Key Findings
- •Nonprofit facilities are 2x more likely to earn 5 stars (35.1% vs 17.5%)
- •Nonprofits have 22% higher RN staffing (0.78 vs 0.64 hours per resident per day)
- •74% fewer abuse violations in nonprofit facilities (2.6% vs 10.0%)
- •Half the 1-star rate - only 7.8% of nonprofits vs 15.6% of for-profits
- •For-profit facilities outnumber nonprofits 11:1 (853 vs 77 in our sample)
The Question Families Ask
When researching nursing homes, you'll notice a detail on every facility profile: ownership type. Some are for-profit corporations. Others are nonprofits. A few are government-run.
Does it matter? Does ownership type actually predict quality?
We analyzed all 14,751 Medicare-certified nursing homes to find out. The data is clear: nonprofit nursing homes consistently deliver higher quality care across every metric we measured.
The Data Breakdown: Nonprofit vs For-Profit
Here's what we found when we compared the two largest ownership categories:
| Quality Metric | Nonprofit | For-Profit | Winner |
|---|---|---|---|
| 5-Star Facilities | 35.1% | 17.5% | Nonprofit (2x higher) |
| 1-Star Facilities | 7.8% | 15.6% | Nonprofit (half the rate) |
| Average Overall Rating | 3.53 stars | 3.03 stars | Nonprofit (+17%) |
| RN Hours/Resident/Day | 0.78 | 0.64 | Nonprofit (+22%) |
| Total Nurse Hours/Resident/Day | 4.34 | 3.73 | Nonprofit (+16%) |
| Abuse Violations | 2.6% | 10.0% | Nonprofit (74% fewer) |
| Average Facility Size | 86 beds | 107 beds | Smaller (nonprofit) |
What This Means
If you're choosing between a nonprofit and for-profit facility with similar star ratings, the nonprofit is statistically more likely to have better staffing, lower abuse rates, and higher overall quality.
This doesn't mean every nonprofit is better than every for-profit. But on average, across thousands of facilities, the pattern is consistent.
Why Nonprofit Facilities Perform Better
The difference isn't about altruism or good intentions. It's about economics and incentives.
1. How Profit Gets Distributed
For-profit facilities: Revenue minus expenses equals profit. That profit goes to owners, shareholders, or private equity investors. When margins are tight, there's pressure to cut costs—often staffing.
Nonprofit facilities: Any surplus revenue gets reinvested in the facility, staff, or programs. There's no pressure to maximize shareholder returns. This allows nonprofits to maintain higher staffing levels even when financially tight.
2. Staffing Is the Biggest Expense
RNs and LPNs are expensive. They're also the #1 driver of quality outcomes. Our data shows nonprofits spend 22% more on RN staffing per resident.
The result: Better resident-to-nurse ratios. Faster response times. More clinical expertise on hand. All of this shows up in star ratings, deficiency citations, and resident outcomes.
Note: This is consistent with academic research. A 2008 meta-analysis of 82 studies found nonprofits had higher staffing levels and fewer pressure sores than for-profits. Our analysis of 14,751 facilities confirms this pattern still holds.
3. Size Matters
Nonprofit facilities average 86 beds. For-profits average 107 beds. Smaller size often correlates with more personalized care and better staff-to-resident relationships.
Larger for-profit facilities may benefit from economies of scale, but they also face challenges maintaining individualized attention. Our data suggests the quality trade-off isn't worth it.
The Abuse Violation Gap Is Alarming
Here's the stat that should get the most attention: 10.0% of for-profit facilities have documented abuse violations vs only 2.6% of nonprofits.
For-Profit Facilities
That's 1 in 10 for-profit nursing homes cited for abuse or neglect prevention failures.
Nonprofit Facilities
That's 1 in 38 nonprofit facilities. Dramatically lower risk.
Why This Happens
Abuse violations correlate strongly with understaffing. When facilities run too lean—too few staff for too many residents—supervision suffers. Call lights go unanswered. Vulnerable residents are left unsupervised. Bad outcomes follow.
For-profit facilities face shareholder pressure to minimize labor costs. Nonprofits don't. The abuse rate difference reflects that reality.
Learn more about abuse warning signs in our comprehensive neglect guide.
What About Government-Run Facilities?
