Per-facility ownership chain, PE/REIT flags, and the top-10-chain gap CMS won't close.
Fonteum surfaces per-facility ownership cascades from the CMS SNF All Owners dataset (PECOS-derived; released November 2024 with PE/REIT fields). Where ownership percentages are missing — of top-10-chain owners and 55.21% of all owners per Health Affairs March 2024 — the facility carries an explicit DataAvailabilityState flag. No fabrication, no interpolation. The off-cycle revalidation that was meant to close the gap is indefinitely suspended (CMS, December 11–16, 2025).
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Top-10-Chain Ownership Gap
Chen / Grabowski / Konetzka, Health Affairs Vol. 43 No. 3, March 2024 — ownership percentages missing for of owners in the top ten chains; 55.21% missing across all U.S. facilities.
Operator + REIT Landlord Layer
Top-10 operators (Ensign, Genesis, Life Care Centers, ProMedica, Consulate, Saber, Trilogy, Signature) + the four major healthcare REIT landlords (Omega, Welltower, CareTrust, Sabra). Affiliated Entity ID joins to Chain Performance Measures.
Healthcare REIT Investment 2025
Welltower + Ventas + CareTrust + Omega — $25.28 billion in 2025 senior-care investment activity (Lument 2026 Market Outlook), up from $9.96 billion in 2024. <17% of REIT investments appear in CMS data per Health Affairs.
Ownership transparency by state — every facility carries an explicit DataAvailabilityState flag
Phase-1 Fonteum ingestion (2026-05-08): every facility in the snapshot carries the OWNERSHIP_PCT_MISSING DataAvailabilityState code because Fonteum has not yet ingested the CMS SNF All Owners ownership_percentage column. This is the maximum case of the top-10-chain gap that Health Affairs March 2024 documents in CMS itself; Phase-2 ingestion (operator- triggered, requires data.cms.gov network access) will lower per-state shares to the documented 82.40% top-10-chain / 55.21% all-facilities baseline.
Phase-1 PE-chain match rate across all facilities: 0.39% (heuristic name-match against PE_REIT_ENTITY_REGISTRY: 6 healthcare REITs + 8 chain operators + 4 named PE sponsors). Phase-2 ingestion replaces the heuristic match with CMS-self-reported PE/REIT flags + ownership_percentage chains.
Federal data gap on nursing home ownership won't close — and Fonteum maps what CMS doesn't.
of CMS top-10-chain ownership percentages are missing. The Trump administration suspended the mechanism that was supposed to close the gap. PE-owned nursing homes face 11% higher resident mortality and 10× greater bankruptcy risk.
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