payment-rate reform (MedPAC Payment Basics 2024 — LTCH chapter). Kindred / ScionHealth / LifePoint and Select Medical operate a substantial share of LTCH capacity per MedPAC and company SEC filings; specific market-share figures should be pulled from the most recent 10-K filings and MedPAC report at publication time.

Consumer experience. Care Compare has an LTCH tab with LTCH-QRP measures (CAUTI, C. diff, pressure ulcers, ventilator liberation rate, discharge to community). No star rating. No pricing. The aggregators do not list LTCHs.

Gaps. Near-zero consumer awareness. The distinction between SNF and IRF and LTCH is poorly explained anywhere consumer-accessible. No side-by-side comparison of vent-weaning success rates.

3.4 Assisted living / residential care / personal care homes

The largest senior-care setting with the least federal oversight. State-licensed residential setting providing room, board, twenty-four-hour supervision, help with ADLs, and some health oversight, without daily nursing-home skilled care. Terminology is a Tower of Babel — "ALF" (FL), "RCFE" (CA), "AL Establishment" (IL), "Adult Home / Assisted Living Residence / EALR / SNALR" (NY), "Residential Care Facility" (OH), "Personal Care Home" (PA, GA), "Adult Care Home" (NC) — for substantially the same product.

Scale. NCAL claims ~31,400 licensed communities with ~1.2 million licensed beds and ~800,000 current residents; Argentum's annual "State of Seniors Housing" (joint with ASHA/NIC/LeadingAge) uses overlapping but distinct figures. Size ranges from small board-and-care homes under ten beds to 200+ unit communities.

Cost. Genworth / CareScout 2024: national median $5,900/month (~$70,800/year), up ~10% year over year. Memory-care add-on $1,500–$2,500/month. Wide geographic variation — roughly $3,500 in Mississippi to $9,000+ in DC, NJ, and MA.

Payer mix. ~82% private pay (or LTC insurance or VA Aid & Attendance). ~18% of residents rely on Medicaid for services via 1915(c) HCBS waivers, 1115 demonstrations, or state-plan PACE — but Medicaid does not pay room and board in AL. Medicare does not pay AL. The VA Aid & Attendance benefit can provide up to ~$2,727/month for a veteran couple in 2025.

Consumer experience. Consumer AL search is dominated by referral-fee directories: A Place for Mom, Caring.com, and Seniorly. A Place for Mom offers filters by city, care type, room size, budget, and veteran status; users submit contact information and are connected with advisors who route inquiries to communities under APFM's placement-fee contracts. The category's typical placement fee, reported in Sen. Casey's June 17, 2024 letter to APFM and in Senior Housing News, is roughly one month's resident rent (commonly cited at $3,000–$5,000). Facilities without a placement-fee contract with a given referral-fee directory do not appear in that directory's results (the category's own economic structure, as described in Sen. Casey's letter and company disclosures). Caring claims 120+ filters and publishes some pricing. Seniorly's own methodology page describes ML-based pricing estimates for approximately 60,000 communities with confirmed pricing surfaced where available. State inspection reports, state license numbers, ownership-chain data, staffing detail, and Medicaid-waiver acceptance are not consistently surfaced on these three consumer interfaces as of April 2026. Medicare Care Compare does not cover AL.

On June 17, 2024, Sen. Bob Casey sent a letter to A Place for Mom's CEO requesting information about the company's business practices [Casey press release]. The letter cited a Washington Post analysis finding that more than a third — about 37.5% — of the facilities APFM recommended as "Best of Senior Living" across 28 states had been cited by state regulators for neglect or substandard care in the prior two years. The letter also cited APFM-provided data showing that 38% of families placed into assisted living paid monthly rent above their stated upper-limit budget, a figure rising to 55% for memory-care placements [Casey letter]. The Senate Special Committee on Aging held a hearing on assisted living oversight on January 25, 2024 (the committee's first substantive review of AL in approximately 20 years, per committee press releases); a GAO-referenced figure of more than 20,000 critical incidents (physical assault, sexual abuse, unexplained death, unauthorized restraint, medication errors, inappropriate discharge) is drawn from state Medicaid-agency reporting, and GAO found that only 22 of 48 state Medicaid agencies tracked this data using consistent definitions [GAO reports and Senate Aging Committee press release, Jan 2024].

Quality data available. State licensing inspection reports, with enormous variance across states. Florida's AHCA / FloridaHealthFinder portal (quality.healthfinder.fl.gov) is the best large-state consumer experience. Texas HHSC LTCSearch and the TULIP portal, California's CCLD Facility Search plus the CHHS Open Data Portal, North Carolina's DHSR ACLS star ratings, Oregon APD facility search, Washington DSHS RCS locator, Minnesota MDH's post-2021 rewrite, and Arizona ADHS directory are the other strong performers. Illinois migrated from idph.illinois.gov to llcs.dph.illinois.gov in 2024–2025 and both old and new URLs are partially live; Ohio splits data across ODH and ODA; Pennsylvania's consumer directory at humanservices.state.pa.us is strong for rosters but inspection content is FOIA-only through DHS regional offices. New York's Adult Care Facility Directory on the health.data.ny.gov Socrata API is the easiest ingestion of any state roster, but inspection content is FOIL-only and a July 2025 State Comptroller audit concluded that DOH "does not adequately oversee" adult care facilities.

Observable state-by-state gaps in public AL inspection access. As of April 2026, the following states publish limited or no AL community-level inspection narratives online; consumers seeking inspection detail must file public-records requests with the state agency. Louisiana: no online AL inspection portal observed during URL verification. Mississippi, Arkansas, Kentucky (partial coverage), South Carolina, South Dakota, North Dakota, Alaska, Hawaii, New Hampshire, Utah: limited or no publicly searchable AL inspection-report interface as of verification. Massachusetts: facility roster published, inspection reports not on the roster page as of this writing (Massachusetts announced AL-oversight reforms following the 2024 Gabriel House fire; verify current posture at publication time). Describing these observable gaps on state pages — "the state publishes a roster but does not post inspection reports online" — is accurate and serves consumers without attributing motive.

Gaps. No federal quality framework. No uniform staffing reporting (nothing like SNF PBJ). No standardized price disclosure; "care levels" pricing varies facility-to-facility. Change-of-ownership in state databases is often not linked to historical violation records, creating continuity gaps. Memory-care specialty claims lack standardized third-party validation. The referral-fee directory category's economic model is disclosed at varying levels of prominence across APFM, Caring, and Seniorly — review each site's current "advisors" / "our business" / "how we work" pages for current disclosure language; it is typically footnoted rather than front-and-center (as of April 2026). Real-time availability is absent. No published national Medicaid-waiver acceptance list at the facility level.

3.5 Memory care

A service tier, not a license type in most states: either (a) a locked wing inside an AL community, (b) a freestanding memory-care community, or (c) a dementia-designated unit in a SNF. Residents are typically mid-to-late-stage Alzheimer's or related dementias, 80+, often requiring exit-door security and behavioral-intervention-trained staff.

Scale. No single authoritative count. NIC MAP estimated ~255,100 dedicated memory-care beds — about 8.5% of senior-housing inventory — as of 2022. NCAL data show ~29% of AL communities serve memory-care residents (18% with a dedicated unit, 11% exclusively memory-care). Add dementia-designated units in SNFs and the true count is larger.

Cost. $7,000–$8,500/month median nationally, typically AL rate + $1,500–$2,500 premium. Premium freestanding MC communities in high-cost metros regularly exceed $12,000/month.

Consumer experience. Memory care is a prominent category on referral-fee directories (industry reporting and Sen. Casey's June 2024 letter cite memory-care placements as a notable share of A Place for Mom's referral activity). Seniorly's pricing estimates differentiate memory care as a category. Medicare Care Compare covers dementia-designated SNF units only via the SNF listing.

Quality data. Essentially none standardized. Florida and a handful of other states require specialty Alzheimer's training documentation and separate endorsement; most do not publish compliance data. CMS added dementia-care quality measures to SNF QRP (antipsychotic use for long-stay residents) but these are not unit-level. Human Rights Watch's 2018 "They Want Docile" report documented the antipsychotic-overmedication pattern and remains the canonical editorial anchor.

Gaps. Dementia-specific staff training hours, staff-to-resident ratios on night shift, antipsychotic use rates, elopement history, and secured-environment design standards are all invisible to consumers. No systematic distinction between "memory care" as a meaningful specialty and as a marketing claim.

3.6 Independent living (IL)

Age-restricted rental or cooperative / condo housing for generally healthy older adults, bundling housekeeping, meals (usually one per day), transportation, activities, and emergency-call systems, but little to no personal care or medical oversight. Typical resident 75–85, independent in ADLs, downsizing. Median length of stay ~3 years.

Scale. NIC / ASHA tracks ~618,000 occupied senior-housing units across the 31 Primary Markets in Q4 2024 (IL + AL + MC + CCRC combined). National IL inventory is estimated at 600,000–700,000 units across ~6,000 communities (including IL portions of CCRCs). Independent-living occupancy reached 90%+ in 2024.

Cost. $3,000–$5,000/month typical for IL (rent + service fees); CCRC-embedded IL at end of 2024 ran a median around $3,747/month per NIC. Luxury markets run $6,000–$10,000+.

Payer. 100% private pay. Medicare / Medicaid / VA Aid & Attendance generally do not apply unless care services are attached.

Consumer experience. APFM, Caring, and Seniorly list IL communities; industry reporting (e.g., Senior Housing News) notes that placement fees for IL are typically lower than for AL/MC within the referral-fee category. Medicare Care Compare does not cover IL.

Gaps. Rent-escalation clauses are rarely surfaced. Triggers for involuntary move-out to AL are buried in lease documents. The distinction between "IL with services" and "55+ active adult without services" confuses consumers who will age in place and later need care.

3.7 Continuing Care Retirement Communities / Life Plan Communities (CCRCs / LPCs)

A single campus offering IL + AL + SNF, usually with MC, under a contractual promise of aging-in-place across levels. Four main contract types — Type A (Life Care) with high entry fee and stable monthly fee across levels of care, Type B (Modified) with lower entry and limited days of higher-level care included, Type C (Fee-for-Service) with lower entry and market rates at each level, and Rental with no entry fee and market-rate monthly — carry radically different financial-risk profiles. Residents are usually 75–82 at entry, private-pay, health-screened. ~79% of CCRCs are nonprofit.

Scale. About 1,950 CCRCs nationally per Ziegler. The LeadingAge-Ziegler 200 (LZ 200) tracks the largest nonprofit multi-site senior-living organizations — 22nd edition released September 2025, covering 300,000+ units across ~1,600 communities; National Senior Communities ranked #1 with 23,329 units.

Cost. Entry fees $100,000 to $1M+, national average ~$400,000. Monthly fees $3,000–$7,000 for IL in most markets, higher for AL/SNF levels in Type C contracts. Refundable entry-fee models — 50%, 90%, 100% of entry fee returned to the estate — are increasingly common.

Consumer experience. LeadingAge's member list is not a search tool. myLifeSite and U.S. News Best CCRCs are the most usable consumer comparison tools; Newsweek / Statista's Best CCRCs list expanded to 300 communities in 2025. APFM, Caring, and Seniorly coverage of CCRCs is uneven; the referral-fee placement model that structures those sites is built around rental AL/MC rather than entry-fee contract comparison.

Quality and financial data. State CCRC financial disclosures are the key dataset, and they vary wildly by state. Pennsylvania is the gold standard: the Pennsylvania Insurance Department posts actual Annual Disclosure Statements as PDFs (pa.gov/agencies/insurance/filing-reporting-requirements/financial-filing-requirements/ccrc-filing), with audited financials, reserves, entrance-fee structure, and resident agreements, under 31 Pa. Code Ch. 151. California is also excellent: CDSS's Continuing Care Contracts Branch posts 3-year rolling annual reports at cdss.ca.gov/inforesources/community-care/continuing-care/annual-reports, including audited financials and a Key Indicator Report with standardized liquidity/occupancy ratios, and CANHR's plain-English "Guide to CCRC Financial Reports" is the best consumer decoder. Florida regulates CCRCs as specialty insurers under Chapter 651 and OIR posts examination reports; HB 1573 (2023) tightened requirements. Other strong regulators include Maryland, Virginia, North Carolina, Illinois, Washington (whose 2022 CCRC Study is publicly posted), New Jersey, and Oregon.

Count of CCRC regulators. Roughly 38 states + 0 DC regulate CCRCs in some form (figures vary 37–39 depending on how hybrid regimes are counted). The 12 non-regulator states + DC most notably include Ohio (the largest state by CCRC population without CCRC-specific financial regulation), Alabama, Wyoming, West Virginia, Montana, Idaho, Arkansas, Alaska, Hawaii, and Tennessee (light). Only 17 states require actuarial / long-term viability studies.

EMMA / MSRB. Tax-exempt bond offering documents and continuing disclosures for CCRCs that issued municipal debt (very common for nonprofit CCRCs) are free, public, and often the deepest audited-financial source — particularly for residents of the 12 non-regulator states. Searchable by CUSIP, issuer name, or state at emma.msrb.org.

