The State of Long-Term Care in 2026: Recovery, Reshuffling, and Red Flags

The long-term care industry continues to navigate a shifting landscape. After years of pandemic-driven disruption, the latest CMS data paints a picture that is cautiously optimistic at the national level — but reveals deep trouble brewing at hundreds of individual facilities.

We analyzed three snapshots of CMS Nursing Home Compare data spanning two years (March 2024, October 2025, and February 2026) alongside Payroll Based Journal staffing records, Chain Performance Measures, and Minimum Data Set quality data. Here's what we found.

The Big Picture: Slow Recovery Nationally

Between March 2024 and February 2026, 168 nursing homes left the market — dropping from 14,878 to 14,710 nationally. But the facilities that remain are filling up: total residents climbed from 1.21 million to 1.24 million, pushing average occupancy from 75.9% to 79.0%.

Average star ratings ticked up from 2.87 to 2.98, and total fines dropped significantly — from $566 million to $480 million. On the surface, the industry appears to be stabilizing.

But these national averages mask significant disparity. The closures and the gains are not evenly distributed, and a large cohort of facilities is showing signs of serious trouble.

The Ownership Shuffle: Nearly 2,000 Facilities Changed Hands

One of the most striking findings is the volume of ownership activity. Between March 2024 and February 2026, we identified 1,995 facilities whose legal business name changed — a strong signal of an ownership transfer, sale, or corporate restructuring. On top of that, 11 facilities are currently flagged by CMS as having changed ownership (CHOW) in the past 12 months.

Notable Ownership Transfers

Several patterns stand out. In Florida, we see a wave of facilities being transferred to new LLC entities with "Opco" in the name — a structure common in REIT arrangements where operations are separated from property ownership. In Illinois, multiple facilities changed hands while carrying 1-star ratings and six-figure fines.

The Decline Watch: 5,687 Facilities Showing Warning Signs

We built a composite decline score for every facility by tracking census drops, low occupancy rates, rating declines, increasing fines, high turnover, Special Focus Facility status, and abuse flags.

The Most Troubled Facilities

Where Decline Is Concentrated

Texas leads with 63 facilities showing decline signals, followed closely by Illinois with 62. California has 36, Florida 25, and Missouri 22. These five states account for more than a third of all flagged facilities.

The Chain Story: Big Operators, Big Differences

Life Care Centers of America operates across the most states (26) and carries the highest average rating (3.5) among the top chains with the lowest turnover at 42.1%. Genesis Healthcare averages just 2.4 stars across 197 facilities.

Nationally, nursing home chains carry $492 million in total fines with average turnover of 46.4% and 3.9 total nurse hours per resident per day.

Staffing: 2.1 Million Workers

Payroll Based Journal data for Q3 2025 reveals 2.1 million unique employees logged 514 million work hours across all 53 reporting states and territories.

National average staff turnover sits at 46.4% — meaning nearly half of nursing staff leave their positions each year. While this is an improvement from the 52.7% seen in March 2024, it remains far above sustainable levels.

The For-Profit Question

73.7% of all facilities are for-profit, split between corporations (33.4%), LLCs (33.0%), individuals (4.5%), and partnerships (2.8%). Nonprofits account for 19.9% and government-run facilities just 6.4%.

This matters because the entity transfer patterns we're seeing — facilities being passed between LLC shell entities while carrying 1-star ratings and hundreds of thousands in fines — are overwhelmingly concentrated in the for-profit sector.

What to Watch

• Occupancy below 50%: 137 facilities operating at less than half capacity. Many are likely candidates for closure.
• Florida's Opco wave: Significant restructuring under new operating entities.
• Texas and Illinois: Highest concentration of decline signals. State regulators should pay close attention.
• Turnover plateau: After dropping from 52.7% to 46.4%, CMS staffing mandates could move the needle — or drive more closures.
• Fines declining: The $86M drop could reflect improvement or lighter enforcement.

The national averages tell a story of gradual recovery. But behind every improving average are individual facilities where census is collapsing, staff are leaving, and fines are accumulating. Those are the ones that matter most — because they're where real people live.