Nursing Home Statistics

According to our research team’s analysis of the latest available data:

• About 1,290,000 Americans currently reside in nursing homes, according to the 2020 U.S. Census. That number is expected to nearly double by 2050.
• Over 15,600 nursing home facilities are in operation, 69% of which are for-profit.
• The average monthly cost of nursing home care in 2021 was $8,910 per month.
• For people who are discharged from nursing homes, the average length of stay is 8.9 months.

Read further for breakdowns on resident demographics, industry size, the effects of COVID-19, and more.

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The number of nursing home residents has remained fairly static over the past 20 years, with 1,359,159 seniors living in skilled nursing facilities in 2003 and 1,290,177 residing there in 2020, according to the Kaiser Family Foundation.

However, as the senior population grows, those numbers are expected to increase dramatically over the next two decades. The total number of nursing home residents in the U.S. is projected to be 1,870,905 in 2030 and 2,969,573 in 2040, according to data from the NHCA. The table below details the number of nursing home residents in each U.S. state from 2015 through 2022.

The fairly consistent number of nursing home residents over the past 20 years may seem surprising, considering the rapid growth of elderly populations in the U.S. There are three primary reasons for this consistency:

• Assisted living is on the rise. The number of assisted living communities in the U.S. has steadily increased since 2010, with over 996,000 registered beds available in 2021. Many seniors who once may have turned to a nursing home have chosen to age in assisted living communities — preferring an active, maintenance-free lifestyle to round-the-clock medical care — until they are no longer able.
• Nursing homes are for older, more medically needy adults. Though the senior population is growing, most baby boomers are not yet old enough to require the comprehensive medical care nursing homes provide.
• Nursing homes are expensive. The majority of nursing homes are for-profit and have far higher monthly rates than assisted living communities or home care agencies. While many assisted living residents do end up transitioning to nursing home care once it becomes medically necessary, that move may be delayed for financial reasons. Not-for-profit or Medicaid-approved nursing homes may have long waiting lists and limited bed availability, forcing families who can’t afford private care to help their loved ones age at home.

There are about 1,290,000 people living in a nursing home in the U.S. today, according to the 2020 U.S. Census. This number is expected to almost double by 2050. Below is a breakdown of nursing home resident demographics, followed by a description of common health conditions and the average length of stay in a nursing home.

Age, race, and gender

The average age at admission among nursing home residents in 1997 was 82.6 years, according to the Centers for Disease Control and Prevention (CDC). Today, still nearly half of nursing home residents are 85 years or older, according to the Health in Aging Foundation, and very few are younger than 65 years of age.

The nursing home population is overwhelmingly female, according to the Journal of Women’s Health, with the majority of residents being women who have been widowed, got divorced, or were never married. Take the following ratios for example:

• Among nursing home residents age 65-74, there are 132 women for every 100 men.
• Among residents age 75-84, there are 246 women for every 100 men.
• Among residents 85 and older, there are 425 women for every 100 men.

To outline the greater demographics of nursing home residents, the following two charts detail the estimated number of residents on Medicare by race, age, and gender, according to the Centers for Medicare and Medicaid Services’ most recent survey.

Health conditions

The most common reason that seniors move to a nursing home is having some type of issue in the performance of their activities of daily living (ADLs), such as dressing, bathing, and using the toilet. The following is true of physical health conditions among nursing home residents in the U.S., according to the Health in Aging Foundation:

• Over 80% of residents in a nursing home need help with three or more ADLs.
• Around 90% require supervision or assistance with walking.
• More than one-third have trouble seeing or hearing.
• Over half of residents suffer from elderly incontinence, the inability to control their bladder or bowel movements.

The following is also true of mental health conditions among nursing home residents:

• 50-70% are affected by some type of dementia.
• More than three-fourths of residents experience difficulty with decision-making.
• Two-thirds struggle with their memory.
• At least one-third experience problematic behaviors, such as being verbally or physically abusive, wandering, and resisting or refusing necessary care.
• Almost half struggle with being understood and understanding others, which has led to depression in many cases.

Length of stay

The average length of stay for people who are discharged from nursing homes is 8.9 months. However, the length of time that nursing home residents stay in the same facility can vary greatly, according to the Health in Aging Foundation. About 50% of residents stay at least one year, 21% stay for about five years, and about 25% of people admitted stay three months or less. A shorter length of stay is largely because so many seniors are admitted to a nursing home for rehabilitation or end-of-life care. To learn more about specific nursing homes, explore the nursing home ratings by Medicare.