Industry data. Ziegler's Credit Surveillance Special Reports — notably the 2024 CCRC Default Study — and the annual LZ 200 provide the best industry-median benchmarks for financial ratios, occupancy, and bond defaults. Free to read but not licensed for ingestion — cite, do not host.

Gaps. Contract-type comparison (A vs. B vs. C) is opaque. Entry-fee refund math is buried in 100-page residency agreements. Waitlist transparency is absent. Monthly-fee escalation history — many CCRCs raise fees 4–6% annually — is not published. No consumer product standardizes a solvency scorecard across states.

3.8 Adult day services and PACE

Two related but distinct settings. Adult Day Services (ADS) are community-based day programs, either social model (activities, meals, socialization) or medical model (nursing, therapy, meds), typically 6–10 hours per day, enabling a family caregiver to work. PACE (Program of All-Inclusive Care for the Elderly) is a capitated, integrated, Medicare + Medicaid model for adults 55+ who meet nursing-home level of care but can safely live in the community; participants get all services — primary care, specialty care, Rx, therapies, transportation, adult day, home care, hospital, SNF if needed — through a single PACE organization centered on a PACE day center.

Scale. ADS: ~4,600 centers per NADSA's membership count; higher estimates to ~7,500 including non-member centers. PACE: 202 programs serving ~92,000 participants in 33 states + DC as of 2025; 25 new programs opened in 2024 alone.

Cost. ADS private pay: ~$95/day national median, ~$2,058/month. PACE: $0 out-of-pocket for dual-eligibles; Medicare-only participants pay a Part D + Medicaid-equivalent private premium ($3,500–$5,000/mo in many markets). PACE capitation PMPM per MACPAC ranges $2,737 (OK) to $8,279 (SF).

Consumer experience. The National PACE Association's Find-a-PACE locator is the only national PACE directory; basic zip-code search with no quality data. NADSA's directory is member-only and incomplete. APFM, Caring, Seniorly have essentially no ADS or PACE coverage. Medicare.gov has a PACE locator but no quality comparison.

Gaps. Consumer awareness of PACE is extraordinarily low given its generosity. No PACE quality comparison. ADS capacity, program type, and Medicaid-waiver acceptance are hard to find.

3.9 Home health (Medicare-certified)

Medicare-certified agency delivering physician-ordered skilled services at home — skilled nursing, PT, OT, speech therapy, medical social work, and home-health-aide services — typically for post-acute or chronic-disease-exacerbation patients who are homebound. Episodic, time-limited: 30-day payment periods under the Patient-Driven Groupings Model (PDGM).

Scale. ~11,400–11,500 Medicare-certified HHAs as of recent CMS data, declining slightly year-over-year due to enforcement and rate pressure.

Cost. Medicare pays the agency under PDGM, ~$2,000–$3,500 per 30-day period. Patient owes $0 for covered services.

Consumer experience. Medicare Care Compare's Home Health tab shows a composite Quality of Patient Care star rating, HHCAHPS patient-experience star rating, and process / outcome measures. Filterable by distance and services. No pricing (Medicare-covered). No visit availability. APFM, Caring, Seniorly have limited coverage; most consumers reach HH via hospital discharge planner choice forms.

Quality data. CMS Home Health Care Compare; OASIS-based outcomes; HHCAHPS patient experience. CMS released ownership data for all Medicare-certified HHAs and hospices for the first time in 2023 via the home-health-agency-all-owners dataset.

Gaps. Star ratings lag real performance by 12+ months. Per-patient staffing ratios are not reported publicly. Acceptance rates by insurer (particularly Medicare Advantage plans) are not shown. Families frequently discover post-admission that their preferred agency does not serve their zip or take their MA plan.

3.10 Home care (non-medical)

Private-pay or Medicaid-HCBS-funded aides delivering help with ADLs, IADLs, companionship, and supervision at home. No skilled nursing or therapy. Provided by personal care aides and home health aides employed by non-medical home care agencies, or hired directly. Median worker is female, ~47, earning $16/hour; 25%+ are uninsured (PHI).

Scale. No authoritative national agency count; ~30,000–33,000 non-medical home care agencies industry-wide. The home-health-and-personal-care-aide workforce was ~4.3 million jobs in 2024 per BLS — the largest direct-care occupation.

Cost. Genworth 2024: homemaker services $33/hour; home health aide $34/hour. Full-time 24/7 care runs $18,000–$25,000/month in many markets.

Payer. Private pay majority; Medicaid HCBS waivers (including consumer-directed programs like California's IHSS and New York's CDPAP); LTC insurance; VA Aid & Attendance; some VA Homemaker / Home Health Aide program funding.

Consumer experience. Care.com is a direct-hire marketplace (not agency-based); caregiver vetting on that platform is user-driven. APFM and Caring list non-medical home care agencies in some markets on a referral-based model. Seniorly has limited coverage. There is no federal database. State-level licensure varies; roughly 30 states require home-care-agency licensure.

Quality data. Very thin. Some states (NY) require registration. No national inspection framework. Private designations such as Home Care Pulse's "Best of Home Care" are paid evaluation/award programs administered by industry vendors; they are not government or third-party-regulatory credentials.

Gaps. Standardized background-check disclosure. Caregiver turnover data (industry median ~65%). Wage transparency (matters for quality). Medicaid-waiver agency participation.

3.11 Hospice

Medicare-certified (or Medicaid/commercial-certified) benefit providing comfort-focused, interdisciplinary care (physician, nurse, aide, social worker, chaplain, bereavement) to patients with a physician-certified terminal prognosis of 6 months or less, who elect to forgo curative treatment for the terminal condition. Most care delivered in the patient's "home" — including a SNF or AL. Inpatient hospice for complex symptom management or respite. Median LOS ~18 days; mean ~90 days.

Scale. Approximately 6,100+ Medicare-certified hospices as of 2023–2024. For-profit hospice provider counts in California, Texas, Nevada, and Arizona have grown significantly since 2015; HHS OIG reports (notably "Vulnerabilities in Hospice Care," OIG 2019; "Hospice Deficiencies Pose Risks to Medicare Beneficiaries," OEI-02-17-00020) documented quality-of-care and billing concerns concentrated in these markets.

Cost. Medicare pays the hospice a per-diem by level of care. FY2024 national base rates: Routine Home Care (days 1–60) ~$218/day; RHC (days 61+) ~$172/day; Continuous Home Care ~$1,691/day; Inpatient Respite Care ~$525/day; General Inpatient Care ~$1,145/day. Patient owes ~$0 (nominal Rx copay).

Consumer experience. Care Compare's Hospice tab shows HIS (Hospice Item Set) process measures and CAHPS Hospice family-experience measures; no overall star rating yet (CMS has been finalizing one for 2025–2026). No pricing. APFM and Caring list hospices in some markets; quality-data integration on those consumer interfaces is limited compared with Medicare Care Compare.

Quality data. CMS Hospice Care Compare; a series of HHS OIG reports (2019–2022) on hospice oversight and billing; hospice ownership data released publicly by CMS for the first time in 2023.

Gaps. No star rating yet. HHS OIG reports (2019–2022) have documented elevated concentrations of hospice-billing and quality concerns in California, Texas, Nevada, and Arizona, which affects consumer choice in those markets [cite OIG reports above]. Visit-frequency data (how often a nurse or aide actually comes) is not surfaced on Care Compare. Consumer-facing sources do not distinguish operator type (nonprofit, for-profit, PE-owned) in a standardized way; ownership type has been empirically associated with differences in service patterns in peer-reviewed research [e.g., Aldridge et al.; see NHPCO/CMS ownership files for primary data].

3.12 Subsidized senior housing

Federal or state rental-housing programs that restrict occupancy in whole or in part to elderly households (62+ or 55+ depending on program), with rent subsidized to ~30% of adjusted income.

Sub-programs and scale.

• HUD Section 202 Supportive Housing for the Elderly. ~400,000 units created since 1959; ~6,000 properties assisting ~263,000 elderly households currently. Low-income (<50% AMI), 62+. Often with on-site service coordinator. Inventory has not grown meaningfully since 2011.
• Section 8 Project-Based Rental Assistance (PBRA). ~1.2 million units overall; HUD multifamily assisted programs historically assisted ~422,000 elderly households. A subset of properties is elderly-designated.
• LIHTC with elderly set-aside. HUD reports 40,502 projects and ~2.6 million units placed in service since 1987; industry estimates put ~800,000–900,000 LIHTC units in age-restricted / senior-set-aside properties. No unified national tracker.
• USDA Rural Development Section 515 / 538. ~406,000 units across ~13,000 properties in 87% of U.S. counties; 60%+ of residents are elderly or persons with a disability. Program is winding down as mortgages mature out.
• Section 236. ~89,000 units remaining — a legacy interest-subsidy program.
• Public housing with elderly designation. Of ~900,000 public housing units nationally, a meaningful share are elderly/disabled-designated; no single published count.
• Section 811. Overlaps with Section 202 historically; disability-targeted.

Cost to tenant. Tenant pays 30% of adjusted gross income. Typical Section 202 household earns ~$16,000/year, so monthly rent ~$400.

Consumer experience. HUD Resource Locator (resources.hud.gov) is map-based; senior-filter usability is limited. AffordableHousing.com is a national private aggregator with an age-restricted filter; waitlist status disclosure varies by property. APFM, Caring, and Seniorly do not cover subsidized senior housing as a primary category (subsidized-housing placements do not generate the referral-fee-category's typical contracted fees). This is the single largest coverage gap in the commercial senior-care directory ecosystem as of April 2026. Medicare Care Compare does not cover housing.

Quality and transparency data. HUD REAC physical inspection scores (now NSPIRE as of October 1, 2024 for Multifamily, October 1, 2023 for Public Housing, with affirmative-requirement scoring starting October 1, 2025). HUD tenant characteristics data (Picture of Subsidized Households, annual, aggregated to nation / state / CBSA / county / place / census tract / project / PHA). TRACS financial data. Management and Occupancy Review (MOR) reports on Section 8 PBRA properties, conducted annually by contract administrators, are not public and require FOIA. The National Housing Preservation Database (NHPD), jointly run by NLIHC and PAHRC, cross-walks ~14 federal affordable-housing programs to the property level with subsidy expiration dates — the single most valuable derivative dataset for senior-housing preservation.

Gaps. Waitlists (often 1–10 years) are opaque and property-by-property. Age and income restrictions are not uniformly surfaced. Expiring-use preservation risk — units at risk of losing affordability — is invisible to renters. Service-coordinator presence, the critical variable for aging-in-place, is not listed.

3.13 Affordable market-rate senior housing (55+ without subsidy)

Age-restricted (55+ or 62+) rental or for-sale housing operating under the Housing for Older Persons Act (HOPA) exemption to Fair Housing Act age-protection rules, without federal subsidy. Often includes light amenities (clubhouse, fitness, activities) but no care services. "Active adult" rentals are a fast-growing segment distinct from IL in that they typically don't include meals or transportation.

Scale. ~2,000+ identifiable 55+ active-adult communities per consumer listings. Actual count of HOPA-compliant properties — including small HOAs and condo associations — is tens of thousands. The U.S. active-adult-community market was valued at ~$635.5B in 2024 per Grand View Research.

Cost. Market rent, typically $1,500–$3,500/month depending on metro, often 10–20% premium over general-market comparables due to amenity package.

Consumer experience. 55places.com is the leading consumer directory for 55+ for-sale / community listings, operating on an agent-referral model. Apartments.com and Zillow with 55+ filter cover the rental segment. APFM, Caring, and Seniorly coverage of 55+ market-rate housing is uneven because 55+ lies outside the AL/MC/IL product categories those directories focus on.

Gaps. HOPA compliance (minimum % of units with 55+ occupant) not published per property. HOA financial health, reserve studies, and special-assessment history are invisible to renters and often to buyers. The distinction between "55+ active adult" (no care) and "independent living" (with services) confuses consumers who will age in place and later need care.

4. Source catalog

Every data source in this catalog is described with the same set of fields: name and provider; what it covers (settings, geographic scope, unit of analysis — facility, building, operator, resident); update cadence; access method (public API, bulk download, FOIA, paywall, scrape-only, partnership); known quality limitations; which persona's questions it helps answer; integration difficulty for Placet (easy / medium / hard / research-only / cite-only); ethical notes where relevant.

URLs were verified in April 2026. A handful of occasional 403s on direct fetch are standard bot-blocking, not broken URLs.

4.1 Federal sources

CMS Care Compare (consumer-facing medicare.gov site)

Provider: CMS. URL: https://www.medicare.gov/care-compare/. Covers SNFs, home health agencies, hospices, IRFs, LTCHs, dialysis facilities, hospitals, doctors, and a few other settings — every Medicare-certified post-acute and long-term setting. Unit of analysis: facility / agency (one record per CCN). Update cadence: monthly baseline; inspection-data modernization pause since July 30, 2025. Access: free consumer UI; for bulk data use the Provider Data Catalog below. Limitations: consumer site only, no download; star ratings lag real conditions by months to years (typical health inspection cycle ~15 months); no AL, IL, CCRC, ADS, or non-Medicare-certified facility coverage. Personas: patient, family, discharge planner — the primary consumer starting point. Integration: easy for linking / display.

