How many nursing homes are in the US: CMS counts by ownership, size, state and chain, and the free list

This page is for anyone who needs the number of nursing homes in America, and for companies that sell to them: staffing and scheduling, pharmacy and medical supply, therapy, food service, EHR and billing software, infection control, and facilities services. It sets out each official count, breaks nursing homes down by ownership, size, state and chain, shows the free list and what's in it, and explains who buys. For hospitals, see our list of hospitals.

How many nursing homes there are in the US

Of the 14,686 certified homes, 13,904 take both Medicare and Medicaid, 537 Medicare only and 245 Medicaid only. 608 are located inside a hospital, and 1,548 are part of a continuing care retirement community.

Why the counts differ

• Certification versus licensing. CMS lists only homes certified to bill Medicare or Medicaid. States also license homes that aren't certified, and County Business Patterns counts every establishment classified as a nursing care facility, which is why it finds 18,126.
• Nursing homes aren't assisted living. Assisted living and residential care communities are licensed by states, not certified by CMS, and provide less medical care. NCHS estimates 31,416 of them; County Business Patterns counts 20,884 assisted living facilities for the elderly and 5,639 continuing care retirement communities.
• The list changes monthly. Homes close, open, merge and change owners. CMS refreshes the file each month, so a count from 2022 is a different list from today's.

Nursing homes by ownership

CMS Provider Information, October 2026. 10,681 homes (72.7%) are in urban areas.

Nursing homes by size

The 14,675 homes that report beds. The median home has 100 certified beds. On an average day the homes hold 1,254,183 residents, 80.0% of certified beds (our calculation). County Business Patterns counts 1,426,754 employees in nursing care facilities in 2023, with $63.5 billion in payroll.

Nursing homes by state

CMS Provider Information, October 2026. New York has half as many homes as Texas but nearly as many beds, because its homes are large: 188 beds on average against Texas's 113.

The largest nursing home chains

CMS groups homes into chains that share at least one owner, officer or entity with operational or managerial control. In October 2026, 612 chains ran 10,227 homes (69.6%), and 4,459 homes were independent.

The middle is where most homes are: 278 chains with 10 to 99 homes run 6,656 of them. Those chains are big enough to have a regional operations team and small enough that a vendor can reach the people who decide.

Signals in the CMS file

The same file carries the changes that make a home likely to buy:

Median total nursing staff turnover is 44.7% across the 13,587 homes that report it. As a rule of thumb, a new administrator, a new owner or a low rating means vendors and processes are about to be reviewed.

How to get the list of nursing homes

The CMS file names the legal business name and chain but no people. Federal rules require each home to designate a physician as medical director and to have an administrator licensed by the state where licensing is required, so those roles exist at every certified home; you need their names from elsewhere. To count the industry in Census data, use NAICS code 623110.

Who buys inside a nursing home

As general guidance:

At an independent home the administrator usually signs. At a chain of 10 or more, decisions usually sit with a regional vice president or the corporate office, and the administrator is an influencer.

Worked example: nurse scheduling software in Ohio

Illustrative example. The company, its price and its rates are invented; the counts come from CMS Provider Information for October 2026.

The seller: ShiftPoint (shiftpoint.example) sells nurse scheduling software to nursing homes at an illustrative $9,000 per home a year.

1. Pick the segment. Ohio has 924 certified homes. ShiftPoint targets the 362 that are independent or in chains of fewer than ten homes, where the administrator can buy. Their median size is 79 beds, and their median nursing staff turnover is 48.8%.
2. Start with the signal. 122 of the 362 had at least one administrator leave in CMS's latest measure. ShiftPoint contacts those first, because a new administrator is often reviewing how staffing is run.
3. Do the arithmetic. If an illustrative 10% of the 122 take a meeting and a third of those buy, that's 4 homes, $36,000 a year. Working the other 240 homes over the year at the same rates adds about 8 more, for about $108,000 in total.
4. Find the buyer. The CMS file gives each home's legal owner and phone number but no names. Finding the administrator and director of nursing, and what's changed at each home, is the slow part; Bebop finds the contacts and researches each home in the list.

Next step: profile each target home with the account research template before you call.