Multi-State Chains and the Limits of a Chain-Level Star
Many nursing-home operators run facilities in more than one state. That fact quietly breaks a number people reach for constantly — the chain's average star rating — because CMS grades the largest component of that rating on a curve within each state separately.
What the ownership data shows
- Ownership groups
- 1,288
- CMS-reported
- Cross state lines
- 29.7%
- 383 groups
- Facilities in multi-state groups
- 57.9%
- 6,860 facilities
- Widest reach
- 26 states
- Life Care Centers of America
How far operators reach
Ownership groups by the number of states they operate in.
Operators by geographic reach
How many ownership groups fall into each reach band, and how many facilities each band accounts for.
CMS-reported data · updated 2026-08-21 · site-calculated context, not a CMS rating
Methodology
The widest-reaching operators
Ranked by states touched rather than facility count — reach is what makes a single chain-level average unreadable.
Ownership groups by states operated in
The operators whose facilities span the most state rating curves.
CMS-reported data · updated 2026-08-21 · site-calculated context, not a CMS rating
Methodology
Why a chain-level average star is misleading
The methodological consequence, stated plainly.
CMS builds the overall star rating primarily from the health-inspection rating, and it assigns that inspection rating on a curve within each state — roughly the top tenth of a state’s facilities receive five stars and the bottom fifth receive one. The comparison group is the state, never the country.
So when an operator runs facilities in twelve states, its facilities have been scored against twelve different peer groups, under twelve state survey agencies with their own staffing, backlogs, and enforcement practices. Averaging those stars produces a number with no clean interpretation: it blends real differences in care with differences in where the facilities happen to be. A chain whose facilities cluster in states with tougher survey agencies will show a lower average than an identical chain elsewhere.
This is why ownership pages on this site show the group’s rating distribution against the national picture and its geographic footprint side by side, rather than leading with a single chain-wide average — and why the facility-level comparisons that matter are always within a state or county. Our guide on reading CMS star ratings covers the state curve in more detail.
Limits of this analysis
What the public data can and cannot tell you.
Ownership grouping uses CMS-reported chain and ownership fields, which can be incomplete or lag transactions. A company appearing in these records does not by itself establish that it controlled day-to-day care, and nothing here evaluates any operator. Figures describe a dated CMS snapshot. Confirm the current record on Medicare’s Care Compare. See Methodology and Data updates.
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