How Many Counties Actually Offer a Choice of Nursing Home
Almost every guide to choosing a nursing home — including ours — assumes you have facilities to choose between. This report measures how often that assumption holds, county by county.
What the county data shows
- Counties with a facility
- 2,850
- in this dataset
- Have exactly one
- 29.8%
- 849 counties
- Have three or fewer
- 65%
- limited local choice
- Highest single-facility share
- 78.6%
- Nevada
How much choice a county actually offers
Counties grouped by how many CMS-certified nursing homes they contain.
Counties by number of facilities
How many counties fall into each band of local availability.
CMS-reported data · updated 2026-08-21 · site-calculated context, not a CMS rating
Methodology
Where single-facility counties are most common
States by the share of their counties containing exactly one certified nursing home.
Share of counties with only one facility, by state
Where a county-level search is most likely to return a single option.
This tracks population geography more than anything else — states with many rural counties concentrate at the top.
CMS-reported data · updated 2026-08-21 · site-calculated context, not a CMS rating
Methodology
What this changes about the advice
Guidance written for a metro market does not transfer to a single-facility county.
Standard guidance — shortlist several facilities, compare them on the same CMS fields, tour two or three — assumes a market. In a county with one certified nursing home, that workflow does not apply, and repeating it is not neutral advice but a failure to describe the actual situation.
Where there is one local option, the useful questions change. Instead of comparing facilities, the comparison is between the local facility and the cost of distance: what does the CMS record for that facility show, what would travelling to the next county offer, and what does the family realistically sustain in visiting. Distance has its own consequences for how often relatives visit, which no CMS measure captures.
This also affects how a rating should be read. A one-star facility in a county with six options and a one-star facility that is the only provider for an hour in any direction present very different decisions, though the data shows the same number. Our guide on comparing nursing homes covers the within-state comparison rules that still apply when you do widen the search.
Limits of this analysis
What the public data can and cannot tell you.
Counties are an administrative unit, not a travel radius. A county with one facility may sit beside a metro county with twenty, and a large western county may be several hours across, so county counts approximate access rather than measure it. Counties with no certified facility at all are not represented in the CMS county records this is built from, which means real access gaps are understated here. Nothing in this report evaluates any facility, county, or state. Confirm current availability on Medicare’s Care Compare. See Methodology.
The CMS Research Brief
New CMS data releases, Special Focus Facility changes, and each new analysis.
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