There is a growing problem in this country that is not getting nearly enough attention, but we are seeing the consequences of it every day in our cases. The demand for elder care is rising rapidly, while the system responsible for providing that care is quietly breaking down.
At the center of the issue is a simple imbalance. More seniors need help than ever before, but there are fewer caregivers available to provide it. And the gap is widening.
Families place immense trust in nursing homes. When a loved one enters a facility, the expectation is simple but critical: that they will receive attentive, timely, and competent care. But new federal data released in early 2026 tells a deeply troubling story. Across the United States, nursing homes are operating with dangerously low staffing levels, putting over a million vulnerable residents at risk every single day.
According to the latest report from the Long Term Care Community Coalition (LTCCC), nearly 9 out of 10 nursing homes are failing to meet expected staffing levels. On average, facilities are understaffed by 24 percent each day.
In the heated national debate over immigration, the conversation often centers on the economy, border security, or cultural identity. However, a groundbreaking February 2026 research paper from the National Bureau of Economic Research (NBER) introduces a vital new dimension to the discussion: the life-saving impact of immigration on America’s aging population.
The study, authored by David C. Grabowski, Jonathan Gruber, and Brian E. McGarry, reveals a striking correlation: increased immigration leads to significant declines in mortality among elderly Americans.
If you have ever walked into a nursing home and felt that something was off, call lights ringing, residents waiting too long for help, staff moving at a sprint, you already understand the core issue. Safe nursing home care depends on having enough trained people on the floor, for enough hours, every day.
That is why minimum nursing hours are imperative. They are not a luxury, and they are not a paperwork exercise. They are the basic guardrails that prevent predictable harm.
Recently, a coalition of Attorneys General from across the country sent a formal letter to federal leadership urging strong, quantitative staffing requirements for skilled nursing facilities. The letter is signed by many state Attorneys General, including California Attorney General Rob Bonta, and leaders from New York, Massachusetts, Arizona, Colorado, and many others.
For decades, families transitioning a loved one into a nursing home have relied on one fundamental assumption: someone qualified is always watching. We aren’t just talking about anyone—we are talking about Registered Nurses (RNs). These are the professionals trained to catch the subtle shift in a resident’s breathing, the early signs of sepsis, or the symptoms of a stroke before a situation turns fatal.
That assumption is about to disappear.
Across the country, state leaders are sounding the alarm about the growing influence of private equity in nursing homes and long term care. According to the Private Equity Stakeholder Project’s 2025 legislative tracker, this year marks a turning point in states’ efforts to scale back private equity’s footprint in the healthcare sector. From California to Massachusetts, lawmakers are beginning to recognize what families and advocates have been experiencing for years: when private equity buys nursing homes, patient care often suffers.
How Many Nursing Homes Are Owned by Private Equity
Researchers estimate that private equity firms now own roughly eleven percent of all nursing homes in the United States, representing more than one thousand five hundred facilities nationwide. Some studies place the number even higher when including complex ownership structures, management companies and affiliated real estate trusts used to mask true ownership.
California Attorney General Rob Bonta has filed a lawsuit against Sweetwater Care, a San Diego-based operator of 19 skilled nursing facilities across the state, for gross violations of elder care standards. The lawsuit, filed under California’s Unfair Competition Law, alleges that Sweetwater endangered vulnerable residents by repeatedly failing to meet the state’s minimum staffing requirements—leading to widespread neglect, abuse, and even physical injuries.
The lawsuit follows a sweeping investigation by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse (DMFEA), which uncovered a disturbing pattern of misconduct at Sweetwater facilities between 2020 and 2024. According to the findings, Sweetwater violated minimum staffing laws more than 14,000 times, placing elderly and disabled residents in harm’s way.
The consequences of this understaffing were severe:
The nursing home industry, often perceived as a sector struggling with financial viability due to reported accounting losses, presents a conundrum when analyzed through the lens of recent financial activities and market trends. Despite these reported losses, the industry has seen a surge in private equity investments and high transaction prices, suggesting a disconnect between reported financials and the actual economic value of nursing home facilities.
One explanation for this paradox is the concept of profit tunneling, where businesses who own nursing homes engage in financial maneuvers to misreport or hide true profits, essentially obscuring the true financial health of the enterprise. This tactic not only complicates the industry’s financial landscape but also raises questions about the quality of care provided in these facilities. With staffing levels directly tied to the quality of care, the financial engineering within the industry can have real-world impacts on patient care and facility operations.
Furthermore, the practice of engaging in related party transactions—where businesses make deals within a network of interconnected entities—complicates the financial transparency of nursing homes. Such transactions can mask the true profitability of these facilities, affecting everything from investment decisions to policy regulations concerning the industry.
“Cost-cutting is to be expected in any business, but nursing homes are particularly vulnerable. Staffing often represents the largest operating cost on a nursing home’s ledger. So, when firms buy a home, they cut staff. However, this business model has a fatal flaw. “Nurse availability,” Gupta and his colleagues wrote, “is the most important determinant of quality of care.”
“The data revealed a troubling trend: when private-equity firms acquired nursing homes, deaths among residents increased by an average of ten per cent.”
Read this compelling article from the New Yorker.
The COVID-19 pandemic is causing major disruptions and serious illness concerns in San Diego County and throughout California. Nursing home residents, many of whom are elderly, are not only in a vulnerable age group when it comes to serious COVID-19 infections, but many nursing home residents also have underlying conditions that put them at greater risk for severe infection and even death. To prevent COVID-19 infections in nursing homes, in addition to providing a high quality of care to avoid nursing home neglect injuries, facilities should in theory be improving on the nurse-to-patient ratios required by the state.
Yet according to a recent article in NPR, the state relaxed its nurse-to-patient ratios in mid-December 2020, which ultimately means that fewer nursing home patients are getting the level of care they need.
Staffing Problems Often Result in Nursing Home Neglect Injuries
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