There are about 15,183 total nursing home facilities in the United States, according to the Kaiser Family Foundation. Of those facilities, 23% are nonprofit, 71% are for-profit, and 6% are government owned. The total market size of nursing home facilities in the United States is about $141.8 billion, according to IBISWorld.

As of 2016, the total number of licensed beds in nursing homes was 1.7 million occupied by about 1.4 million patients, according to data from the CDC. In 2020, the average number of certified nursing facility beds in the U.S. ranged from 41 to 184 beds per 1,000 people, depending on the state.

The table below details the number of nursing home facilities in each U.S. state and the District of Columbia as of 2022, according to the Kaiser Family Foundation.

Staffing

Nursing homes have experienced staffing shortages for many decades; however, recent events regarding the COVID-19 pandemic have intensified the issue, according to the Kaiser Family Foundation. Most nursing homes are likely to report a shortage of aides, nursing staff, and clinical staff.  A 2021 study by the National Consumer Voice for Quality Long-Term Care even stated that “staffing standards in almost every state remain severely low.”

Studies show that staffing levels can directly affect the quality of care for nursing home residents, according to the National Academies of Science, Engineering, and Medicine. The following nursing home staffing statistics are according to a study done by the American Health Care Association:

• 60% of facilities are experiencing worse staffing situations since the beginning of 2022.
• 87% are facing moderate or high staffing shortages.
• 98% are finding it difficult to hire staff.
• 99% are asking staff to work overtime.
• 71% have hired temporary agency staff.
• 61% have limited new residential admissions.
• 73% are concerned about having to close due to staffing issues.

To address low staffing issues in nursing homes nationwide, the Biden administration recently proposed a plan to establish new federal minimum staffing adequacy regulations within the next year. In the same vein, the National Academies of Science, Engineering, and Medicine recently recommended minimum staffing levels, policies to ensure competitive wages and benefits, improved staff training and career advancement opportunities, and other reforms to improve nursing home quality.

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COVID-19’s effect on senior living has been substantial, affecting a range of factors from staffing and residency to health standards and various protocols. During the pandemic, the number of residents in a nursing home decreased from 1.33 million in 2019 to 1.16 million in 2022 ─ about 13%, according to the Kaiser Family Foundation. This reduction in nursing home occupancy is largely due to the increasing popularity of in-home care, a trend exacerbated by transmission rates and the pandemic’s threat of severe illness.

There have been 1,297,914 confirmed cases of COVID-19 in nursing home residents, according to the Centers for Medicare and Medicaid Services. Of those cases, 159,126 resulted in death. Among staff members, 1,376,215 experienced a confirmed case of COVID-19, with 2,756 resulting in death.

COVID-19 deaths in long-term care facilities make up at least 23% of all COVID-19 deaths in the United States. As of January 2022, about 82% of nursing home staff and 87% of residents were fully vaccinated; however, there have been more than 200,000 nursing home resident and staff deaths due to COVID-19 since the pandemic began, according to the Kaiser Family Foundation. This death count is based on state and federal data sources.

As of July 2022, Medicaid is the primary source of payment used by residents to cover the cost of nursing home care, according to the Kaiser Family Foundation. Approximately 62% of nursing home residents rely on Medicaid, 13% rely on Medicare, and the remaining 25% use another source, such as private insurance and out-of-pocket payments.

In 2022, the national average cost of a shared room in a nursing home is $290, according to the American Council on Aging. The cost of nursing home care ranges from about $180 per day to over $1,000 per day. The monthly cost of a semi-private room is $7,908, while a private room is $9,034, according to Genworth. The overall average monthly cost of nursing home care in 2021 was $8,910 per month.

Although Medicare and Medicaid both follow strict criteria and eligibility requirements, they will typically both pay 100% of the cost of nursing home care for its beneficiaries if the requirements are met.

Cost of care has been on the rise since 2004, according to Genworth. In response to COVID-19, care providers increased their use of personal protective equipment (PPE) and upgraded their protocols to meet new health and safety concerns. The costs brought on by these expenditures have largely contributed to the increases in rates.