Who runs America's nursing homes — and how they rate

For-profit operators run nearly three-quarters of US nursing homes; 45% of their facilities hold a 1- or 2-star CMS rating, versus 25% of non-profits. And among large chains the spread is wider still — the best 100+-facility chain averages 4.2 stars while several others average under 2.5.

Ownership	Homes	Avg star	Rated 1–2 stars	Turnover (med)	RN hrs/resident/day (med)
For-profit	10,739	2.83	45%	47%	0.53
Non-profit	2,898	3.58	25%	40%	0.79
Government	931	3.29	33%	43%	0.64

Large chains (≥80 facilities), by average CMS rating

Chain	Facilities	Avg CMS star
TRILOGY HEALTH SERVICES	122	4.18
AMERICAN SENIOR COMMUNITIES	91	3.97
LIFE CARE CENTERS OF AMERICA	194	3.50
THE ENSIGN GROUP	337	3.24
COMPLETE CARE	85	3.22
MARQUIS HEALTH SERVICES	88	3.02
SABER HEALTHCARE GROUP	125	2.99
GOOD SAMARITAN SOCIETY	91	2.96
PACS GROUP	274	2.95
COMMUNICARE HEALTH	122	2.95
LEGACY HEALTHCARE	88	2.94
PRUITTHEALTH	99	2.89
CIENA HEALTHCARE/LAUREL HEALTH CARE	83	2.86
SIMCHA HYMAN & NAFTALI ZANZIPER	90	2.52
GENESIS HEALTHCARE	180	2.41
CREATIVE SOLUTIONS IN HEALTHCARE	149	2.28
AVIR HEALTH GROUP	117	2.23

Simple averages of CMS's published per-facility overall ratings. Chain affiliation as reported to CMS.

Read this carefully: Ownership correlates with payer mix, acuity, and geography — this is a system-level pattern, not a verdict on any facility. Chain averages are simple means of CMS ratings (n ≥ 80 facilities shown). All figures are CMS's own published ratings, aggregated.

Source: CMS Care Compare, Nursing Home Provider Information (ratings, ownership, chain affiliation). Computed 2026-06-12; reproducible from the analysis code against the files hashed on the methodology page.

The chain league table proves the point twice: organizations under identical rules and similar ownership diverge by two full stars. Operations decide.

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