CMS Provider Data Catalog

Provider: CMS. URL: https://data.cms.gov/provider-data/. This is the authoritative bulk data behind Care Compare, delivered as CSV / ZIP monthly, with a documented data dictionary. The Nursing Home topic alone is ~38 MB zipped and includes 18 datasets: NH_ProviderInfo (dataset 4pq5-n9py), NH_Ownership (y2hd-n93e), NH_HealthCitations, NH_FireSafetyCitations, NH_Penalties (g6vv-u9sr), NH_SurveySummary, NH_StateUSAverages, NH_QualityMsr_Claims, NH_QualityMsr_MDS, NH_CovidVaxStaff, NH_CovidVaxResident, and the data-dictionary PDF. Parallel dataset families exist for home health (HH_Provider_Data, HHCAHPS), hospice (Hospice_General_Information, Hospice_Provider_CAHPS_Data, Hospice_Provider_Data), IRF (IRF_Provider, IRF_National, IRF_State), LTCH (LTCH_Provider, LTCH_National, LTCH_State), and dialysis. Unit: facility for "Provider Information" tables; provider-measure or provider-deficiency for long tables. Cadence: monthly. Access: free bulk CSV + Socrata-style APIs at data.cms.gov/provider-data/api/1/; archived monthly ZIPs at .../archived-data/nursing-homes. Limitations: inspection-based elements paused since July 30, 2025; ownership data is self-reported; fire-safety and health citations only cover federally-surveyed sub-certification. Personas: discharge planner, aging life care manager, researcher. Integration: easy (stable CSV, monthly, documented).

CMS Special Focus Facility list + candidates

Provider: CMS / QSOG. Monthly PDF at https://www.cms.gov/files/document/sff-posting-candidate-list-[month]-[year].pdf. Two tabs: SFFs (~88 at a time) and SFF Candidates (~400+). Unit: facility (CCN). Cadence: monthly. Access: free PDF. No official CSV — third parties (StarPRO, Nursing Home 411) re-publish as tables. Limitations: PDF-only makes programmatic ingestion fragile; SFF status is a lagging, consensus-of-surveys measure. The 2022 SFF program reform added the candidate list and exit-from-SFF post-monitoring requirements. Personas: discharge planner (hard-avoid list), aging life care manager, family, journalist. Integration: medium (PDF parsing + facility-name-to-CCN matching).

CMS Provider Information file + Ownership file (expanded by 2023 rule)

Provider: CMS. URLs: Provider Information at data.cms.gov/provider-data/dataset/4pq5-n9py; Ownership (PDC) at data.cms.gov/provider-data/dataset/y2hd-n93e; SNF All Owners (expanded 2023 rule) at data.cms.gov/provider-characteristics/hospitals-and-other-facilities/skilled-nursing-facility-all-owners; SNF Change of Ownership at data.cms.gov/provider-characteristics/hospitals-and-other-facilities/skilled-nursing-facility-change-of-ownership. Final rule: CMS-3441-F, 88 FR 80141, published November 17, 2023, effective January 16, 2024 (Medicare) / October 1, 2024 (Medicaid).

Newly public fields vs. pre-2023: additional disclosable parties (ADPs) including officers, directors, members, partners, trustees, managing employees; private equity company (PEC) indicator; REIT indicator (publicly and non-publicly traded); organizational chart / role data for each ADP (management, administrative, clinical, financial, operational); organizational structure (LLC, partnership, etc.). Unit: SNF All Owners is one row per owner per facility. Cadence: quarterly. Access: free CSV / API. Limitations: self-reported; Health Affairs (Braun et al., 2023, 10.1377/hlthaff.2023.01110) found major gaps in PE / REIT chain identification because of inconsistent name spelling and the ADP category's broad definition; no parent-chain graph exposed. Personas: researcher, policy analyst, journalist, sophisticated consumer tool. Integration: medium (entity resolution across name variants is the analytic burden).

CMS Minimum Data Set + CASPER survey data

Provider: CMS. URLs: public reports at cms.gov/data-research/computer-data-systems/minimum-data-sets-3.0-public-reports; restricted-use via ResDAC at resdac.org/cms-data/files/mds-30. CASPER is operated by state survey agencies; extracts flow into Care Compare; raw CASPER is not publicly released.

Unit: MDS = resident-assessment-level; CASPER = survey-level (deficiencies per facility per cycle). Cadence: MDS public reports quarterly; restricted MDS files released annually with 1–2 year lag. Access: public aggregated MDS frequency reports (active residents, admissions) at state / facility level with no PHI; restricted resident-level MDS via ResDAC Data Use Agreement, IRB, and fees typically $4,000–$20,000 per year of data, cross-referenceable via BENE_ID to claims. Limitations: schizophrenia-coding accuracy issues surfaced by a 2022 OIG report and ongoing CMS audits; LTCFocus.org publishes aggregated facility-year MDS-derived measures as a free alternative. Personas: academic researchers for restricted data; clinicians and families only for aggregated public reports, which have low decision utility. Integration: public medium; restricted research-only.

CMS Payroll-Based Journal (PBJ)

Provider: CMS. URL: data.cms.gov/quality-of-care/payroll-based-journal-daily-nurse-staffing. Unit: facility-day (one row per CCN × work day × labor category). Non-nurse staffing in a parallel file. Cadence: quarterly; facilities submit within 45 days of quarter-end. Public release usually 4–5 months after quarter-end. Access: free bulk CSV, 200+ MB per quarter uncompressed. File names PBJ_Daily_Nurse_Staffing_CY[year]Q[q].csv and PBJ_Daily_NonNurse_Staffing_CY[year]Q[q].csv. Detail: facility × date × labor category (RN, LPN, CNA, director of nursing, medication aide, admin RN, etc.) with hours worked; no individual employee identifiers; contract vs. employee staff separable. Limitations: payroll/time-and-attendance hours only (no patient-care-vs-non allocation); 5-Star uses case-mix-adjusted HPRD, raw PBJ doesn't include the denominator; facilities that fail or submit erroneously get auto-lowest staffing-turnover score (QSO-23-21-NH). With the federal minimum staffing floor repealed (December 2025 IFC, effective February 2026), PBJ remains public and used in 5-Star but is no longer a compliance benchmark. Personas: discharge planner (real staffing levels beyond the star), researcher, operator. Integration: medium (big files, needs aggregation).

CMS HCRIS cost reports (SNF Form 2540-10)

Provider: CMS / Office of the Actuary. URLs: PDC summary at data.cms.gov/provider-compliance/cost-reports/skilled-nursing-facility-cost-report; raw HCRIS at cms.gov/data-research/statistics-trends-and-reports/cost-reports/skilled-nursing-facility-2540-2010-form; NBER mirror at nber.org/research/data/hcris-snf. Unit: cost report (facility × fiscal year). ~15,000 SNF reports per year. Cadence: quarterly HCRIS refreshes adding newly-finalized reports and reclassifications, ~2-year lag to finalization. Access: free bulk download of pipe-delimited flat files split across RPT / ALPHA / NMRC / ROLLUP by worksheet; researchers concatenate using the 2540-10 structure; GB-scale per fiscal year across worksheets. Key worksheets: S-2 (facility ID / beds), S-3 (occupancy / staffing hours by labor type), G (balance sheet), B (cost allocation), E (Medicare settlement). Limitations: voluntary data-entry errors common; private-pay revenue understated; related-party transactions (management fees to parent) obscure operator profitability. Personas: researcher, policy analyst, operator M&A analysis. Integration: hard (worksheet parsing is nontrivial).

CMS Nursing Home Compare Archive

Provider: CMS. URL: data.cms.gov/provider-data/archived-data/nursing-homes. Monthly ZIPs from late 2017 forward. Files named nursing_homes_including_rehab_services_MM_YYYY.zip. Metadata oddity: December 2021 archive file contains November 2021 data (archive snapshot taken before December refresh loaded); pattern persists. Access: free. Personas: researcher, legal / defense analyst needing historical facility state. Integration: easy for single pulls; medium for longitudinal panels (column changes over time).

CMS Medicare Provider Enrollment (PECOS public extract)

Provider: CMS. URL (public extract): data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/medicare-fee-for-service-public-provider-enrollment. Internal PECOS at pecos.cms.hhs.gov. Unit: enrolled provider / NPI / specialty. Subset of internal PECOS. Cadence: quarterly. Access: free CSV. The SNF All Owners file above exposes the ADP piece of PECOS. Limitations: no enrollment history, denial reasons, or sanctions — partially covered by CMS Preclusion List + OIG LEIE exclusions. Personas: discharge planner (provider verification), fraud / compliance analyst. Integration: easy.

Nursing Home Five-Star methodology

Provider: CMS. URL: cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS. Current Users' Guide: April 2026; state cut-point tables updated March 2026. Components: health inspections (three most recent standard surveys + complaint surveys, deficiency-weighted by scope-and-severity A–L, recency-weighted); staffing (from PBJ — case-mix-adjusted RN HPRD and total nursing HPRD plus staff turnover and weekend staffing since 2022; auto-1-star for non-submitters since April 2024); quality measures (15 short-stay and long-stay MDS-derived and claims-based measures). Composite rule: Overall = Health Inspection rating, ±1 star for staffing, ±1 star for QM, with downward limits (can't get overall 5 with 1-star staffing). Limitations: CMS has conducted schizophrenia-coding audits (2023–2026) that have adjusted long-stay antipsychotic quality-measure ratings for facilities with coding-accuracy issues (per CMS QSO memos); inspection rating is lagging; no AL / CCRC coverage; inspection-data modernization pause since July 30, 2025. Personas: family, patient, discharge planner — primary decision screen. Integration: easy to display; medium to recompute from raw inputs.

HUD Multifamily Assistance & Section 8 Contracts Database

Provider: HUD / Office of Multifamily Housing. URL: hud.gov/hud-partners/multifamily-assist-section8-database. The huduser.gov/portal/datasets/mfsc.html path now 404s — authoritative host is hud.gov. Data.gov mirror: catalog.data.gov/dataset/multifamily-assistance-section-8-contracts. Unit: contract with associated property/project identifier; rolls up to property. Cadence: monthly refresh of property, contract, rent, and utility-allowance datasets. Access: free bulk Excel + CSV. Limitations: contract-level granularity requires rollup for properties with multiple contracts; doesn't include Section 202 Capital Advance properties without a Section 8 contract — cross-reference with the Section 202 feature service. Personas: discharge planner, aging life care manager, housing counselor. Integration: easy.

HUD Section 202 inventory

Provider: HUD. URLs: ArcGIS feature service at hudgis-hud.opendata.arcgis.com/datasets/hud-section-202-properties/about; catalog at catalog.data.gov/dataset/section-202-properties; Section 202 tool at huduser.gov/portal/maps/section202/home.html. A subset of the Multifamily dataset — the feature service is a filtered view flagging elderly-serving properties. Both sources are useful: the Multifamily DB has richer contract / rent / subsidy detail; the 202 feature service has geographic data and the elderly-serving flag. Unit: property. Cadence: approximately quarterly. Access: free ArcGIS REST (GeoJSON, Shapefile, CSV). Limitations: "primarily serves elderly" flag is HUD designation, not unit-level restriction; Section 202 PRAC-only (post-1991 capital advance) mixes with older 202/8 hybrid — check the subsidy code. Inventory ~400,000 units and has not grown meaningfully since 2011. Personas: aging life care manager, discharge planner, housing counselor. Integration: easy.

HUD Picture of Subsidized Households

Provider: HUD / PD&R. URL: huduser.gov/portal/datasets/assthsg.html. Unit: aggregated (nation / state / CBSA / county / place / census tract / project / PHA). Cadence: annual; 2023 data published late 2024. Access: free Excel / CSV; aggregates from HUD tenant-level administrative data (tenant-level is restricted). Senior-relevant household-type breakdowns include "Elderly non-disabled" and "Elderly disabled." Limitations: aggregate only; project-level counts suppressed when cell sizes <11. Personas: policy analyst, housing counselor, needs-assessment work. Integration: easy.

HUD LIHTC database

Provider: HUD / PD&R (properties); Treasury / IRS operates the program. URLs: property-level at huduser.gov/portal/datasets/lihtc.html; query at huduser.gov/lihtc/; ArcGIS at hudgis-hud.opendata.arcgis.com. Scope: 40,502 projects and ~2.6 million units placed in service since 1987, per current HUD refresh. Unit: property; separate tenant-level LIHTC data (annual, at huduser.gov/portal/datasets/lihtc/tenant.html). Cadence: property file annual (typically 18 months after PIS year); tenant file annual. Access: free CSV; ArcGIS for mapping. Senior-targeted developments tagged in the TARGET_POP field. Limitations: voluntary state HFA reporting (~4% of projects missing); can't derive current rents (LIHTC caps at AMI, not deep subsidy); some projects layer Section 8 / 202 — cross-join required to find truly senior-affordable. Personas: aging life care manager, housing counselor. Integration: easy for property file; medium for tenant file.

