CHAIN ANALYSIS
Analysis of the Largest Nursing Home Chains in the United States
Understanding the largest nursing home chains is crucial for families, policymakers, and healthcare providers. These major operators collectively manage thousands of facilities across the United States, significantly impacting the quality and accessibility of long-term care services nationwide.
This analysis examines the top 15 largest nursing home chains by facility count, providing insights into their quality ratings, performance metrics, and operational scale. The data helps illuminate industry trends and performance patterns among the nation's largest long-term care providers.
Industry Overview
Data as of June 1, 202615
Largest Chains
2,186
Total Facilities
3.0
Avg Overall Rating
14.1%
Market Share*
Performance Highlights
Highest Overall Rating
Best Quality Measures
Best Staffing
Complete Rankings: Top 15 Largest Chains
Ranked by total number of facilities. Click on any chain name to view detailed analysis.
| Rank | Chain Name | Facilities | Overall Rating | Health Inspection | Staffing | Quality Measures | Performance |
|---|---|---|---|---|---|---|---|
| #1 | THE ENSIGN GROUP | 342 | 3.2 | 2.9 | 2.4 | 4.4 | Average |
| #2 | PACS GROUP | 280 | 3.0 | 2.5 | 2.4 | 4.3 | Average |
| #3 | LIFE CARE CENTERS OF AMERICA | 194 | 3.5 | 2.9 | 3.3 | 4.5 | Average |
| #4 | GENESIS HEALTHCARE | 187 | 2.4 | 2.3 | 2.5 | 3.6 | Below Average |
| #5 | CREATIVE SOLUTIONS IN HEALTHCARE | 149 | 2.2 | 2.7 | 1.1 | 3.5 | Below Average |
| #6 | SABER HEALTHCARE GROUP | 127 | 2.9 | 2.7 | 2.3 | 4.0 | Below Average |
| #7 | TRILOGY HEALTH SERVICES | 124 | 4.2 | 3.5 | 3.2 | 4.8 | Average |
| #8 | COMMUNICARE HEALTH | 121 | 3.0 | 2.5 | 2.6 | 4.4 | Average |
| #9 | AVIR HEALTH GROUP | 118 | 2.3 | 2.4 | 1.6 | 3.6 | Below Average |
| #10 | PRUITTHEALTH | 99 | 2.8 | 2.8 | 2.5 | 3.7 | Below Average |
| #11 | GOOD SAMARITAN SOCIETY | 92 | 2.9 | 2.8 | 3.9 | 3.0 | Average |
| #12 | AMERICAN SENIOR COMMUNITIES | 91 | 3.9 | 3.4 | 2.2 | 4.7 | Average |
| #13 | LEGACY HEALTHCARE | 89 | 2.9 | 2.9 | 2.6 | 3.4 | Below Average |
| #14 | MARQUIS HEALTH SERVICES | 88 | 3.0 | 2.5 | 2.5 | 4.3 | Average |
| #15 | COMPLETE CARE | 85 | 3.2 | 2.8 | 2.5 | 4.4 | Average |
Key Insights
Market Concentration
The top 3 largest chains operate 816 facilities, representing approximately 5.3% of all nursing homes in the United States.
The largest chain, THE ENSIGN GROUP, operates 342 facilities with an average overall rating of 3.2 stars.
Quality Distribution
1 of the top 15 chains have an average overall rating of 4+ stars (high quality).
7 chains have ratings below 3 stars, indicating potential quality concerns.
The average overall rating across all top 15 chains is 3.0 stars.
Data Sources and Methodology
This analysis is based on the most recent data available from the Centers for Medicare and Medicaid Services (CMS). Chain affiliations are determined based on the chain identification numbers and names provided by CMS in their Provider Information database.
Ranking Methodology: Chains are ranked by total number of facilities. Quality ratings represent the average performance across all facilities within each chain, as calculated and provided by CMS.
Data Currency: Information was last updated on June 1, 2026. CMS updates this data monthly, and we refresh our analysis accordingly.
* Market share calculation is based on an estimated 15,500 total nursing homes in the United States.