Drops in Nursing Home Staffing Levels Often Fueled by Ownership Changes: Study

Study finds that when nursing homes shift to “for-profit” ownership, facilities often have drops in staffing levels, higher occupancy and an overall degradation in the quality of care provided to residents.

A new study suggests that widespread ownership changes during the COVID-19 pandemic may have contributed to ongoing staffing shortages and declining care in nursing homes throughout the U.S.

Data indicates that nearly 60% of nursing homes changed ownership during the first three years of the pandemic, with many shifting to for-profit operators. According to findings published March 10 in The Gerontologist, researchers found that facilities transitioning to for-profit ownership often reported lower staffing levels than nonprofit homes, raising concerns about the impact these changes may be having on quality of care provided to residents.

Staffing shortages were a key factor behind the high number of COVID-19 deaths among elderly residents, as reduced staffing strained infection control and day-to-day care. The problem has persisted beyond the pandemic. A 2025 Medicare report found that nearly 90% of U.S. nursing homes remain understaffed, with additional pressure coming from immigration restrictions that have limited a major source of the workforce.

Researchers say targeted incentives, such as rewarding facilities for increasing staffing levels, could help reduce hospitalizations among nursing home residents. However, despite these potential solutions, staffing shortages remain a widespread and unresolved issue.

In the new study, researchers from the University of Saskatchewan analyzed nursing home data from the Centers for Medicare and Medicaid Care Compare datasets. The data included a sample of 1,200 nursing homes in the U.S., including information on ownership changes during the pandemic from March 2020 to March 2023.

According to the findings:

• About 63% of nursing homes experienced ownership changes during the early stages of the COVID-19 pandemic
• A total of 745 government-run facilities and 2,555 nonprofit nursing homes were converted to for-profit ownership during that period
• Overall, 49% of government nursing homes and 43% of nonprofit facilities transitioned to for-profit status amid the pandemic

In total, the data indicates more than one-third of the country’s public nursing homes were changed to for-profit status.

The study also showed that staffing shortages often accompanied the changes in ownership, with nursing homes that changed to for-profit status often reducing staffing hours for nurses and other critical staff.

Nursing hours among facilities without ownership changes averaged 2 to 11.6 hours per resident day. However, in facilities with ownership changes, nursing hours only averaged 0.5 to 10.5 hours per resident day.

Led by Tyler Pittman, MSc, the researchers also found that nursing homes which changed ownership had lower government quality ratings, being rated an average of 2.8 out of 5 stars compared to 3.6 out of 5 stars for nursing homes that didn’t change to for-profit.

Prior data indicates 7% to 13% of nursing homes changed ownership annually from 1993 to 2010. Researchers said the new data shows nursing home ownership changes have accelerated since the pandemic.

The study concluded that the ownership changes were largely driven by profit and occupancy decisions. For-profit nursing homes had higher occupancy rates than non-profit nursing homes. However, even when the higher occupancy is accounted for, other variables showed quality of care and staffing hours also dropped after ownership changes.

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