HUD REAC inspection scores (PASS → NSPIRE)

Provider: HUD / REAC. URLs: Multifamily scores at hud.gov/stat/mfh/inspection-scores; public housing + multifamily state-level at huduser.gov/portal/datasets/pis.html; NSPIRE program at hud.gov/reac/nspire. Transition status: UPCS → NSPIRE for public housing October 1, 2023; for Multifamily October 1, 2024; NSPIRE affirmative-requirement scoring begins October 1, 2025. Unit: property / project (0–100). Cadence: inspection cycle 1 / 2 / 3 years by prior score; public file updated quarterly to semi-annually. Access: free Excel. MOR reports (Management & Occupancy Reviews for Section 8 PBRA, annual, by contract administrators, rating Superior / Above Average / Satisfactory / Below Average / Unsatisfactory) are not public — FOIA or state HFA only. Limitations: score-only files lack item-level defect detail; PASS vs. NSPIRE not directly comparable; MORs FOIA-only. Personas: housing counselor, aging life care manager, advocate. Integration: medium (scores easy; historical normalization across PASS / NSPIRE hard).

HUD Income Limits + Fair Market Rents

Provider: HUD / PD&R. URLs: FMR at huduser.gov/portal/datasets/fmr.html; IL at huduser.gov/portal/datasets/il.html; API docs at huduser.gov/portal/dataset/fmr-api.html. Free token JSON API at huduser.gov/hudapi/public/fmr and .../il with endpoints for state / county / MSA / zip. Unit: HUD Metro FMR Area / county / zip for FMR; same for IL. Cadence: annual — FY FMRs published ~August; proposed FMRs for public comment in spring; final by October 1 fiscal year start. Access: free API + Excel bulk. Senior use cases: 30 / 50 / 80% AMI eligibility for Section 202, LIHTC, HCV; calibrating affordability thresholds for Medicare Savings Program QMB / SLMB counseling. Limitations: ZIP-code payment standards lag market by 6–18 months. Personas: all. Integration: easy.

National Housing Preservation Database (NHPD)

Provider: Not federal — jointly operated by NLIHC and PAHRC; built from federal administrative data. URL: preservationdatabase.org. User Guide (Sept 2025): preservationdatabase.org/wp-content/uploads/2025/09/National-Housing-Preservation-Database-User-Guide.pdf. Free public mapping tool at experience.arcgis.com/experience/a5d6ef93eed54d2bb795af627bd7f3b1. Cross-walks ~14 federal affordable-housing programs to the property level — LIHTC, Section 8 PBRA, Section 202/811, Public Housing, HUD-insured 221(d)(3)/(4)/236, USDA 515/514/538/516, HOME, National Housing Trust Fund, Section 236 preservation, and state/local flags where available — and adds subsidy expiration dates, the key preservation field missing from any individual federal source. Unit: property. Cadence: quarterly. Access: subscription (free for nonprofits / research / government; paid tiers for consultants / developers). Limitations: not a federal primary source; discrepancies with HUD / USDA records should be resolved against the upstream source; tenant-level data not included. Personas: aging life care manager (critical for subsidy-expiration risk), housing counselor, policy analyst. Integration: medium (subscription for bulk; mapping tool free).

USDA Rural Development Section 515 / 538

Provider: USDA / Rural Development, Rural Housing Service. URL: sc.egov.usda.gov/data/MFH.html. Datasets include 514/515 Property Assignments (most recent as of 3-18-2026) and 538 with data dictionary. Unit: property and loan / assignment record per property. Cadence: quarterly to semi-annual. Access: free Excel / CSV with data dictionary PDF. Limitations: USDA property data historically less standardized than HUD; no live online query tool comparable to huduser.gov; properties clustered in rural markets, many at 515-loan-maturity preservation risk (NHPD tracks better). Personas: rural aging life care manager, rural housing counselor. Integration: medium.

Census ACS 5-year

Provider: Census Bureau. URL: census.gov/data/developers/data-sets/acs-5year.html. Most recent release: 2019–2023 ACS 5-year published December 2024; 2020–2024 expected December 2025. Key senior-relevant tables: B25072 (age of householder by gross rent as % of household income — housing cost burden by age); B25093 (age of householder by monthly owner costs as % of household income); B17020 (poverty status by age); S0103 / S0101 (population 65+ subject tables); B27010 (health insurance by age 65+); B23027 (work status by age); B18101 (sex by age by disability status). Unit: state / county / tract / block group. Cadence: annual release of 5-year rolling estimate. Access: free API with key at api.census.gov/data/2023/acs/acs5; data.census.gov UI; FTP bulk. Limitations: 5-year estimates lag ~13 months and smooth over a 5-year window; MOEs grow at small geographies; tract definitions changed in 2020. Personas: all, especially market / need sizing. Integration: easy.

American Housing Survey

Provider: Census Bureau, on behalf of HUD. URL: 2023 PUF at census.gov/programs-surveys/ahs/data/2023/ahs-2023-public-use-file--puf-.html (released September 25, 2024). Unit: household — longitudinal sample of ~60,000 households nationally + oversamples of 15 largest metros. Senior-relevant variables: HOWDH / HOWDW (age of head), MOVHERE (reason for move), MODGRD (grab bars, ramps, widened doorways, lever handles), MOBILITY (mobility limitations), ACCESS (accessibility features), HOMEIMP / HOMEIMPND (home improvement spending). Topical supplements vary: aging-in-place modifications, emergency preparedness, caregiving. Cadence: biennial (odd years). Access: free public-use microdata (SAS + ASCII); restricted-use geography via FSRDC. Limitations: small cells for stratification by senior subgroup in non-metro areas; topical supplements not every cycle. Personas: researcher, policy analyst. Integration: hard (microdata requires statistical software and weighting logic).

Administration for Community Living (ACL) data

Provider: HHS / ACL. URLs: AGID portal at agid.acl.gov; Senior Nutrition at acl.gov/senior-nutrition/data-and-reports; data-projects overview at acl.gov/programs/research-and-development/data-collection-projects; NORS guidance at ltcombudsman.org/omb_support/nors. Sub-datasets within AGID: State Program Reports (SPR) under Title III / VII of the Older Americans Act (congregate meals, home-delivered meals, transportation, personal care, homemaker, adult day, case management, legal assistance, caregiver support at state + AAA level, annual); National Survey of Older Americans Act Participants (NSOAA) — annual participant-level survey on food security, isolation, caregiver strain; NORS — National Ombudsman Reporting System complaints received and resolved by state LTC ombudsman programs (SNF + AL + board & care; revised FY2020 for more granular complaint taxonomy; annual, state-level public; facility-level not public in AGID but available through state ombudsman programs); NAMRS — National Adult Maltreatment Reporting System APS case data (annual); ACL Profile of Older Americans (annual). Unit: state × year mostly; AAA / PSA for some SPR tables; complaint-type for NORS. Cadence: annual. Access: free web query + CSV export; bulk tables downloadable. Limitations: substantial state-to-state definitional variation in service units; facility-level ombudsman data not in AGID; OAA spending self-reported. Personas: aging life care manager (AAA service inventory), policy analyst, advocate. Integration: medium (per-table download, no unified API).

VA Community Living Centers (CLCs)

Provider: Department of Veterans Affairs / VHA / Geriatrics and Extended Care. URLs: program overview at va.gov/geriatrics/pages/va_community_living_centers.asp; location PDF at va.gov/geriatrics/docs/VA_Community_Living_Center_Locations.pdf; CLC Compare internal to VA. Scope: more than 100 CLCs operated directly by VA (distinct from contracted community nursing homes and State Veterans Homes). Unit: facility. Cadence: directory PDF updated periodically; internal ratings quarterly. Access: facility list free PDF; CLC quality ratings VA-published via internal CLC Compare pages but not exposed as bulk CSV; detailed survey / staffing / census data FOIA or VA Office of Geriatrics. Limitations: CLCs are NOT in CMS Nursing Home Compare / PDC — Title 38 facilities, not Medicare-certified, do not appear in the 15,000-facility CMS SNF universe; separate rating system; no PBJ equivalent publicly released. Personas: veterans and families, discharge planners at VA medical centers. Integration: hard (fragmented, FOIA-dependent for detail).

IHS and tribal senior care facilities

Provider: HHS / IHS + tribal health organizations. URLs: IHS Locations at ihs.gov/locations/; complete IHS facility list (Excel) linked from locations; CMS Tribal Nursing Home & Assisted Living Facility Directory (2026 edition) at cms.gov/files/document/tribal-nursing-home-assisted-living-facility-directory-2026.pdf. The CMS Tribal Directory covers ~30 tribally-operated nursing homes and AL facilities nationwide. Tribally-run facilities Medicare-certified appear in regular Care Compare / PDC data; non-certified do not. Unit: facility. Cadence: annual directory. Access: free PDF + Excel. Limitations: small universe, non-comparable to SNF universe; no quality / outcomes data published; no PBJ for non-certified. Personas: American Indian / Alaska Native elders and families; IHS discharge planners. Integration: hard (PDF parsing).

4.2 State sources

A full 50-state catalog is out of scope; the structure and the seven priority states follow.

Structure of state data

Each state has its own licensing regime for assisted living / RCFE / personal care / adult family homes, typically under the state Department of Health, sometimes DHS / CDSS (CA, PA, IL), sometimes a hybrid. Statutory inspection cadences vary — from annual (PA statutory) to multi-year intervals in some large states. Placet does not publish a specific current CA inspection-cadence figure in its own voice; readers should verify current cadence with CDSS publications at time of reading, as published cadences have changed over time. Publicly-observable online-access posture, as of April 2026, clusters into three buckets based on what each state regulator publishes online at time of verification: public portal with searchable inspections (FL, TX, OH, CA partial, NC, VA, NV, NM, IL partial); public roster online with inspection detail available only via state public-records request (MA, NY partial, PA partial, most of the Mountain West); limited online access to either roster or inspection detail, as of April 2026 (AK, AR, HI, KY, LA, MS, NH, ND, SC, SD, UT). These classifications describe observable online access at the time of writing; state publishing practices have changed historically and readers should re-verify at time of use.

Seven priority state portals

Florida — AHCA / FloridaHealthFinder. Consumer URL: quality.healthfinder.fl.gov/. ALF search: quality.healthfinder.fl.gov/Facility-Provider/ALF?type=0. Regulator at ahca.myflorida.com/health-quality-assurance/bureau-of-health-facility-regulation/assisted-living-unit/assisted-living-facility. Public: facility demographics, license type, owner of record, limited-nursing-services / extended-congregate-care / limited-mental-health endorsements, administrator, last inspection date, inspection reports in HTML + PDF, facility-level complaint records, administrative actions. Cadence: licensure roster daily; inspection PDFs ~30 days post-survey. Format: searchable HTML database + PDF survey reports. Observed data limitations: AARP Florida reporting (2025) stated that more than 60% of Florida nursing homes changed ownership during 2019–early 2024, with approximately one-third of those transactions involving private-equity-affiliated entities [cite AARP Florida 2025 report]; AARP's analysis also noted that AHCA's public file exposes the facility's owner of record but does not publish the full beneficial-ownership chain. Integration: easy-medium (structured; scrape + PDF parse).

California — CDSS Community Care Licensing. Search: ccld.dss.ca.gov/carefacilitysearch/. Data hub: cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/ccld-data. RCFE landing: cdss.ca.gov/inforesources/community-care-licensing/rcfe. Public: facility name, address, capacity, licensee, administrator, visit history, Type A / Type B citations, LIC 9099 complaint summary, quarterly enforcement statistics. Cadence: daily status updates; citations within ~10 business days; statewide hub quarterly. Reporting context: ProPublica's "Life and Death in Assisted Living" investigation (2013; A.C. Thompson) reported that CDSS at the time did not maintain consolidated counts of annual inspections or unusual incidents and documented approximately $1 million in unpaid RCFE fines. ProPublica's 2013 reporting is more than a decade old; Placet does not extend its specific findings to CDSS's current operations and does not publish a current inspection-cadence figure in its own voice. Current CDSS cadence should be verified directly with CDSS publications at time of reading. The independent nonprofit CANHR (canhr.org) maintains parallel, publicly-available datasets that Placet can overlay for editorial context. California is the largest RCFE market (~7,700 facilities). Integration: medium (primary data is there; overlay ProPublica reporting and CANHR data for editorial context).

Texas — HHSC TULIP / LTC Provider Search. apps.hhs.texas.gov/LTCSearch/ (verified 200 OK). New Salesforce portal at tulip.hhs.texas.gov/TULIP/s/ltc-provider-search. Public: license status, last inspection date, Health and Life Safety Code deficiencies, statewide-average comparison, cited-regulation narrative. Covers ALFs (Type A / B / AL-Alzheimer's), DAHS, NFs, ICF/IID, HH, hospice. Cadence: approximately 2-year inspection cycle on average; surveys posted within ~60 days. Observed context: Texas's inspection publishing is structured and searchable (among the stronger large-state portals); the ~2-year cadence means posted violations may reflect conditions more than 12 months prior. Texas Medicaid Fraud Control Unit has been a primary enforcement pathway for facility-linked fraud and neglect cases; see HHS OIG MFCU annual reports. Integration: easy (stable URL schema, consistent markup).

