What share of skilled nursing facilities are independent vs chain-owned?

Of the 14,064 skilled nursing facilities in CMS ownership filings analyzed here, 1,068 (7.6%) are independent single-site operators and 12,996 are owned by operators that run two or more facilities (chains / roll-ups). A facility is classified by the size of its largest owner's portfolio.

Which states have the most independent healthcare facilities to acquire?

The state-by-state ranking below sorts states by independent share — the percentage of facilities still run by single-site operators. States at the top of the list are the most fragmented and therefore have the highest acquisition-target density for buyers pursuing a regional roll-up.

How is independent vs chain ownership defined?

Each facility is matched to its owners in CMS PECOS ownership filings. We measure the largest owner's portfolio — the number of distinct facilities of that type the owner controls. If that owner controls exactly one facility, the facility is independent; if two or more, it is chain-owned. Portfolio size is used instead of CMS's owner-type flag because it is the consolidation signal acquirers care about and is consistently recorded.

STETHO · DATA STUDY · 2025 EDITION

Healthcare M&A: consolidation by state

8% of U.S. skilled nursing facilities are still independent, single-site operators. Of the 14,064 SNFs in CMS ownership filings, 1,068 are run by owners with a single facility — the fragmented long tail that roll-ups target. Below: how the independent-vs-chain split breaks down by state, ranked by acquisition-target density, plus the same cut across home health and hospice. Drawn from the latest CMS ownership filings; updated annually.

7.6%

INDEPENDENT SHARE (SNF)

1,068

INDEPENDENT SNFs

12,996

CHAIN-OWNED SNFs

14,064

SNFs ANALYZED

BY FACILITY TYPE

Where post-acute care is still fragmented

Skilled Nursing Facilities

7.6%

Independent

1,068 independent · 12,996 chain-owned · 14,064 total

Home Health Agencies

68.8%

Independent

4,511 independent · 2,044 chain-owned · 6,555 total

Hospices

48.3%

Independent

1,614 independent · 1,725 chain-owned · 3,339 total

MOST TARGET-RICH STATES

Independent share of skilled nursing — top 12 states

SKILLED NURSING · BY STATE

The most target-rich SNF markets

States ranked by independent share — the percentage of skilled nursing facilities still run by single-site operators. A higher share means a more fragmented market and greater acquisition-target density. Click any state for its full SNF directory with financials and ownership.

#	State	Independent share	Independent	Chain-owned	Total SNFs
1	Wyoming	34.5%	10	19	29
2	North Dakota	33.3%	24	48	72
3	Montana	19.0%	11	47	58
4	Vermont	17.6%	6	28	34
5	Rhode Island	16.4%	11	56	67
6	South Dakota	14.8%	12	69	81
7	Nebraska	14.5%	24	141	165
8	Maine	14.5%	11	65	76
9	New Hampshire	12.9%	9	61	70
10	Wisconsin	12.7%	40	274	314
11	Minnesota	12.5%	41	287	328
12	Hawaii	11.9%	5	37	42
13	Idaho	11.5%	9	69	78
14	Connecticut	11.5%	22	169	191
15	Alabama	11.2%	24	190	214
16	Kansas	11.0%	29	235	264
17	Iowa	11.0%	40	325	365
18	New Jersey	10.5%	36	306	342
19	Oklahoma	10.4%	28	242	270
20	Louisiana	9.9%	26	236	262
21	Nevada	9.5%	6	57	63
22	New York	8.6%	51	540	591
23	Arkansas	8.3%	18	198	216
24	Tennessee	8.3%	23	254	277
25	Georgia	8.2%	28	312	340
26	Missouri	8.2%	38	427	465
27	Pennsylvania	8.0%	51	584	635
28	Washington	7.6%	14	170	184
29	Delaware	7.5%	3	37	40
30	California	7.4%	83	1,034	1,117
31	Massachusetts	7.2%	24	309	333
32	Colorado	6.8%	13	179	192
33	New Mexico	6.6%	4	57	61
34	West Virginia	6.3%	7	104	111
35	Virginia	6.1%	16	245	261
36	Mississippi	6.1%	11	169	180
37	Illinois	6.1%	39	601	640
38	Michigan	6.0%	25	392	417
39	South Carolina	5.8%	10	162	172
40	Ohio	5.6%	50	841	891
41	Kentucky	5.2%	13	238	251
42	Maryland	5.1%	11	205	216
43	North Carolina	4.6%	18	374	392
44	Arizona	4.3%	6	132	138
45	Oregon	4.2%	5	113	118
46	Florida	3.7%	25	645	670
47	Utah	3.3%	3	88	91
48	Texas	2.7%	31	1,105	1,136
49	Indiana	1.2%	6	496	502

Methodology

Each Medicare-certified facility is matched to its owners in CMS PECOS facility-ownership filings (the ownership dataset). For every owner we compute a portfolio — the number of distinct facilities of that type the owner controls. A facility is counted as independent when its largest owner controls exactly one facility, and chain-owned when its largest owner controls two or more. We use portfolio size rather than CMS's owner-type flag because the flag is inconsistently recorded, while portfolio size is exactly the consolidation signal an acquirer evaluates.

Independent share is independent facilities divided by total facilities. States are ranked by independent share, and only states with at least 25 facilities are listed to avoid small-sample noise. Counts reflect facilities present in CMS ownership filings, which is a subset of all certified facilities; portfolios may overlap where a facility has multiple organizational owners (holding structures).

Want the targets behind the numbers? Browse the operator roll-up tracker, the deal-signal feed, or jump straight to any state's SNF directory.

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CITATION

Stetho. (2025). Healthcare M&A: Consolidation by State. Retrieved from https://stetho.io/consolidation-by-state

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<a href="https://stetho.io/consolidation-by-state" style="display:inline-block;border-left:4px solid #84cc16;padding:10px 14px;font:14px/1.4 system-ui,sans-serif;color:#0f172a;text-decoration:none;background:#f8fafc;border-radius:4px;max-width:520px"><strong>8% of U.S. skilled nursing facilities are still independent operators</strong><br>Source: Stetho — Healthcare M&A: Consolidation by State (2025)</a>

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8% of U.S. skilled nursing facilities are still independent operators
Source: Stetho — Healthcare M&A: Consolidation by State (2025)