Care Considered Research · 2026 edition · CMS data vintage Aug2026
Care Considered Nursing Home Accountability Report
Computed directly from CMS Care Compare public files covering 14,690 Medicare/Medicaid-certified nursing homes. Methodology below. Cite freely with attribution and a link.
Free to quote and reuse with attribution and a link.
Care Considered. (2026). Care Considered Nursing Home Accountability Report. Own the Answer. https://careconsidered.com/research/nursing-home-accountability/ (CMS Care Compare data, Aug2026). Charts and figures on this page may be reproduced with attribution and a link to this page. For a custom data cut (a specific state, chain, or measure), or the underlying dataset, contact us — we're glad to help reporters and researchers.
Free to reuse, republish, and analyze — with attribution and a link to careconsidered.com. Refreshed with each CMS data update.
Key findings
- Nursing homes carry $456,752,787 in federal fines on the current CMS record — and 44.3% of all facilities (6,514) have at least one fine.
- Ownership predicts quality in nursing homes — unlike home health. For-profit facilities average 2.8 stars vs 3.57 for non-profits (a 0.77-star gap), and staff 0.71 fewer nurse hours per resident per day. Our home health report found no such gap — the two findings belong together.
- 1,719 facilities carry a CMS warning flag (abuse icon or Special Focus status); 1,426 carry the abuse icon specifically.
- 68.9% of nursing homes belong to a chain (610 distinct chains); the largest operate hundreds of facilities under a single owner.
Quality and staffing by ownership
Average CMS overall star rating by ownership type. The gap here is real and consistent with the staffing gap — for-profit facilities average fewer nurse hours per resident and higher penalty rates.
| Ownership | Facilities | Avg rating | Nurse hrs/resident/day | Turnover | % fined |
|---|---|---|---|---|---|
| Non-profit | 2,868 | 3.57 | 4.4 | 41.2% | 35.4 |
| For-profit | 10,877 | 2.8 | 3.69 | 47.2% | 47 |
| Government | 945 | 3.3 | 4.28 | 44.1% | 40.4 |
Federal fines by state (per facility)
| # | State | Facilities | % fined | Total fines | Per facility |
|---|---|---|---|---|---|
| 1 | Illinois | 666 | 68.6 | $75,126,367 | $112,802 |
| 2 | Vermont | 33 | 72.7 | $2,973,183 | $90,096 |
| 3 | Delaware | 44 | 72.7 | $3,121,569 | $70,945 |
| 4 | Rhode Island | 72 | 73.6 | $4,681,317 | $65,018 |
| 5 | Montana | 61 | 68.9 | $3,469,724 | $56,881 |
| 6 | Washington | 193 | 60.6 | $10,468,594 | $54,241 |
| 7 | Louisiana | 265 | 49.1 | $12,483,516 | $47,108 |
| 8 | Texas | 1177 | 69 | $53,534,320 | $45,484 |
| 9 | Wisconsin | 323 | 42.1 | $14,038,502 | $43,463 |
| 10 | New Mexico | 68 | 60.3 | $2,820,337 | $41,476 |
The largest nursing home chains
By number of facilities under one reported chain owner, with each chain's average CMS rating and share of facilities carrying a federal fine.
| Chain | Facilities | Avg CMS rating | % fined | Total fines |
|---|---|---|---|---|
| The Ensign Group | 342 | 3.18 | 47.7 | $7,057,363 |
| Pacs Group | 274 | 2.87 | 51.8 | $8,781,073 |
| Life Care Centers Of America | 194 | 3.37 | 40.7 | $3,464,555 |
| Genesis Healthcare | 184 | 2.37 | 54.3 | $7,729,601 |
| Creative Solutions In Healthcare | 149 | 2.13 | 73.8 | $8,191,964 |
| Saber Healthcare Group | 126 | 2.89 | 49.2 | $3,042,312 |
| Trilogy Health Services | 123 | 4.2 | 15.4 | $441,407 |
| Avir Health Group | 116 | 2.33 | 70.7 | $6,811,835 |
| Communicare Health | 110 | 3.21 | 47.3 | $3,897,007 |
| Pruitthealth | 95 | 2.91 | 43.2 | $1,354,358 |
| Good Samaritan Society | 92 | 2.98 | 50 | $2,150,138 |
| American Senior Communities | 90 | 3.89 | 11.1 | $242,737 |
Lowest-rated large chains (20+ facilities)
| Chain | Facilities | Avg CMS rating | % fined |
|---|---|---|---|
| Reliant Care Management | 34 | 1.18 | 82.4 |
| Arcadia Care | 25 | 1.35 | 84 |
| Athena Healthcare Systems | 22 | 1.55 | 68.2 |
| Ephram Lahasky | 22 | 1.75 | 68.2 |
| Hill Valley Healthcare | 43 | 1.77 | 55.8 |
| Empire Care Centers | 20 | 1.85 | 60 |
| Focused Post Acute Care Partners | 25 | 1.88 | 80 |
| Harborview Health Systems | 22 | 1.9 | 59.1 |
| Aperion Care | 33 | 1.94 | 60.6 |
| Journey Healthcare | 32 | 1.94 | 50 |
Methodology
All figures computed from CMS Care Compare public data files, Aug2026 refresh: Provider Information (ratings, staffing, ownership, chain), Penalties (federal fine amounts and payment denials), and Ownership. Fine dollar totals are summed from the penalties file; a facility is 'fined' if it has one or more federal fines on the current record. Ownership is bucketed from CMS's ownership type. State per-facility figures exclude states with fewer than 20 facilities. Chain figures use CMS's reported chain name; 'flagged' means the facility carries CMS's abuse icon or a Special Focus (SFF) designation.
© Care Considered (careconsidered.com). Source: CMS Provider Data Catalog — Nursing homes including rehab services (data.cms.gov), quarterly refresh. Reuse of these findings is permitted — and encouraged — with attribution and a link to this page.