Illinois — IDPH Office of Health Care Regulation. Modern: llcs.dph.illinois.gov/s/facility-lookup?language=en_US (Salesforce-hosted). Legacy: idph.illinois.gov/healthca/assisted_living_list.htm (still live). Open data: data.illinois.gov/dataset/379idph_assisted_living_and_shared_housing_licensed_establishments_listing. Public: license status, capacity, Alzheimer / adult-day offerings, shared-housing vs. AL distinction. Inspection reports historically FOIA; LLCS portal is supposed to expose survey history but coverage is uneven. Cadence: annual inspection required by statute; 30–90 day publication lag. Integration: medium (dual scrapers for 12–18 months during migration).

New York — DOH Adult Care Facility Directory. Consumer: profiles.health.ny.gov/acf/. Open data (Socrata): health.data.ny.gov/Health/Adult-Care-Facility-Directory/wssx-idhx. Regulator: health.ny.gov/facilities/adult_care/. Public: ACF license type (Adult Home, Enriched Housing Program, ALR, Enhanced ALR / EALR, Special Needs ALR / SNALR, Assisted Living Program / ALP), bed count, operator. Inspection reports and enforcement history are not on profile pages — available only via DOH FOIL request. Cadence: directory nightly; inspection publishing ad hoc. The New York State Comptroller's audit "Oversight of Adult Care Facilities" (released July 9, 2025, covering January 2018 – October 2024) reported that DOH's oversight program did not adequately ensure quality of care (see osc.ny.gov/state-agencies/audits/2025/07/09/oversight-adult-care-facilities for the full audit report language). Integration: easy for roster (Socrata API), hard for inspections (FOIL).

Ohio — ODH Residential Care Facilities + Ohio Department of Aging Long-Term Care Consumer Guide. odh.ohio.gov/know-our-programs/residential-care-facilities-assisted-living and the ODA Nursing Home Quality Navigator at aging.ohio.gov/navigator (launched February 2024 for NFs; RCF scope narrower). OH Admin Code 173-45-08 requires ODA to refresh survey data weekly and retain 4 years. Public: licensure status, inspection narrative for RCFs, plan-of-correction filings; AL-specific inspection summaries exist but are less consolidated than the NF interface. Cadence: weekly (statutory). Observed context: Ohio does not have CCRC-specific financial regulation (see CCRC filings subsection below for the non-regulator list); Ohio RCF inspection data is distributed across multiple ODH and ODA pages rather than a single consolidated interface. Integration: medium (data is there but spread across ODH + ODA).

Pennsylvania — DHS Personal Care Home / ALR Directory. humanservices.state.pa.us/HUMAN_SERVICE_PROVIDER_DIRECTORY/. Category landing: pa.gov/agencies/dhs/resources/aging-physical-disabilities/personal-care-homes. Daily-refreshed directory by service type, ZIP, county, region; license size and status for PCHs and ALRs. Inspection narrative, annual licensing renewal data, and unusual-incident stats not on the public directory — DHS regional office records, FOIA-responsive but not posted. Cadence: directory daily; inspections annual. Most "assisted living" in PA is actually licensed as a PCH (smaller, older regime) rather than an ALR (newer, larger). Integration: medium for roster, hard for inspections.

CCRC financial solvency filings

Roughly 38 states + 0 DC regulate CCRC financial solvency. Strongest publicly-available filings:

Pennsylvania (gold standard): Insurance Dept at pa.gov/agencies/insurance/filing-reporting-requirements/financial-filing-requirements/ccrc-filing posts Annual Disclosure Statements as PDFs, with audited financials, reserves, entrance fee structure, resident agreement. 31 Pa. Code Ch. 151; $750 filing fee.

California (also excellent): CDSS Continuing Care Contracts Branch at cdss.ca.gov/inforesources/community-care/continuing-care/annual-reports — 3-year rolling annual reports with audited financials and a Key Indicator Report (standardized liquidity / occupancy ratios). CANHR's "Guide to CCRC Financial Reports" at canhr.org/wp-content/uploads/2021/08/FS_Guide_CCRC_Financial_Reports.pdf is the plain-English decoder.

Florida: OIR regulates CCRCs as specialty insurers under Chapter 651; quinquennial market-conduct exams publicly posted at floir.gov. HB 1573 (2023) tightened requirements.

Other robust regulators: Maryland, Virginia, North Carolina (ncdoi.gov/licensees/continuing-care-retirement-communities-ccrc), Illinois, Washington (2022 CCRC Study at insurance.wa.gov/sites/default/files/2024-09/2022-ccrc-study.pdf), New Jersey, Oregon.

Non-regulators (12 states + DC): states that do not have a CCRC-specific financial-solvency regulatory framework, per NaCCRA's state-regulation tracker and the analysis in GAO-10-611 (2010) as updated by myLifeSite's ongoing state survey: Ohio (the largest such state by CCRC population); Alabama; Wyoming; West Virginia; Montana; Idaho; Arkansas; Alaska; Hawaii. Nevada and Tennessee maintain partial or light CCRC regimes per those sources.

Only 17 states require CCRCs to submit actuarial or long-term viability studies (GAO-10-611, updated by myLifeSite).

Medicaid HCBS waiver data

Medicaid.gov waiver tracker at medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list is authoritative for waiver existence and approval status (1915(c), 1915(i), 1915(k), 1115) but does not surface eligibility, wait times, or services in operational detail. KFF's "Medicaid Home Care (HCBS) in 2025" at kff.org/medicaid/medicaid-home-care-hcbs-in-2025/ — the 23rd annual state survey — is the single best structured comparative dataset. Fielded April–July 2025. CRS R48519 (congress.gov/crs-product/R48519) is the statutory primer. 46 states offer HCBS waivers that cover AL services (personal care, medication management, meal assistance); Medicaid never covers AL room and board. >710,000 people on HCBS waiting lists (2024, KFF). The 2024 HCBS Access Final Rule (CMS-2442-F, issued April 22, 2024) imposed new access, payment-transparency, and incident-reporting standards, phased through 2030. Integration: medium for waiver existence; hard for state-by-state waitlist + services detail.

Certificate of Need (CON) laws

35 states + DC enforce CON (NCSL 2025). Applies most to SNF bed additions, hospital-based SNFs, hospice, and home health; to AL in only a handful of states. Recent movement: South Carolina repealed May 2023; North Carolina scheduled near-total repeal effective January 2025; Florida repealed most CON in 2019 (retains hospice + ICF/IID); Texas never had CON. CON applications and decisions are generally public but format varies — NC and GA publish structured decision logs; NY's PHHPC publishes meeting materials; some states only publish calendars. Integration: hard as 50-state feed; medium state-by-state; likely research-only for Placet v1 beyond NC, GA, NY, FL, TN.

State AG consumer protection / healthcare fraud enforcement

53 Medicaid Fraud Control Units (50 states + DC + USVI + PR) operate under state AGs. Coordinating body: NAMFCU at naag.org/about-naag/namfcu/. HHS OIG FY24 annual report (oig.hhs.gov/reports/all/2025/medicaid-fraud-control-units-annual-report-fiscal-year-2024/) reported $1.4B recovered and 1,151 convictions (817 fraud / 334 patient abuse-neglect). The FY25 OIG report (released early 2026) reported 1,185 convictions, approximately $2B in total recoveries, and 674 civil settlements, including roughly $702K in criminal + civil recoveries attributed to assisted-living-specific cases, with approximately 300+ open investigations. Publicly-announced state AG settlements involving nursing home operators in the last two years include (each settlement summarized per the state AG's own press release, which is the primary source and should be linked from Placet facility pages): NY AG Letitia James' November 2024 $45M settlement with the owners/operators of four nursing homes managed by Centers for Care, LLC (see NY AG press release of November 14, 2024); the August 2025 $12M settlement involving Van Duyn Home & Hospital (NY AG press release, August 2025); the March 2024 $8.6M settlement with Fulton Commons with governance reforms (NY AG press release); and MA AG Andrea Campbell's 2024 $4M settlement with Next Step Healthcare, LLC covering 16 nursing homes (MA AG press release). Integration: medium — 50-state press-release scraper + NLP classifier to identify facility-linked enforcement. Placet v2 feature.

State Long-Term Care Ombudsman reports

Federal anchor: ACL's Long-Term Care Ombudsman Program at acl.gov/programs/Protecting-Rights-and-Preventing-Abuse/Long-term-Care-Ombudsman-Program + National Consumer Voice at ltcombudsman.org. NORS data since 1996. FY22: ~180,000 complaints; 70% from/about NH residents; top complaint categories discharge / eviction, response time, medications. Visit cadence FY22: 47% of NHs got quarterly routine visits; only 19% of residential-care communities did. Facility-level complaint data is NOT generally public. Exceptions: California's CHHS Open Data Portal at data.chhs.ca.gov/dataset/long-term-care-ombudsman-complaints-in-residential-care-facility-for-the-elderly-settings (facility-level); Texas state annual report at hhs.texas.gov/sites/default/files/documents/ltcs-sfy-2023-annual-report-nov-2023.pdf (county / regional). Integration: hard — CA facility-level CSV + 49 states of aggregate text.

4.3 Private / academic / nonprofit sources

NYU / Stern private equity in health care research

Sabrina Howell's group at NYU Stern, collaborating with colleagues across NYU Wagner, Wharton, and Chicago. URLs: wagner.nyu.edu/focus/areas/health; stern.nyu.edu/faculty/bio/sabrina-howell; key paper at nber.org/papers/w28474. Canonical citation: Gupta, Howell, Yannelis, and Gupta (2024), "Owner Incentives and Performance in Healthcare: Private Equity Investment in Nursing Homes," Review of Financial Studies 37(4): 1029–1077. Headline: PE ownership increases short-term mortality of Medicare patients by ~10%, implying ~20,150 lives lost over 12 years in the sample. Mechanisms: declines in frontline nurse staffing, worse compliance with care standards, increased antipsychotics, higher Medicare billing. Gandhi, Song, Upadrashta (2020 / 2023) on PE-owned SNFs under COVID — higher cases and deaths. Access: papers free on NBER / SSRN; published journal versions often paywalled. Integration: cite-only for papers; medium to ingest replication state-year panels. Persona: high for discharge planners and ALCMs; critical editorial anchor.

KFF Kaiser Family Foundation

Nonprofit, nonpartisan. URLs: kff.org/medicaid/a-look-at-nursing-facility-characteristics/ (2025 edition); kff.org/medicaid/5-key-facts-about-nursing-facilities-and-medicaid/; kff.org/medicaid/medicaid-home-care-hcbs-in-2025/. Coverage: annual nursing facility and HCBS characteristics; 50-state Medicaid LTSS survey (with Health Management Associates); ownership (for-profit, nonprofit, government, PE, REIT), staffing, deficiency rates, resident demographics. Unit: facility for NH work (derived from Care Compare + CASPER); state-level for Medicaid LTSS design. Cadence: annual for flagship briefs; HCBS 50-state survey every 1–2 years. Access: free web; downloadable tables. Key 2024–2026 facts: 1.2M residents July 2024; Medicaid primary payer 60%+; share of facilities with serious deficiencies rose from 17% (2015) to 27% (2025); 2025 reconciliation law lowered Medicaid home-equity limits for NF applicants to $1M starting 2028; 2024 minimum staffing rule vacated (May 2025) and rescinded (December 2025). Integration: easy to cite; medium to ingest specific indicators. Persona: broad.

LTCFocus.org (Brown University)

A product of the Shaping Long-Term Care in America project at Brown's Center for Gerontology and Healthcare Research (Vincent Mor and colleagues), funded by NIA. URL: ltcfocus.org; data at ltcfocus.org/data. 70+ measures over 17+ years at NH, county, and state levels — facility characteristics, resident acuity, market competition, geocoded locations, state LTC policy indicators. Unit: NH / county / state. Cadence: annual. Access: free CSV download with click-through user agreement. Focused on nursing homes, not AL. Lags 1–2 years. Integration: easy-medium; ingestable. Persona: research-grade; backs Placet's credibility.

Commonwealth Fund

LTC topic hub at commonwealthfund.org/trending/long-term-care; 2025 Scorecard on State Health System Performance; 2025 Medicare State Scorecard; Healthcare Access for Older Adults (10-country survey, 2024–2025). Coverage: state performance rankings, Medicare beneficiary experience, international comparisons. Unit: state + international. Cadence: annual / biennial. Access: free PDF reports. Integration: cite-only primarily; indicator data reproducible. Persona: editorial voice, not facility lookup.

The SCAN Foundation

LA-based aging-services philanthropy. URL: thescanfoundation.org. State-by-state LTSS fact sheets; long-running co-funder of AARP LTSS Scorecard; older-adult consumer experience research. Cadence: irregular. Access: free. Integration: cite-only for qualitative framing.

