Washington, D.C. — More than half of all U.S. nursing homes changed ownership during the first three years of the COVID-19 pandemic, and the facilities most likely to change hands were already struggling with lower quality ratings.
Researchers led by Pittman found that 57.8% of nursing homes nationwide saw an ownership transfer between 2020 and 2022. Among for-profit facilities, that number climbed to nearly 63%. The findings paint a striking picture of an industry in flux at the very moment it was fighting its deadliest challenge in decades.
Lower-Quality Homes Most Likely to Flip
The ownership shuffle wasn’t random. “Less desirable facilities may have been the target of an ownership change by shareholders during the COVID-19 pandemic,” the researchers wrote — raising pointed questions about who was buying, and why.
The quality gap between ownership types was hard to ignore. For-profit facilities that changed hands averaged just 2.8 stars on Medicare’s Five-Star rating system. Nonprofit facilities with no ownership change averaged 3.6 stars — a full star higher. That difference matters: lower ratings typically reflect worse staffing, more health deficiencies, and weaker inspection results. Nonprofit and government-owned facilities with ownership changes showed a different profile, according to the study, suggesting their transfers were driven by factors other than profit extraction during a crisis.
The Scale of Turnover
An ownership rate approaching 58% across the entire industry — in just three years — is remarkable by any measure. It means that while nursing homes were dealing with PPE shortages, devastating outbreaks, and the loss of thousands of residents and staff, the business of buying and selling facilities was running at high speed in the background.
The study adds to a growing body of evidence documenting the financial pressures facing private-equity-owned nursing homes, including research showing those facilities carry 10 times the bankruptcy risk and significantly higher resident mortality compared to non-PE facilities.
What It Means for Residents
Ownership transitions are rarely smooth for anyone inside a facility. Staff face uncertainty about new management and contracts. Residents and families may see disruptions in care continuity. And surveyors know that the period immediately following an ownership change can be among the most vulnerable windows for a facility.
The study doesn’t establish whether the ownership changes improved or worsened care outcomes — but the pattern it documents isn’t likely to ease concerns about transparency and accountability in an industry already under intense scrutiny.
