New Report Reveals Declining Quality in Florida Nursing Homes Following Private Investor Acquisition

AARP Florida’s latest nursing home quality report reveals troubling trends as private investment group acquisitions reshape the state’s long-term care sector. Change of Ownership and Quality in Florida Nursing Homes, the latest installment in AARP Florida’s long-term care report series, developed in partnership with Dr. Lindsay Peterson, Associate Professor of Research at the University of South Florida (USF), finds that private equity takeovers are often tied to declines in resident care, and decreased transparency and accountability of those responsible for providing the care.

Key Findings Among Private Equity Owned Nursing Homes:

• Quality Ratings Drop: Nursing homes acquired by private equity groups saw their average CMS Five-Star Quality Ratings fall from 3.4 to 2.9 stars between 2019 and early 2024.
• Staffing Reductions: Direct care staffing levels decreased by 13% per resident, resulting in 33 fewer minutes of care per day.
• Increased Costs: Medicare costs per resident were $1,000 higher in private equity-owned facilities, with more frequent hospitalizations for conditions that could be treated on an outpatient basis.
• Opaque Ownership Structures: Complex networks of LLCs and trusts make it difficult to determine who is responsible for care quality and spending.

Link to Report

“Florida’s nursing home ownership data reveals a growing trend of private investor involvement and a lack of transparency in ownership structures, making it difficult to assess accountability for care quality,” said Lindsay Peterson, Ph.D. “Unlike publicly traded companies, private investors are not required to disclose financial and operational details, complicating efforts to track how public funds are used in these facilities.”

“All Floridians deserve access to high-quality, transparent care for their loved ones,” said AARP Florida State Director, Jeff Johnson. “Our latest findings show that private investment in nursing homes often comes at the expense of residents’ well-being. We urge lawmakers to prioritize transparency and accountability in the sector.”

Over the past five years, more than 425 nursing homes—over 60% of Florida’s total—have changed ownership, with many acquired by private equity investors. As the pace of nursing home sales accelerates, policymakers and families face growing challenges in identifying who controls care quality and how public dollars are spent.

The report highlights the urgent need for greater transparency and accountability in ownership reporting, especially as new federal rules requiring more detailed disclosures have been delayed until 2026.

This report builds on previous issues in our series, including deep dives into nursing home staffing levels and hospitalization rates. Together, these reports provide a comprehensive look at the evolving landscape of long-term care in Florida and underscore the importance of informed decision-making for families and policymakers.

Read the Full Report or visit the AARP Florida Nursing Home Report Hub for the complete series and resources for families navigating long-term care decisions.