AARP Public Policy Institute — LTSS State Scorecard

URL: ltsschoices.aarp.org. Most recent edition: 5th, 2023 ("Innovation and Opportunity"). Next expected 2026. Methodology: ltsschoices.aarp.org/scorecard-report/methodology. 50 indicators across 5 dimensions: affordability / access; choice of setting / provider; safety / quality; support for family caregivers; community integration. Unit: state. Access: free web; indicator data + technical appendices downloadable. Limitations: triennial; several indicators lag 2–3 years. Integration: easy to cite; medium to ingest. Persona: family, ALCM.

Health Affairs / Health Services Research

URLs: healthaffairs.org; onlinelibrary.wiley.com/journal/14756773. Peer-reviewed journals, paywalled for most articles. Health Affairs Forefront blog is free. Coverage: staffing, quality, Medicaid, PE ownership, hospice, home health, COVID. Integration: cite-only. Persona: editorial.

LeadingAge LTSS Center @ UMass Boston

Joint research center of LeadingAge and the Gerontology Institute at UMass Boston. URL: ltsscenter.org. Coverage: workforce, quality, consumer experience, innovation pilots. Access: free reports. Institutional context: co-housed with LeadingAge (the nonprofit senior-services trade association); readers should note that affiliation when weighing the center's framing against for-profit-operator-inclusive research. Integration: cite-only with attribution of the LeadingAge co-affiliation.

Center for Medicare Advocacy

CT-based beneficiary-advocacy nonprofit. URL: medicareadvocacy.org. Coverage: nursing home enforcement, Medicare appeals, observation status, PE ownership critique. Access: free. Advocacy voice — factual, pro-beneficiary. Integration: cite-only with attribution. Persona: discharge planner, ALCM, legally sophisticated family.

4.4 Industry trade associations

LeadingAge + Ziegler 200 (LZ 200)

URLs: leadingage.org; LZ 200 at leadingage.org/leadingage-ziegler-200/ and ziegler.com/what-we-do/investment-banking/senior-living/2025-leadingage-ziegler-200-lz-200-publication/. Ranks the 200 largest nonprofit multi-site senior-living organizations. 22nd edition (September 2025): 300,000+ units across ~1,600 communities; National Senior Communities #1 with 23,329 units. Unit: parent organization. Cadence: annual (September). Access: free summary; full PDF free with registration. Limitations: nonprofit-only; excludes for-profit and PE operators (most of market). 74% plan campus expansion; 13% new builds. Integration: cite-only; underlying org-level unit counts ingestable.

Argentum

Assisted living trade association (formerly ALFA). URL: argentum.org. Publishes annual "State of Seniors Housing" (joint with ASHA / NIC / LeadingAge / NCAL) and "Largest Providers" (2025 at argentum.org/wp-content/uploads/2025/07/2025-Largest-Providers.FINAL_.pdf). Cadence: annual. Access: free member-facing PDFs; detailed operator survey data behind membership / paywall. Industry-advocacy framing. Integration: cite-only.

NCAL (National Center for Assisted Living), under AHCA/NCAL

URL: ahcancal.org/Assisted-Living/Facts-and-Figures/. Represents ~5,300 AL communities (Q4 2025 claim). Publishes "Assisted Living Facts & Figures" annually — ~32,231 AL communities and ~1.2M licensed beds. Integration: cite-only.

AHCA

SNF trade association. URL: ahcancal.org. Publishes "Nursing Home Facts and Figures," workforce surveys, and policy advocacy materials. AHCA filed a lawsuit challenging the 2024 CMS minimum-staffing rule (American Health Care Assoc. v. Becerra, N.D. Tex.) and has publicly opposed the rule in its own communications [cite AHCA press releases]. Integration: cite-only, paired with non-industry primary sources.

NIC (National Investment Center for Seniors Housing & Care) — NIC MAP

URLs: nic.org; nicmap.com (formerly NIC MAP Data Service; now NIC MAP Vision after 2021 VisionLTC merger). Gold standard for operator / market benchmarking — 35,000+ properties nationwide; rate, occupancy, construction pipeline, and transaction data for 15,000+ properties across 140 MSAs. Unit: property, operator, MSA. Cadence: quarterly core; monthly select. Access: paywalled subscription — aimed at operators, REITs, lenders, institutional investors. Some aggregate occupancy figures in quarterly NIC press releases. Integration: research-only / cite-only.

4.5 Consumer-facing referral-fee directories

These four consumer directories share an economic model in which contracted senior-living communities pay the directory a placement fee when a user's inquiry results in a move-in. The category's economic structure is documented in Sen. Bob Casey's June 17, 2024 letter to A Place for Mom [Casey press release], in Senior Housing News trade coverage, and on the companies' own "advisors" / "how we work" pages. Because facility universe on these directories is limited to communities under contract, Placet should treat them as market competitors rather than as primary data vendors — ingesting their rosters would import the placement-contract-based subset into Placet's facility universe.

A Place for Mom

URL: aplaceformom.com. Silver Lake and General Atlantic announced their acquisition of A Place for Mom in July 2017, completed August 2017 (PR Newswire press release, July 5, 2017; McKnight's Senior Living; Senior Housing News). A Place for Mom has publicly stated a network of approximately 14,000+ contracted communities. APFM's own advisor pages describe a placement-fee model; industry trade press (Senior Housing News) and Sen. Casey's June 17, 2024 letter describe placement fees in the range of roughly one month's resident rent, commonly cited at $3,000–$5,000 per move-in. APFM's search results are drawn from its contracted community network (per the company's own disclosures and the referral-fee category's economic structure). Sen. Casey's June 17, 2024 letter (Casey Senate press release, June 20, 2024) cited a Washington Post analysis finding that more than a third (approximately 37.5%) of facilities APFM recommended as "Best of Senior Living" across 28 states had been cited by state regulators for neglect or substandard care in the prior two years; and cited APFM-provided data that 38% of families placed into AL paid monthly rent above their stated upper-limit budget (55% for memory-care placements). A Place for Mom has not been charged with, or found liable for, any specific claim referenced in the Senate letter as of this document's compilation date; the letter was a congressional information request, not an enforcement action. Integration posture: do not use APFM's facility roster or honoree lists as primary facility coverage; cite as a market reference with the sources above.

Caring.com

URL: caring.com. Caring operates on a similar referral-fee placement model (per the company's "For Partners" pages and industry trade coverage). User reviews are displayed on community pages. Integration posture: do not use Caring's facility roster or showcase placements as primary facility coverage.

Seniorly

URL: seniorly.com. Venture-backed company; Seniorly's own methodology page describes approximately 50,000 community listings and an ML-based pricing estimator, with confirmed pricing displayed where available. Seniorly also operates on a referral-fee placement model (per its own disclosures). Integration posture: same as other sources in this category — cite rather than ingest as primary.

SeniorAdvisor.com

URL: senioradvisor.com. Operated as a subsidiary brand of Caring.com; shares the Caring referral pipeline. Integration posture: same as Caring.

4.6 Quality methodology references

U.S. News & World Report Best Nursing Homes

URLs: health.usnews.com/best-nursing-homes; 2026 methodology update at health.usnews.com/health-news/blogs/second-opinion/articles/2025-10-20/updated-methodology-for-2026-best-nursing-homes-ratings. ~15,000 facilities; separate Short-Term Rehab (17 measures, 40% outcomes weight) and Long-Term Care (17 measures, 20% outcomes weight) ratings across Staffing / Process / Outcomes. Data: CMS + LTCCC antipsychotic-use measure. Integration: cite-only for rankings (copyrighted compilation); Placet can replicate from CMS Provider Data Catalog directly.

Newsweek America's Best Nursing Homes (with Statista)

URLs: rankings.newsweek.com/americas-best-nursing-homes-2026; methodology PDF at assets.newsweek.com/wp-content/uploads/2025/09/20250916_Methodology_Nursing-Homes-US-2026.pdf. 1,200 facilities, 33 states. 2026 weights: Performance 55%, Reputation (peer survey) 30%, Accreditation 10%, Resident Satisfaction (Google reviews) 5%. Integration: cite-only.

LongTermCare.gov / ACL

URL: acl.gov/ltc. Public-domain government work. Plain-language explainers on paying for care, types of care settings, advance planning. Integration: easy — ingestable verbatim with attribution.

4.7 Ownership / corporate

SEC filings — publicly traded senior-living operators

Free at sec.gov/edgar/search/. Ensign Group (NASDAQ: ENSG) — SNF and transitional care operator, CIK 0001125376. Brookdale Senior Living (NYSE: BKD) — a large U.S. senior-living operator; scale and recent transaction activity should be cited from the company's most recent 10-K / 10-Q filings at the time of publication (per the FY2024 10-K filed February 2025 and subsequent 10-Q filings, Brookdale reported operating several hundred communities across more than forty states; specific unit, revenue, and transaction figures should be pulled directly from the filing date-of-record). Integration: easy — 10-K "Properties" schedules (community-by-community lists), lease-obligation tables, and risk-factor sections are particularly useful.

SEC filings — healthcare REITs with senior housing exposure

10-K property-exhibit tables are structured, ingestable, and authoritative for "who owns the real estate." Cross-referencing REIT property lists to operator identities reveals the operator-vs-landlord structure that obscures accountability. Integration: easy.

Private equity deal databases

PitchBook (pitchbook.com), Preqin (preqin.com), S&P Capital IQ (capitaliq.com), Crunchbase / CB Insights. Subscription; licensing explicitly prohibits redistribution into derivative products. Integration: research-only.

Private Equity Stakeholder Project (PESP)

pestakeholder.org. PESP is an advocacy-research nonprofit; its reports should be cited with that positioning disclosed, and its specific operator-attribution claims should be cross-referenced to primary sources (bankruptcy dockets, SEC filings, state SoS records) before ingestion. PESP's April 2025 report "Private Equity Is Continuing to Acquire — and Bankrupt — Nursing Homes" (pestakeholder.org/wp-content/uploads/2025/04/PESP_Report_NursingHomes_April2025.pdf) summarizes publicly-filed Chapter 11 and restructuring events in the PE-owned nursing-home segment during 2021–2024. Placet does not republish PESP's specific operator attributions in its own voice; readers should consult the PESP report directly and verify any specific-operator bankruptcy claim against the underlying PACER court docket before citation. PESP estimates PE ownership at roughly 5–13% of U.S. nursing homes (with a caveat that the true share is likely higher given CMS ownership-data gaps); PESP's senior living summary identifies eight of the largest U.S. senior-living operators as PE-owned per its 2024 analysis, covering 968 properties / 152,392 units. Integration: cite-only for PESP's analysis; facility-level operator attributions should be validated against CMS SNF All Owners, SEC filings, or court records before use on a facility page.

Secretary of State LLC filings

50 states + DC + territories; each state maintains its own entity database. Highest-quality consumer access: Florida Sunbiz (search.sunbiz.org) — free search including officer / manager names; California bizfileonline.sos.ca.gov; Delaware icis.corp.delaware.gov (Delaware entity filings include the entity but do not require member / manager name disclosure under current statute); New York apps.dos.ny.gov/publicInquiry; Texas mycpa.cpa.state.tx.us/coa/. Lower-quality access (paywalled search, CAPTCHA, minimal fields, or narrow disclosure requirements) includes AL, MS, AR, WV, WY, NV, NM. Wyoming and Nevada LLC statutes require disclosure of fewer beneficial-ownership fields than many other states (per state business-entity code comparisons; see e.g. the Harvard Law School Forum on Corporate Governance and academic reviews of state LLC-anonymity regimes). FinCEN Corporate Transparency Act beneficial-ownership reporting was narrowed by Treasury in March 2025 to foreign reporting companies only — domestic PE-owned operators no longer file beneficial ownership to FinCEN under current guidance. Integration: medium to hard — state-by-state schema differences, rate limiting, and terms-of-service friction.

EMMA / MSRB

emma.msrb.org. Tax-exempt bond offering documents and continuing disclosures for CCRCs / Life Plan Communities that issue municipal debt (most nonprofit CCRCs). Includes full audited financial statements, occupancy reports, actuarial studies, days-cash-on-hand — often deeper than anything available for for-profit operators. Searchable by CUSIP, issuer name, or state. Free. Unit: obligated group (usually parent nonprofit). Cadence: annual audited + event-driven. Integration: easy to medium (PDF OCR + extraction for continuing disclosures). Persona: critical for CCRC due diligence.

4.8 Investigative journalism anchors

These are the stories that shaped public understanding of PE in senior care 2013–2025. Placet should reference them prominently.

