San Juan Capistrano, California — The Ensign Group isn’t slowing down. The skilled nursing giant posted second-quarter revenue of $1.44 billion on Monday, a 17.3% jump from the same period last year, while lifting its full-year guidance for the second time this year.
The California-based operator, which runs facilities across 15 states, reported GAAP diluted earnings per share of $1.68, up 16.7% year-over-year. Adjusted earnings came in at $1.92 per share, a 20.8% increase that beat analyst expectations.
CEO Barry Port pointed to a simple formula: “Exceptional outcomes ultimately create their own form of accountability.” The company’s same-facility occupancy hit 84.1%, up 2.7% from Q2 2025, while skilled mix revenue climbed 10.1%.
Clinical Metrics Outpace Industry
Ensign’s quality scores are running well ahead of competitors. According to CMS data, the company’s same-facility quality measures were 23% better than industry peers in its operating states. Over 80% of Ensign’s skilled nursing operations earned a 4 or 5-star rating from Medicare.
The company’s rehospitalization rates were 15% better than the national average, while long-stay emergency department visits came in 24% below the norm. Perhaps most telling: none of Ensign’s 398 affiliated facilities are on CMS’s Special Focus Facility list, which flags operators with persistent quality problems.
Acquisition Engine Keeps Running
Ensign added 20 new operations during the quarter, all with real estate included. Since 2024, the company has acquired 102 facilities, many of which are already performing at or above expectations.
“We continue to see opportunities that include everything from larger portfolios to traditional one-offs,” said Chad Keetch, Ensign’s Chief Investment Officer. The company highlighted three recent Texas acquisitions: Willow Park Rehabilitation and Care Center, Southern Oaks Therapy and Living Center in Dallas, and Country Village Care.
These Texas facilities currently run below Ensign’s average occupancy, which Keetch said presents “significant clinical and operational upside” as the company applies its turnaround playbook.
Leadership Stability a Differentiator
Administrator turnover at Ensign’s same facilities was 46% lower than the state average across its footprint, according to CMS data. Director of Nursing turnover is also improving, and RN retention runs 8% better than the regional average.
“Outstanding resident outcomes begin with engaged, supported, and empowered caregivers,” Port said. “This level of leadership stability is one of the key differentiators of our organization.”
Guidance Raised Again
Based on the strong quarter, Ensign raised its 2026 earnings guidance to $7.75 to $7.85 per diluted share, up from the previous range of $7.48 to $7.62. Revenue guidance now sits at $5.87 billion to $5.92 billion.
The midpoint of the new earnings guidance represents an 18.7% increase over 2025 and a 41.8% jump from 2024. The company finished the quarter with $262.3 million in cash and $591.6 million available on its credit line.
The results come as other large operators like PACS Group navigate their own financial challenges in a post-acute market that’s rewarding scale and operational discipline.
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