Minnesota’s One-Star Nursing Homes Have Nearly Doubled Since 2019 — and Federal Fines Have Tripled

Minneapolis, Minnesota — Federal fines against Minnesota nursing homes have more than tripled since 2019, and the number of facilities stuck with the lowest possible rating has nearly doubled, according to a new analysis of state and federal data.

The numbers tell a stark story. In 2019, 34 Minnesota nursing homes carried a one-star rating under the Centers for Medicare & Medicaid Services’ five-star system. By last month, that figure had climbed to 64. Over the same stretch, federal fines for neglectful or substandard care jumped from $2.3 million to $8.2 million.

Fewer homes, more pressure

The state has also lost facilities. Minnesota counted 376 nursing homes in 2019; fewer than 340 operate today. Thirty-three of the closed homes shut down because of staffing shortfalls or financial strain, or they were converted into assisted living buildings.

Here’s the part that surprises people outside the industry: Minnesota still ranks 15th among states for average nursing home quality. The slide has been real, but ratings have held steady since 2023, and fines and deficiencies have actually eased in recent years.

Ownership plays a role in where the worst ratings cluster. Minnesota’s nursing home sector was once almost entirely nonprofit, and those facilities posted some of the best quality scores in the country. Today, for-profit operators control roughly 30% of the state’s homes — and half of all one-star facilities. Industry observers caution the correlation isn’t simple, though. For-profit companies often take over the troubled properties nobody else wants, which drags down their averages from day one.

Monarch Healthcare Management, which has acquired 44 nursing homes across the state, says several came on board already poorly rated and at risk of closing. CEO Marc Halpert argues the company needs time to turn those buildings around. On the staffing front, 84 facilities had to replace at least half of their nursing staff in the past year, and federal data shows for-profit homes running lower nurse and aide ratios per resident than their nonprofit counterparts.

What advocates want next

Lawmakers have poured energy into home and community-based services and licensed more than 2,000 assisted living facilities, many with substantial medical capabilities. State nursing home associations say that’s not enough. The $300 million in closure-prevention funding that flowed during the pandemic is long gone, and the Long-Term Care Imperative — a coalition representing two trade groups — is pushing for a plan that guarantees every resident can reach a nursing home within 45 minutes of home, backed by significant new state investment. Operators elsewhere are experimenting with their own fixes, from creative approaches to filling chronic staffing gaps to new ownership models.

Whether Minnesota’s one-star spike reflects failing operators or the sector’s hardest cases landing in one place, the outcome is the same for families: fewer beds, farther drives, and thinner margins between a home that stays open and one that doesn’t.