Nonprofit vs. For-Profit Nursing Homes in Atlanta: What Ownership Structure Means for Care Quality
Originally published: September 2026 | Reviewed by Sadie Mays
Originally published: September 2026 | Reviewed by Sadie Mays
Nonprofit ownership is associated with higher nursing staffing levels and fewer care-quality problems than for-profit ownership, according to a 2009 systematic review of 82 studies published in the BMJ.
Sadie G. Mays Health & Rehabilitation Center is a 206-bed, 501(c)(3) nonprofit skilled nursing facility in northwest Atlanta, founded in 1947.
Ownership structure is one of several factors families can check before choosing a long-term care setting, alongside staffing ratios and inspection history.
Ownership structure is one factor among many in a placement decision. The Sadie G. Mays admissions team can walk through this alongside staffing and care-plan questions during a tour.
A nonprofit nursing home reinvests any revenue beyond operating costs back into the facility rather than distributing it to shareholders or owners. In contrast, a for-profit nursing home operates to generate a financial return for its owners or investors.
Both ownership types can be Medicare- and Medicaid-certified and are held to the same state licensing and federal survey requirements.
The difference lies in how each organization uses its revenue, not in a separate regulatory category.
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A 2009 systematic review and meta-analysis in the BMJ, examining 82 studies published between 1965 and 2003, found that nonprofit nursing homes delivered higher quality care than for-profit facilities on two of the four most frequently reported quality measures.
The Comondore et al. meta-analysis found nonprofit facilities had higher or higher-quality staffing levels and a lower prevalence of pressure ulcers, with two additional measures — physical restraint use and regulatory deficiencies — trending in the same direction without reaching statistical significance across the pooled studies.
| Quality Measure | Result Favoring Nonprofit Homes | Statistical Significance |
| Nurse staffing levels | Higher or higher-quality staffing | Statistically significant |
| Pressure ulcer prevalence | Lower prevalence | Statistically significant |
| Physical restraint use | Lower use | Not statistically significant |
| Regulatory deficiencies | Fewer cited deficiencies | Not statistically significant |
Researchers have proposed an economic explanation for the staffing gap rather than treating it as a settled mechanism: Dr. Gordon Guyatt, the BMJ meta-analysis’s senior author and a professor of medicine at McMaster University, has attributed the difference to for-profit administrators needing to direct a portion of revenue toward shareholder returns rather than staffing.
Separately, a 2021 study by Tuck School of Business’s Lauren Lu and Purdue’s Susan Lu, examining 631 nursing homes that converted from nonprofit to for-profit ownership between 2006 and 2017, found that registered nurse staffing declined by 7.2% following conversion, as new for-profit owners reduced RN staffing to lower costs.
That conversion-study design is useful because it tracks the same facilities before and after an ownership change, rather than comparing different facilities at one point in time.
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Ownership structure is a statistical tendency across large samples of facilities, not a guarantee for any single nursing home. Some for-profit facilities outperform on quality measures, and some nonprofit facilities underperform.
Researchers have also raised a related caveat: differences in quality between ownership types may stem partly from differences in available revenue rather than mission alone, since nonprofit facilities in some markets serve a different payer mix than nearby for-profit competitors.
Families evaluating any specific facility should treat ownership type as one data point to check alongside that facility’s own CMS Care Compare rating, not as a substitute for it.
Federal law under Section 6101 of the Affordable Care Act requires Medicare- and Medicaid-certified nursing homes to disclose ownership, management, and financial-control information, which CMS now publishes as part of its transparency initiative.
Families can look up a specific facility’s ownership type, staffing data, and inspection history through CMS Care Compare.
In Georgia, the Georgia Department of Community Health maintains licensing and inspection records for any nursing home, regardless of the facility’s ownership structure.
Sadie G. Mays Health & Rehabilitation Center has operated as a 501(c)(3) nonprofit since its founding in 1947, under the Atlanta Association for Convalescent Aged Persons, Inc.
A volunteer Board of Directors, rather than private shareholders or an investor group, governs the facility.
As with any nonprofit nursing home, this structure means revenue beyond operating costs is directed back into the facility rather than distributed as profit — though, consistent with the research above, families are encouraged to verify current staffing and inspection data for any facility, including this one, through CMS Care Compare rather than relying on ownership type alone.
Ownership structure works best as an early screening factor, checked alongside — not instead of — a facility’s specific staffing levels, inspection history, and CMS star rating.
A practical approach is to note ownership type when building an initial shortlist, then verify each shortlisted facility’s actual current performance data before ruling anything in or out.
The step-by-step guide to finding long-term care in Atlanta walks through that fuller evaluation process in sequence.
What is the difference between a nonprofit and for-profit nursing home? A nonprofit nursing home reinvests revenue beyond operating costs back into the facility, while a for-profit nursing home operates to generate a financial return for owners or investors. Both types are held to the same state licensing and federal Medicare/Medicaid certification requirements.
Do nonprofit nursing homes provide better care than for-profit ones? A 2009 BMJ meta-analysis of 82 studies found nonprofit nursing homes had higher-quality staffing and fewer pressure ulcers than for-profit facilities, on average. Individual facility performance still varies within both ownership types, so this is a general pattern rather than a guarantee for any specific home.
Why do nonprofit nursing homes tend to have higher staffing levels? Researchers, including the BMJ study’s senior author, have proposed that for-profit facilities direct part of their revenue toward shareholder returns rather than staffing. A separate 2021 conversion study found RN staffing dropped 7.2% at facilities that switched from nonprofit to for-profit ownership.
How can a family check a specific nursing home’s ownership type? Federal law requires Medicare- and Medicaid-certified nursing homes to disclose ownership information, which CMS publishes through its transparency initiative. Families can look up a facility’s ownership type, staffing levels, and inspection history directly through CMS Care Compare.
Are there exceptions to the nonprofit quality pattern? Yes, ownership structure is a statistical tendency across large samples, not a guarantee for any individual facility. Some for-profit homes outperform on quality measures and some nonprofit homes underperform, so you should always check a specific facility’s staffing and inspection data directly.
Is Sadie G. Mays a nonprofit facility? Yes, Sadie G. Mays Health & Rehabilitation Center has operated as a 501(c)(3) nonprofit since its 1947 founding, under the Atlanta Association for Convalescent Aged Persons, Inc., governed by a volunteer Board of Directors rather than private shareholders.
Does ownership type change what Medicare or Medicaid covers? Medicare and Medicaid benefit rules are set at the federal and state program level and apply to a certified facility regardless of whether it is organized as nonprofit or for-profit. Ownership structure affects how a facility uses its revenue, not which government benefits a resident can access there.
Should ownership structure be the only factor in choosing a nursing home? No, ownership structure works best as one early screening factor alongside a facility’s specific staffing levels, inspection history, and CMS star rating. A shortlist built partly on ownership type should still be verified against each facility’s current performance data before a final decision.
Nonprofit ownership is statistically associated with higher staffing levels and fewer care-quality problems than for-profit ownership, per a 2009 BMJ meta-analysis of 82 studies. However, individual facility performance varies within both categories.
Researchers attribute part of the staffing gap to revenue directed toward shareholder returns at for-profit facilities, as a 2021 study of ownership conversions found.
Federal law requires ownership disclosure, and families can verify any specific facility’s data through CMS Care Compare. Sadie G. Mays has operated as a nonprofit since 1947.
Checking ownership type takes minutes and adds real context to a placement decision. Call the Sadie G. Mays admissions team at 678-420-2946 with any questions about how the facility is structured and governed.