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Private equity in nursing homes
Private-equity ownership of nursing homes is one of the most-discussed topics in long-term care and one of the hardest to measure — because the only national flag for it is a checkbox providers tick themselves.
What CMS collects
Enrollment forms include a private-equity company indicator on each owner. When a PE firm is a direct owner and identifies itself, the flag appears. When ownership sits behind two holding companies, it usually does not.
The measurement gap
Across the 10,280 owner organisations in our current dataset, only a small fraction carry the PE flag — far below published academic estimates of true penetration. Health policy researchers have documented the same gap. Treat the flag as a floor.
A better proxy
Ownership churn. Facilities that changed hands repeatedly in a short window, held by entities created shortly before the acquisition, with a holding company above them, look like financial ownership regardless of what box was ticked. CMS records the association date and an explicit "created for acquisition" marker — both are in the data.
Common questions
How many nursing homes are owned by private equity?
Nobody knows precisely. The CMS flag captures well under one percent of facilities, while academic estimates put true penetration several times higher.
Does CMS track private equity ownership?
It collects a self-reported private-equity indicator on enrollment forms. It does not independently verify ownership.