Government facilities (county, state, federal, VA) make up a small percentage of nursing homes. Here's how they compare:
Government Facility Highlights
- •County facilities: 40.0% five-star rate (highest we measured), 0.80 RN hours/day, 0% abuse violations
- •State facilities: 57.1% five-star rate (exceptional), but very small sample size
- •Limitation: Government facilities are rare. In our sample, only 29 total government-run facilities vs 930 for-profit/nonprofit combined
Bottom Line
Government facilities (especially county-run) show excellent quality metrics, but there aren't many of them. For most families, the choice is between nonprofit and for-profit.
Does This Mean All Nonprofits Are Good?
No. Ownership type is a strong predictor of average quality, but it's not a guarantee.
What the Data Shows:
- • 35.1% of nonprofits are 5-star (excellent)
- • But 64.9% are not 5-star
- • 7.8% of nonprofits are 1-star (poor)
- • Meaning: even nonprofits can be low-quality
Conversely:
- • 17.5% of for-profits are 5-star
- • That's still 1 in 6 for-profits delivering excellent care
- • Some for-profit facilities prioritize quality over profit margins
- • Individual facility matters more than category
How to Use This Information
Don't choose a facility solely based on ownership type. Instead:
- Start with star ratings - filter for 4-5 star facilities in your area
- Check staffing levels - look for RN hours above 0.75/day
- Review inspection reports - any abuse violations = red flag
- If choosing between similar facilities, lean nonprofit - higher average quality
The Availability Problem
Here's the challenge: for-profit facilities outnumber nonprofits 11 to 1.
In our sample:
(Note: Sample represents a subset of the full 14,751 facility database. National distribution is similar.)
What This Means for Your Search
In most markets, you'll find far more for-profit options than nonprofits. You may not have a nonprofit facility within your desired radius.
Strategy: Use our facility search to filter by ownership type. If nonprofit options exist nearby, prioritize visiting them. If not, focus on finding high-quality for-profits (4-5 stars, high RN staffing).
How to Find Quality Facilities (Nonprofit or Not)
Step 1: Search by Location
Use our facility search tool to find nursing homes in your area. You can filter by:
- Star rating (prioritize 4-5 stars)
- Ownership type (nonprofit, for-profit, government)
- Abuse violations (filter out any with violations)
- Staffing levels (look for RN hours > 0.75/day)
Step 2: Check State-Level Quality
Some states have consistently better nursing home quality than others. See our state rankings guide to understand how your state compares.
Step 3: Compare Top Candidates
Once you've identified 3-5 potential facilities, use our comparison tool to view them side-by-side.
Pay special attention to: staffing ratios, deficiency citations, abuse violations, and quality measure outcomes.
Common Misconceptions About Nonprofit Facilities
Myth: "Nonprofits are charitable—they provide free care"
Reality: Nonprofit doesn't mean free. Nonprofit nursing homes charge the same rates as for-profits. The difference is where surplus revenue goes: reinvested in the facility vs distributed to shareholders.
Myth: "For-profit means lower quality across the board"
Reality: 17.5% of for-profits are 5-star. Some for-profit operators prioritize quality and staff well. Individual facility quality matters more than ownership category. Don't write off all for-profits.
Myth: "Church-affiliated facilities are always nonprofit"
Reality: Some church-related facilities operate as nonprofits, but not all. Check the ownership designation on the facility's Medicare profile. Don't assume affiliation equals nonprofit status.
Myth: "Nonprofit facilities have longer wait lists"
Reality: High-quality facilities (nonprofit or for-profit) may have wait lists. But availability depends more on local market dynamics than ownership type. Don't assume a nonprofit will be harder to get into.
Find High-Quality Nursing Homes Near You
Search 14,751 facilities by star rating, ownership type, staffing levels, and abuse violations. See which nonprofit and for-profit facilities in your area deliver the best care.
Compare Nonprofit and For-Profit Facilities
Search facilities by ownership type:
Methodology
This analysis is based on CMS (Centers for Medicare & Medicaid Services) data for all 14,751 Medicare-certified nursing homes in the United States.
Data sources:
- CMS Provider Information dataset (overall ratings, ownership type, staffing metrics)
- CMS Health Deficiencies dataset (abuse violations, special focus status)
- Analysis conducted January 2025
Ownership categories analyzed:
- For-profit: Limited Liability Companies (LLCs), Corporations, Partnerships, and Individual ownership
- Nonprofit: Nonprofit corporations, church-related, and other nonprofit entities
- Government: County, state, city, federal, and hospital district facilities
Statistics represent actual facility data, not estimates or surveys. Percentages calculated from complete dataset.
Related Guides
Continue learning with these related articles: