America's largest nursing-home chains
CMS records the chain behind every nursing home. Counting facilities by chain shows how concentrated the industry is — and how the biggest operators rate. 611 chains10,184 chain facilities
Key findings
- THE ENSIGN GROUP operates the largest network in the data with 344 facilities.
- The ten largest chains together run 1,723 nursing homes — 17% of all chain-affiliated facilities in the dataset.
- Average overall ratings among the largest chains range from 2.1 to 4.2 stars.
| # | Chain | Facilities | Certified beds | Average rating |
|---|---|---|---|---|
| 1 | THE ENSIGN GROUP | 344 | 37,581 | 3.19 ★ |
| 2 | PACS GROUP | 275 | 31,274 | 2.89 ★ |
| 3 | LIFE CARE CENTERS OF AMERICA | 194 | 25,340 | 3.39 ★ |
| 4 | GENESIS HEALTHCARE | 184 | 21,582 | 2.34 ★ |
| 5 | CREATIVE SOLUTIONS IN HEALTHCARE | 149 | 17,670 | 2.09 ★ |
| 6 | TRILOGY HEALTH SERVICES | 127 | 8,453 | 4.17 ★ |
| 7 | SABER HEALTHCARE GROUP | 126 | 13,568 | 2.90 ★ |
| 8 | AVIR HEALTH GROUP | 118 | 12,935 | 2.27 ★ |
| 9 | COMMUNICARE HEALTH | 110 | 11,954 | 3.23 ★ |
| 10 | PRUITTHEALTH | 96 | 10,457 | 2.97 ★ |
| 11 | LEGACY HEALTHCARE | 95 | 11,889 | 2.88 ★ |
| 12 | GOOD SAMARITAN SOCIETY | 92 | 5,883 | 3.07 ★ |
| 13 | MARQUIS HEALTH SERVICES | 90 | 12,504 | 3.07 ★ |
| 14 | AMERICAN SENIOR COMMUNITIES | 90 | 8,948 | 3.89 ★ |
| 15 | COMPLETE CARE | 85 | 12,081 | 3.15 ★ |
| 16 | CIENA HEALTHCARE/LAUREL HEALTH CARE | 81 | 9,350 | 2.78 ★ |
| 17 | SIMCHA HYMAN & NAFTALI ZANZIPER | 79 | 7,985 | 2.67 ★ |
| 18 | NATIONAL HEALTHCARE CORPORATION | 71 | 8,891 | 4.00 ★ |
| 19 | INFINITY HEALTHCARE CONSULTING | 70 | 8,723 | 2.07 ★ |
| 20 | OPCO SKILLED MANAGEMENT | 68 | 8,166 | 2.31 ★ |
What this means for families
Chain affiliation is not a quality measure, but it is a practical thing to know: staffing policies, training and management are often set at chain level, and problems tend to repeat across a chain's facilities. CMS publishes chain-level averages alongside facility ratings for exactly that reason.
Method
Facility counts by the CMS "Chain Name" field; average of the overall star rating across rated facilities in the chain. Independents and facilities without a chain are excluded. Data: CMS Provider Data Catalog, Nursing Home Provider Information (public domain).