For-Profit vs. Nonprofit
What the Data Shows
Peer-reviewed research and federal data consistently show for-profit nursing homes provide fewer RN hours and receive more quality citations than nonprofits — though individual facility quality varies widely.
at for-profit vs. nonprofit facilities
vs. nonprofit (no recent ownership change)
at PE-owned facilities vs. other for-profits
Chart 1
RN Hours per Resident Day by Ownership Type
Registered nurse staffing hours, measured per resident per day, from CMS Payroll-Based Journal (PBJ) data analyzed by HHS ASPE (May 2024). Higher hours indicate more direct nursing coverage.
Source: HHS ASPE, "Nurse Staffing Estimates in US Nursing Homes" (May 2024). Data from CMS Payroll-Based Journal (PBJ).
Chart 2
Five-Star Quality Rating by Ownership Type
CMS Five-Star ratings (1–5) reflect inspection results, staffing levels, and quality measures. Analysis by HHS ASPE (2024) across ownership structures from 2013–2022.
Source: HHS ASPE, "Trends in Ownership Structures of U.S. Nursing Homes (2013–2022)." Ratings from CMS Five-Star Quality Rating System.
Chart 3
PE & REIT Ownership: Impact vs. Other For-Profits
Relative change in RN staffing hours and deficiency citation scores compared to non-PE for-profit facilities, from a peer-reviewed JAMA Health Forum study (2022) covering 2013–2019 CMS data.
Source: JAMA Health Forum (2022), "Private Equity Investment in US Nursing Homes." Relative changes from multivariable regression models controlling for facility, market, and time characteristics.
Important: Individual Facilities Vary Widely
These statistics describe population-level averages across thousands of facilities. Many for-profit nursing homes provide excellent care, and some nonprofits underperform. Ownership structure is one factor — not a guarantee of quality in either direction.
When evaluating a specific facility, always check the RN hours per resident day, CMS Five-Star rating, recent inspection results, and staffing stability — all available on each facility's page on this site.
Methodology Note
This data draws on federal CMS Payroll-Based Journal (PBJ) staffing reports, the CMS Five-Star Quality Rating system, and peer-reviewed analyses of nursing home ownership structures. All source studies are linked in the citations below. The HHS ASPE reports (2024) use facility-level CMS data covering the full U.S. nursing home industry from 2013–2022. The JAMA Health Forum study uses multivariable regression models controlling for facility characteristics, market conditions, and time trends to isolate the effect of ownership type.
Individual facility performance varies — use the RN hours and CMS Stars displayed on each facility's page to evaluate the specific facility you're considering.
Citations
- 1.
HHS ASPE. "Nurse Staffing Estimates in US Nursing Homes." May 2024.
HHS ASPE PDF - 2.
HHS ASPE. "Trends in Ownership Structures of U.S. Nursing Homes (2013–2022)." 2024.
HHS ASPE PDF - 3.
Braun RT et al. "Private Equity Investment in US Nursing Homes and the Quality and Cost of Care." JAMA Health Forum. 2022;3(3):e220247.
JAMA Health Forum - 4.
Comondore VR et al. "Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis." BMJ. 2009;339:b2732.
PMC / BMJ - 5.
Center for Medicare Advocacy. "Non-Profit vs. For-Profit Nursing Homes: Is There a Difference in Care?"
Medicare Advocacy