Nursing Homes: Why They Cost So Much

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One of retirees’ biggest fears is that they will have to go into a nursing home. This fear isn’t just psychological – it’s also financial.

Roughly half of older Americans will find themselves in a nursing home at some point, according to a 2015 estimate. These stays usually last months, but sometimes years, and the costs add up quickly for those who have to pay for them out of their own pockets.

At an average price of at least $225 per day for a semi-private room, a nursing home stay can put a big dent in retirees’ savings.

A new study in the journal Medical Care Research and Review on how much seniors pay out-of-pocket for facilities in eight states – California, Florida, Georgia, New York, Ohio, Oregon, Texas, and Vermont – found that prices across the board are rising at about two times the general inflation rate.

Some of the fastest price increases are in California and Oregon – 5 percent to 6 percent a year. There is also a large disparity between high- and low-cost states: the price tag for a typical New York nursing home is more than double the cost in Texas.

Yet little is understood about what’s behind the disparities. In this study, conducted for the Retirement Research Consortium, the researchers begin to uncover some of the things that determine whether an individual happens to live in a high-cost state.

One factor affecting the prices is the competitiveness of each nursing home market, which works in ways one would expect. When a small number of operators dominate in local markets, they can charge more. The results also suggest that prices are higher in markets where limited competition is combined with a high demand for beds.

Another important factor is who owns the nursing homes, and each state has a different mix of private and non-profit chains and smaller operators. For-profit companies own about 70 percent of U.S. nursing homes. More than half of the for-profit facilities are chains, and these chains charge the lowest prices.

The non-profit chains are the most expensive. Their prices, adjusted for staffing levels, location and other facility-level factors, are about 6.6 percent more than the for-profit chains – or about $4,160 more annually – the study found.

While the nonprofit chains are more expensive, they have also been shown to provide higher quality care, the researchers said. But the picture is more complex, because non-profits disproportionately attract people who can afford to pay directly for their care, rather than being covered by a government program.

Taken together, “it is unclear whether not-for-profit chains are providing substantially higher quality or other community benefits to justify their tax-exempt status,” the researchers said.

Nursing-home stays are a high-stakes event for retirees. This study provides a few clues as to why they cost so much.

To read the study, authored by Sean Shenghsiu Huang, Jane Banaszak-Holl, Stephanie Yuan, and Richard Hirth, see “The Determinants and Variation of Nursing Home Private-Pay Prices: Organizational and Market Structure.”

The research reported herein was performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement Research Consortium. The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of SSA or any agency of the federal government. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.


Have you ever met a poor nursing home operator? They seem to be feeding from both ends of their governmental trough – with Medicaid footing many patient’s bills and receiving state level loan subsidies to buy the places. Like much of the rest of the medical industrial complex, they need the chill wind of competition.

Edward Hoffer MD

I suspect a large part of the cost is administrative overhead – nursing homes are heavily regulated – and profit. Certainly not because of staff payrolls. Much of the care is delivered by low-paid aides. In my experience the best quality is found in nursing homes run by religious orders.


The cost is high because old people are helpless and vulnerable.

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