• ProPublica, "Life and Death in Assisted Living" (2013; A.C. Thompson) — foundational investigative series on AL oversight; the series' reporting included cases of resident deaths at facilities then operated by Emeritus Corporation. Emeritus was subsequently acquired by Brookdale Senior Living in July 2014 (a matter of public record; PR Newswire and company announcements at the time). Placet references the ProPublica series as a historical, pre-acquisition record of that period's AL oversight landscape and does not extend the series' findings to Brookdale's current operations.
• The New York Times, "As Nursing Homes' Profits Grew, Care Suffered" — Silver-Greenberg and Gebeloff series starting 2021, with follow-ups examining PE-backed chains, staffing, and related-party transactions (nytimes.com/2021/09/19/business/nursing-homes-care-corporate.html).
• The New Yorker, "When Private Equity Takes Over a Nursing Home" (Yasmin Rafiei, August 2022) — case study of a 72-bed skilled-nursing facility in Richmond, VA acquired by a private-equity-affiliated owner; the article reported staffing reductions following the acquisition (from approximately 100 to 60 staff, per the Rafiei reporting), pharmacy-contract changes, and associated quality concerns. Specific operator and ownership names are identified in The New Yorker article; Placet does not republish those names in its own voice and directs readers to the article directly for the operators identified.
• The Washington Post, "Memory Inc." (2023–24; Christopher Rowland) — a reporting series on elopement deaths in assisted living and memory care; a separate Post report in April 2024 covered Brookdale Senior Living's use of staffing-scheduling software, based on internal documents reviewed by the Post; the Post reported approximately 100 wandering-related deaths industry-wide since 2018 across AL and memory care operators (per the Post's analysis).
• The New York Times (Jordan Rau, 2023–24) — "U.S. Pays Billions for 'Assisted Living,' but What Does It Really Get?" and "What to Know about Assisted Living" (Nov 11, 2023).
• Human Rights Watch, "They Want Docile" (2018) — report on antipsychotic medication use in U.S. nursing homes; 2021 "US: Concerns of Neglect in Nursing Homes."
• GAO-18-179, "Better Oversight Needed of Assisted Living Facilities that Serve Medicaid Beneficiaries," and its 2024 follow-up; the 20,000-critical-incidents figure is drawn from state Medicaid-agency reporting summarized in GAO and Senate Aging Committee materials.
• GAO-23-105324 on nursing home ownership transparency — GAO's analysis of CMS ownership-file quality concluded that the data available at that time did not adequately capture private equity ownership structures (see GAO report language).
• Senate Special Committee on Aging, January 25, 2024 hearing and associated press releases (the committee's own materials characterize the hearing as the most significant Congressional review of assisted living in approximately 20 years).

4.9 Recent regulatory developments (2023–2026)

5. Persona → source crosswalk

This section translates "which data source should a given user reach for" into concrete scenarios. In practice, Placet will compose many of these answers automatically by joining across sources; the crosswalk is here so the editorial logic is explicit.

5.1 Discharge planner choosing between two SNFs for a complex dementia patient

Five sources in combination answer the real question: CMS Care Compare (Five-Star + three years of deficiency history, surface the current dementia-related QMs — antipsychotic use for long-stay residents), the CMS SNF Ownership / SNF All Owners dataset (PE or REIT flag on either facility), the CMS PBJ (nurse hours per resident day over the most recent four quarters, not just the smoothed star-rating average; turnover on RN and overall nursing; weekend-staffing component), the CMS Special Focus Facility list plus the candidate list (hard-avoid signal), and LTCFocus for resident mix and historical staffing trajectory. Add: the state AG / MFCU press feed (any open case against the operator?), and the facility's CCN-level complaint narratives in the PDC NH_HealthCitations file filtered for recent scope-and-severity G / H / I / J / K / L deficiencies.

What none of these answer: whether the facility is accepting admissions tonight, whether the dementia-designated unit has an open bed, and whether they take the specific Medicare Advantage plan. For those, the discharge planner is still on the phone.

5.2 Family choosing an AL community for a parent with early-stage dementia

Five sources: the state licensing roster (FL FloridaHealthFinder, TX TULIP, CA CCLD + the CHHS data hub, etc.) for inspection narrative and deficiency history; CANHR or state-equivalent advocacy counter-data in states where the official data is journalistically suspect (California principally); the long-term care ombudsman complaint data where available (California has facility-level RCFE complaints on data.chhs.ca.gov); the AARP LTSS State Scorecard for macro indication of whether this is a state whose AL regulation you can trust; the state AG press feed for any facility-linked enforcement in the last 24 months. Add: a memory-care specialty discloser — is the state one that requires specific dementia training documentation (FL, a handful of others)? If yes, surface the endorsement.

What none of these answer: what will care actually feel like? That is the tour question. The product should generate the tour questions.

5.3 Aging life care manager evaluating a CCRC for a client planning a $400,000 entry fee

Five sources: the state CCRC financial disclosure if the state regulates (PA Insurance Department, CA CDSS Continuing Care Contracts Branch annual reports, FL OIR exam reports, MD, VA, NC, IL, WA, NJ, OR); the EMMA / MSRB continuing disclosure if the community has tax-exempt bonds outstanding (free audited financials and days-cash-on-hand, particularly for the 12 non-regulator states); the Ziegler 2024 CCRC Default Study for industry-median benchmarks to compare the target's ratios against; the LZ 200 for context on the parent organization's scale and trajectory; the facility's SNF wing data on CMS Care Compare (because resident outcomes at the SNF level predict what will happen if the client needs Level 3 care in five years).

5.4 Low-income family searching for subsidized senior housing

Five sources: the National Housing Preservation Database for elderly-designated properties (and critically, their subsidy-expiration dates); the HUD Section 202 feature service for 202-specific inventory; the HUD Multifamily Assistance & Section 8 Contracts Database for PBRA; the HUD LIHTC database with the TARGET_POP elderly filter; the USDA Rural Development 515 / 538 list if rural. Add: HUD Income Limits / FMRs to confirm eligibility; REAC physical-inspection score to signal building condition; and the Picture of Subsidized Households for a rough waitlist-pressure proxy at the state / CBSA level.

5.5 Patient and family considering PACE as an alternative to nursing home placement

Three sources: the National PACE Association Find-a-PACE locator; the state Medicaid waiver pages (PACE is a 1934 / 1894 authority — state Medicaid agencies are the authorized enrollee; eligibility rules vary); the MACPAC PACE analysis for capitation and cost context. PACE quality data at the program level is thin — this is a Placet editorial-research opportunity.

5.6 Journalist or regulator investigating a chain

Six sources: the CMS SNF All Owners dataset for facility-level ownership including PE / REIT flags; the PESP April 2025 report for named-operator context; SEC 10-K filings for any publicly traded operator or landlord REIT; state Secretary of State entity lookups (Florida Sunbiz best) to trace LLC ownership; EMMA / MSRB bond disclosures for any CCRC / nonprofit chain; the relevant state AG press feed for enforcement history. Add CMS PDC NH_Penalties for 3-year fine and payment-denial history, and LTCFocus for multi-year trajectory.

6. Integration roadmap for Placet

Ordered, opinionated. Subject to Placet's engineering throughput and market priorities; this is the sequence that maximizes transparency differentiation per unit of engineering effort.

Next immediately after HUD vertical. CMS nursing home family — Provider Data Catalog (all nursing home topic datasets) on monthly cadence; CMS SFF PDFs parsed to structured CSV; CMS SNF All Owners for PE / REIT flags; PBJ for staffing trend; LTCFocus for academic enrichment. Build the single Best-in-class nursing-home detail page — five-star + underlying PBJ trend + ownership PE flag + three years of deficiency narrative + SFF status + ombudsman / AG link if applicable.

Then Florida + Texas + North Carolina AL. These three states have publicly accessible inspection-report data and mature regulator portals. Parse the FloridaHealthFinder PDF survey narratives, ingest the TULIP Health Deficiency and Life Safety Code feeds, and pull the DHSR ACLS star ratings. Build the AL detail page: state-licensed provider status, last inspection date, deficiency narrative, complaint count, capacity, owner of record, memory-care endorsement if applicable, and overlay with CMS Care Compare data for any co-located SNF.

Then California with the CANHR overlay. California's RCFE universe is the largest in the country (~7,700 facilities). CDSS publishes structured roster and citation data; multiple years of ProPublica reporting have documented operational gaps in CDSS RCFE inspection cadence and enforcement follow-through; CANHR is a respected independent source that maintains parallel public datasets. Place both datasets on the page, side by side, and explain the discrepancies editorially with primary-source citations. This is the single highest-brand-signal integration Placet can build.

Then New York + Illinois + Pennsylvania roster-first. Ingest the easy parts of these states' data (NY Socrata ACF API, IL data.illinois.gov CSV, PA's daily DHS directory) and leave inspection detail as FOIA-follow-up for a later phase. The editorial framing on these state pages should explicitly note what is and is not publicly available.

Then CCRC financial solvency scorecard for PA, CA, FL, MD, VA, NC, IL, WA, NJ, OR. Parse the state CCRC annual disclosure statements and build a standardized solvency scorecard per community: days cash on hand, debt-service coverage ratio, occupancy, average entry fee, refund structure, actuarial adequacy where studies are filed. Overlay with EMMA / MSRB for communities with tax-exempt debt to fill in the non-regulator-state gap. No existing consumer product does this.

Then the PACE + adult day layer. NPA Find-a-PACE ingestion + state Medicaid waiver cross-reference for enrollee eligibility; the NADSA member directory plus state-health-department ADS lists. This is a relatively small data volume, but the consumer gap is enormous.

Then home health, hospice, IRF, LTCH from CMS PDC. Relatively mechanical — CMS provides clean, documented, facility-level data. The value-add here is presentation (the current Care Compare hospice interface is hard to use) and cross-walking (which facilities have co-located home-health and hospice capability).

Then ownership graph — v1. Join CMS SNF All Owners + SEC 10-K REIT property exhibits + PESP named-operator lists + Florida Sunbiz + selected other state SoS feeds. Produce operator-level aggregation pages with facility counts, average Five-Star, and ownership-type flags (public, private-pay, nonprofit, PE-affiliated, REIT-landlord), sourcing every claim to the underlying primary dataset (CMS ADP / SEC exhibit / state SoS filing). This is the feature professional aging life care managers will pay for and evangelize.

Then state AG press-feed scraper. 50-state press-release scraper + NLP classifier → facility-linked enforcement feed → facility detail page signal.

Partnerships to seek. LTCFocus / Brown — direct collaboration on academic advisory voice. NHPD / NLIHC — bulk subscription for non-mapping-tool features. CANHR — data-reciprocity agreement for California. Individual state ombudsman programs — facility-level complaint data where available. State CCRC residents' associations (NaCCRA, CALCRA, WACCRA) — advisory relationships for community-level intelligence. ResDAC (indirectly) if the team ever pursues academic grants for restricted-use MDS work.

Deliberately NOT to build in v1.

Bed availability. No reliable public dataset exists. Building this credibly requires partnerships with health systems or aggregation of proprietary operator systems. Not worth the complexity yet.

Ingestion of APFM / Caring / Seniorly data as primary facility coverage. Structurally. Ingesting these sources' rosters as primary data would import the referral-fee category's placement-contract-based subset into Placet's facility universe. Cite these sources as market references and explain the category's economic model openly; do not use them as a primary ingestion layer.

Reviews. Do not build a consumer-review system until there is an explicit plan for moderation, provenance, and cross-source weighting. Review-heavy products without strong provenance and moderation can drift toward the structural failure modes of the referral-fee directory category; the editorial posture depends on not going there.

A national five-star-style composite of AL. Without federal data or uniform state reporting, a single-number composite for AL would overstate precision. Better to surface the underlying state data with clear "what we don't know" framing.

Known hard problems.

AL state-by-state ingestion. The 50-state heterogeneity is genuinely hard; schema changes are frequent (IL's 2024–2025 migration is an example); PDF parsing of inspection narratives is engineering-heavy. Prioritize per the sequence above and accept that this is a 2–3 year build to reach 50-state coverage with meaningful quality.

Ownership graph completeness. CMS's self-reported ownership data has gaps; Secretary of State LLC filings vary wildly; Wyoming and Nevada are designed for anonymity; the 2025 Treasury narrowing of FinCEN CTA reporting eliminated the domestic PE beneficial-ownership backstop. The ownership product will always be "what we know" rather than "what is." Document the gaps explicitly.

CCRC solvency across non-regulator states. EMMA / MSRB covers nonprofit CCRCs with tax-exempt debt; for-profit CCRCs in non-regulator states are the hardest case. Partial coverage is still a huge consumer advance over nothing.

Entity resolution across data sources. CMS uses CCN; HUD uses REMS property ID; LIHTC uses HUD_ID; state licensing systems use state license numbers; SEC 10-Ks use ad-hoc naming; PE databases use ad-hoc naming. Getting to a canonical Placet facility ID across all of this is a long-running engineering commitment.

Inspection-data modernization pause. CMS's July 30, 2025 pause means SNF inspection ratings are frozen for some facilities. Placet must show last-inspection-date prominently and not hide stale data behind a current-looking star.

7. Gaps the landscape doesn't solve

An honest section on what no dataset currently captures, followed by what responsible original research or crowdsourcing could look like.

What no dataset captures

Staff turnover as it feels day-to-day. PBJ captures nurse hours by labor category. Turnover is a star-rating input. But "the aide who has known my mother for eighteen months" vs. "an agency temp who is new tonight" is what determines her actual experience, and nothing in the federal data structure surfaces this at the individual-resident level. The state AL regimes are worse — there is no AL equivalent of PBJ at all.

Food quality. Nothing systematic exists. Dining is consistently the third- or fourth-ranked dissatisfaction driver in senior-living survey work, but food-service quality is a regulator-blind variable.

The complaint reality behind the inspection narrative. CMS deficiency narratives are written by state surveyors in legal-evidentiary prose. They are not the residents' or families' experience of what happened. The LTC Ombudsman complaint data at the state level (80–85% of complaints never make it into CMS deficiencies) captures more of this, but almost all of it is aggregate, not facility-level, and is not consumer-accessible.

Equity gaps in subsidized availability. Section 202 inventory has not grown since 2011; in many MSAs there is a 1–10 year waitlist. The geographic distribution of subsidized senior housing is highly unequal, and no dataset maps the availability gap against the eligible population at the tract or CBSA level. Placet could build this from HUD Picture of Subsidized Households + Census ACS + NHPD.

What actually happens to CCRC entry fees when the operator fails. Ziegler's CCRC Default Study tracks bond defaults; state regulators track financial distress; but the individual-resident refund experience — what percentage of entry-fee promises have been honored in the bankruptcies of the last 20 years — is a research gap that affects how to interpret every entry-fee disclosure statement.

Clinical capability by facility. Whether a given SNF can manage a vent-dependent patient, an IV antibiotic patient, a behavioral dementia patient, or a bariatric patient is phone-driven. No dataset surfaces it. This is the discharge planner's hardest everyday research problem.

Insurance acceptance, especially Medicare Advantage plan-by-plan. MA prior-auth denials for SNF / IRF / LTCH / home health are increasing; plan-specific facility contracting is unstable; this is almost entirely phone-research territory.

Memory-care quality. Not a regulated tier in most states, therefore not a category in most datasets. A facility can put a "memory care" sign on a locked wing with no specialty training or programming and no public data source will flag this.

Real price. Not state averages. Not "starting at" figures. Not Genworth. The actual price this specific community will charge a specific resident next year — and the escalation path across five years — is the single most common consumer frustration and the single biggest data gap in senior living.

Where Placet could do original research or crowdsourcing, responsibly

Any of these would be meaningful editorial products.

A tour-day survey instrument. Ten to fifteen questions a tour-goer can answer from their phone as they leave a tour. What time of day was the tour; how long did they wait for someone to greet them; how many residents were visibly engaged vs. asleep in common areas; how did the food smell; what questions did staff dodge. Aggregate to facility level with strong de-identification. Publish with clearly-labeled sample-size caveats.

A caregiver exit interview. With consent, partner with home-care and AL operators (at first, the ones who are brave and confident) to survey departing direct-care staff on their reasons for leaving. Publishable only in aggregate at the operator or chain level. This is the closest honest proxy available for staffing culture.

A CCRC refund-history tracker. A volunteer research project to document, case by case, what happened to entry-fee refund promises in every CCRC bankruptcy or restructuring since 2000. Publish as an editorial resource, not a predictive scorecard.

An equity-gap map. Take HUD + Census + NHPD data and map elderly-designated subsidized units per 1,000 eligible elderly (65+, <50% AMI) at tract, CBSA, and state level. Publish as a research deliverable and a state-policy advocacy artifact.

A "state AL regulator transparency scorecard." Classify all 50 states on an observable-access rubric: states that publish searchable inspection narratives online, states that publish only a facility roster, states where inspection detail requires a public-records request, and states where even rosters are not online. Update annually, publish the methodology, and describe each state on the basis of observable online access rather than on characterizations of state agencies' intent or competence.

A food-and-feel crowdsourced review system, with tight moderation. Built after, not instead of, the primary-data product. Moderated for review-farming and astroturfing. Weighted against the primary data (e.g., discount a glowing review from a facility with serious deficiencies). Published with explicit-disclosure of methodology and limitations.

8. Appendix

8.1 Primary URL index (verified April 2026)

CMS

• Medicare Care Compare: https://www.medicare.gov/care-compare/
• Provider Data Catalog: https://data.cms.gov/provider-data/
• SNF Provider Information: https://data.cms.gov/provider-data/dataset/4pq5-n9py
• SNF Ownership (PDC): https://data.cms.gov/provider-data/dataset/y2hd-n93e
• SNF All Owners (expanded 2023 rule): https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/skilled-nursing-facility-all-owners
• SNF Change of Ownership: https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/skilled-nursing-facility-change-of-ownership
• PBJ Daily Nurse Staffing: https://data.cms.gov/quality-of-care/payroll-based-journal-daily-nurse-staffing
• HCRIS SNF: https://data.cms.gov/provider-compliance/cost-reports/skilled-nursing-facility-cost-report
• Five-Star / FSQRS page: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS
• Medicare FFS Public Provider Enrollment (PECOS extract): https://data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/medicare-fee-for-service-public-provider-enrollment
• SNF 2540-10 cost report form: https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports/skilled-nursing-facility-2540-2010-form
• ResDAC MDS 3.0: https://resdac.org/cms-data/files/mds-30

HUD

• Multifamily Assistance & S8: https://www.hud.gov/hud-partners/multifamily-assist-section8-database
• Section 202 feature service: https://hudgis-hud.opendata.arcgis.com/datasets/hud-section-202-properties/about
• Picture of Subsidized Households: https://www.huduser.gov/portal/datasets/assthsg.html
• LIHTC: https://www.huduser.gov/portal/datasets/lihtc.html
• PIS (physical inspection scores): https://www.huduser.gov/portal/datasets/pis.html
• NSPIRE program: https://www.hud.gov/reac/nspire
• FMR API docs: https://www.huduser.gov/portal/dataset/fmr-api.html
• Income Limits: https://www.huduser.gov/portal/datasets/il.html
• NHPD: https://preservationdatabase.org/

USDA / Census / Federal-other

• USDA RD MFH data: https://www.sc.egov.usda.gov/data/MFH.html
• Census ACS 5-year developer: https://www.census.gov/data/developers/data-sets/acs-5year.html
• AHS 2023 PUF: https://www.census.gov/programs-surveys/ahs/data/2023/ahs-2023-public-use-file--puf-.html
• ACL AGID: https://agid.acl.gov/
• ACL LTSS content (was LongTermCare.gov): https://acl.gov/ltc
• Senior Nutrition: https://acl.gov/senior-nutrition/data-and-reports
• VA CLC program: https://www.va.gov/geriatrics/pages/va_community_living_centers.asp
• VA CLC location PDF: https://www.va.gov/geriatrics/docs/VA_Community_Living_Center_Locations.pdf
• IHS Locations: https://www.ihs.gov/locations/
• CMS Tribal NH & AL Directory 2026: https://www.cms.gov/files/document/tribal-nursing-home-assisted-living-facility-directory-2026.pdf

State portals

• FL AHCA FloridaHealthFinder: https://quality.healthfinder.fl.gov/
• CA CDSS CCLD Facility Search: https://www.ccld.dss.ca.gov/carefacilitysearch/
• CA CCLD Data Hub: https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/ccld-data
• TX HHSC LTC Provider Search: https://apps.hhs.texas.gov/LTCSearch/
• TX TULIP: https://tulip.hhs.texas.gov/TULIP/s/ltc-provider-search
• IL LLCS Facility Lookup: https://llcs.dph.illinois.gov/s/facility-lookup?language=en_US
• IL AL + Shared Housing open dataset: https://data.illinois.gov/dataset/379idph_assisted_living_and_shared_housing_licensed_establishments_listing
• NY ACF Directory (Socrata): https://health.data.ny.gov/Health/Adult-Care-Facility-Directory/wssx-idhx
• NY ACF profiles: https://profiles.health.ny.gov/acf/
• OH ODA Navigator: https://aging.ohio.gov/navigator
• PA Human Services Provider Directory: https://www.humanservices.state.pa.us/HUMAN_SERVICE_PROVIDER_DIRECTORY/
• NC DHSR ACLS star search: https://info.ncdhhs.gov/dhsr/acls/star/search.asp
• PA Insurance Dept CCRC filings: https://www.pa.gov/agencies/insurance/filing-reporting-requirements/financial-filing-requirements/ccrc-filing
• CA CDSS CCRC annual reports: https://www.cdss.ca.gov/inforesources/community-care/continuing-care/annual-reports
• CA LTCO RCFE complaint data: https://data.chhs.ca.gov/dataset/long-term-care-ombudsman-complaints-in-residential-care-facility-for-the-elderly-settings

Private / academic / industry

• LTCFocus: https://ltcfocus.org/ and https://ltcfocus.org/data
• KFF NF characteristics: https://www.kff.org/medicaid/a-look-at-nursing-facility-characteristics/
• KFF HCBS 2025: https://www.kff.org/medicaid/medicaid-home-care-hcbs-in-2025/
• AARP LTSS State Scorecard: https://ltsschoices.aarp.org
• Commonwealth Fund LTC: https://www.commonwealthfund.org/trending/long-term-care
• SCAN Foundation: https://www.thescanfoundation.org
• LeadingAge: https://leadingage.org
• Argentum: https://www.argentum.org
• NCAL / AHCA: https://www.ahcancal.org
• NIC: https://www.nic.org and https://www.nicmap.com
• Center for Medicare Advocacy: https://medicareadvocacy.org
• NaCCRA: https://www.naccra.com/
• Ziegler 2024 CCRC Default Study: https://www.ziegler.com/media/crgmi4kc/ziegler-credit-surveillance-special-report-2024-ccrc-default-study.pdf
• CANHR: https://canhr.org/
• PESP NH report (April 2025): https://pestakeholder.org/wp-content/uploads/2025/04/PESP_Report_NursingHomes_April2025.pdf
• EMMA / MSRB: https://emma.msrb.org/
• SEC EDGAR: https://www.sec.gov/edgar/search/
• NPA Find-a-PACE: https://www.npaonline.org/find-a-pace-program

Consumer aggregators (cite, do not ingest as primary)

• A Place for Mom: https://www.aplaceformom.com
• Caring.com: https://www.caring.com
• Seniorly: https://www.seniorly.com
• SeniorAdvisor: https://www.senioradvisor.com

Investigative / regulatory anchors

• ProPublica "Life and Death in Assisted Living": https://www.propublica.org/article/elderly-at-risk-and-haphazardly-protected
• ProPublica CA AL unpaid fines: https://www.propublica.org/article/in-california-1-million-in-unpaid-fines-for-assisted-living-centers
• ProPublica Nursing Home Inspect: https://projects.propublica.org/nursing-homes/
• NYT nursing home corporate series (2021): https://www.nytimes.com/2021/09/19/business/nursing-homes-care-corporate.html
• New Yorker PE / nursing home piece (2022): https://www.newyorker.com/magazine/2022/08/29/when-private-equity-takes-over-a-nursing-home
• Washington Post elopement series: https://www.washingtonpost.com/nation/interactive/2023/assisted-living-deaths-elopement/
• HRW "They Want Docile": https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia
• GAO-23-105324 (NH ownership transparency): https://www.gao.gov/products/gao-23-105324
• Senate Aging Jan 2024 hearing press: https://www.aging.senate.gov/press-releases/new-report-reveals-more-than-20000-serious-health-and-safety-incidents-in-assisted-living-facilities-nationwide
• HHS OIG MFCU FY2024 report: https://oig.hhs.gov/reports/all/2025/medicaid-fraud-control-units-annual-report-fiscal-year-2024/
• Sen. Casey APFM letter and McKnight's coverage: https://www.mcknightsseniorliving.com/news/sen-casey-calls-out-a-place-for-mom-over-potentially-deceptive-business-practices/

8.2 FOIA templates (a short note)

For state AL inspection detail not posted online (NY, PA, MA, GA in varying degree), a FOIA / state FOIL / state open-records request should specify: facility name, license number if known, inspection type (standard / focused / complaint), date range, records requested (inspection reports, plans of correction, statements of deficiency, complaint intake records, administrative actions). For HUD MORs, file with the relevant HUD multifamily contract administrator (CA, in most states; TCAs vary). For state ombudsman facility-level complaint data, file with the state Unit on Aging / state ombudsman program. Expect 30–60 days; free or nominal fees; denials are common for anything named individual-identifying and require narrower scoping.

8.3 Recommended further reading

• Gupta, Howell, Yannelis, and Gupta (2024), "Owner Incentives and Performance in Healthcare: Private Equity Investment in Nursing Homes," Review of Financial Studies 37(4): 1029–1077.
• Private Equity Stakeholder Project (April 2025), "Private Equity Is Continuing to Acquire — and Bankrupt — Nursing Homes."
• KFF (2025), "A Look at Nursing Facility Characteristics."
• KFF (2025), "Medicaid Home Care (HCBS) in 2025."
• Ziegler (2024), "CCRC Default Study."
• AARP LTSS State Scorecard, 5th Edition (2023).
• GAO-23-105324, "Medicare & Medicaid: CMS Should Assess Whether Current Data on Nursing Home Private Equity Ownership Are Sufficient" (2023).
• GAO-18-179, "Better Oversight Needed of Assisted Living Facilities that Serve Medicaid Beneficiaries" (2018).
• Yasmin Rafiei, "When Private Equity Takes Over a Nursing Home," The New Yorker (August 2022).
• Jordan Rau et al., ongoing senior-care coverage in The New York Times and KFF Health News.
• ProPublica, "Life and Death in Assisted Living" series.
• Washington Post, "Memory Inc." elopement deaths series.

End of main document.