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This report is the state. The full read is one building: its occupancy month by month, its cost reports, its Medicaid rate files and its surveys. Free with an account.
October 27, 2026 · Exclusively SNF Sell-Side Advisors · Since 2014
3G Healthcare Real Estate is a sell-side advisory firm working only in skilled nursing facility real estate. This report is the Delaware ownership and operating picture as we track it, drawn from CMS Provider Information, federal ownership filings, county property records, published Medicaid rate files, and our own resolution work.
Every figure below describes the market in aggregate; nothing here is specific to any single owner or property.
44
facilities
4,717
licensed beds
84%
avg occupancy
75%
showing distress
What the Cost Reports Say · FY2024 to FY2026
Seven days in ten are Medicaid.
Every full-year Medicare cost report Delaware's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 39 reports across 3 counties. This is the table an owner puts their own filing against.
39
cost reports read across 3 counties
86.4%
median occupancy
66.0%
of the days reported by payer were Medicaid
6.8%
median net margin, 25.6% filed a loss
Seven of every ten patient days Delaware's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 66.0% of the 1,315,344 patient days on the 39 reports that break days out by payer. The median building ran 86.4% occupancy, with the middle half between 80.3% and 92.6%, on 38 reports that carry it. Patient revenue ran $432 a patient day at the median against $414 of reported operating expense, the cost report's own operating line rather than every cost a building carries. Net margin on the filings themselves was 6.8% at the median. 10 of the 39 reports that carry a bottom line filed a loss, which is 25.6% of them.
Statistic
25th
Median
75th
Reports
National median
Census and payer mix
Occupancy
Patient days as a share of available bed days, both off Worksheet S-3 Part I.
80.3%
86.4%
92.6%
38
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
9.6%
13.6%
20.6%
39
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
51.2%
67.8%
74.9%
39
66.3%
Everyone else as a share of days
Patient days that are neither traditional Medicare nor Medicaid, as a share of all patient days on the same filing. Managed care sits in here.
11.8%
15.8%
25.5%
39
23.4%
Per-resident-day economics
Patient revenue per patient day
Net patient revenue off Worksheet G-3, divided by patient days off Worksheet S-3 Part I. Blended across every payer.
$393
$432
$469
37
$373
Operating expense per patient day
Total operating expense off Worksheet G-3, divided by patient days. Net income also counts income and expense outside patient care, such as investment income, rentals and donations, which is why it is not patient revenue minus this line.
$397
$414
$504
37
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
-$3
$29
$52
37
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
0.5%
6.8%
11.5%
39
3.7%
Current ratio
Current assets over current liabilities on the same filing. Under 1.00 means the building owes more inside a year than it holds to pay it with.
Statewide pool, of the 1,315,344 days on the 39 reports that break days out by payer
Median facility
Medicaid
66.0%
67.8%
Traditional Medicare
15.1%
13.6%
Everyone else, including managed care
18.9%
15.8%
The statewide pool adds to 100 because it divides one set of days three ways. The median facility column does not, and is not meant to: every building’s own mix sums to 100, but the median Medicaid building is not the median Medicare building.
Census is not the constraint
76% of Delaware buildings closed the year at 80% occupancy or better, on the 38 reports that carry occupancy, and 26% of the 39 that carry a bottom line still filed a loss.
A $107 gap per patient day
Operating cost runs $397 a patient day at the 25th percentile against $504 at the 75th, on 37 Delaware reports. At the median building's own year of 35,245 patient days, that gap is $3.8 million a year between a lean cost structure and a heavy one.
Margin without liquidity
The median Delaware filing closed on a current ratio of 0.83, on the 33 reports that carry both sides of the balance sheet, and 58% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 26% of the state's filings lost money on patient care, so this is a working-capital reading rather than an earnings one.
Medicare cost reports as filed, fiscal years ending 2024-06-30 to 2026-03-31, one full-year report per facility: 39 reports covering 1,315,344 patient days, of which 1,315,344 sit on the 39 reports that break days out by payer, which is what the payer table below divides by. Every line carries the number of reports behind it, and a line standing on fewer than 20 reports is not ranked. Operating expense is the cost report’s own operating line. Net income also counts income and expense outside patient care, such as investment income, rentals and donations, which is why it is not patient revenue minus that line.
Medicaid Rate Context
Delaware does not publish facility-level Medicaid daily rates in a form we have been able to obtain, so there is no per-building rate picture published for this market. That absence is itself the point: without published rates most owners have no reliable way to benchmark their own building, and we maintain the comparison independently.
CMS Ownership Analytics · 44 DE SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
For-Profit
32
2.87
3.77
42%
2 / 3
$2.6M
Non-Profit
10
4.20
4.78
39%
0 / 6
$207K
Government
2
3.00
5.00
36%
0 / 0
$179K
Delaware skilled nursing is 73 percent for-profit by facility count: 32 of 44 buildings, averaging 2.87 stars overall and 3.77 on staffing. The balance is 10 non-profit, 2 government. Non-Profit buildings rate highest at 4.20 stars and for-profit lowest at 2.87. Ownership type as CMS records it describes the license holder. The real estate behind it is frequently a different party, and that is the layer we resolve.
Quality, Staffing & Distress Signals
36%
rated one or two stars
6
special focus / candidate
Delaware averages 3.19 stars overall across 44 facilities and 4,717 licensed beds. Average occupancy runs 84 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 16 facilities (36 percent) rate one or two stars overall, 2 of them one star. Special Focus status or candidacy covers 6 of them. CMS fines on the current record total $3.0M across 32 facilities. Total nurse turnover averages 41.3 percent. Counting any facility that carries at least one of a one- or two-star overall rating, Special Focus status or candidacy, CMS fines on the current record, or a distressed-title flag from county records, 33 of 44 buildings show a distress signal, 75 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
New Castle
25
2,504
Sussex
12
1,407
Kent
7
806
Market Structure
59%
run by the eight largest groups
41%
run by everyone else
The eight largest operating groups run 26 of Delaware's 44 skilled nursing facilities, 59 percent of the state and 66 percent of its licensed beds. The remaining 18 buildings are spread across a long tail of smaller operators and independents.
Operating scale is not the same as real-estate ownership, and in most markets the two are separate. The property behind these portfolios is held across a far larger and more fragmented set of owners, many of them holding a single building outright. That is the layer we resolve, and it is why a market that looks consolidated from the operating side is usually anything but from the ownership side.
Hospital Discharge Demand
10,895
SNF-relevant discharges (minimum)
6
reporting hospitals
Delaware's 6 reporting hospitals discharged at least 10,895 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 3,069 discharges. Every one of these patients needed a next setting, and the facilities positioned closest to the highest-volume hospitals see that demand first.
Condition
Discharges (at least)
Sepsis
3,069
Heart failure
1,807
Pneumonia
1,295
Urinary tract infection
1,010
Respiratory infection
1,000
Stroke
857
Kidney failure
854
Hip & femur surgery
490
COPD
436
Hip & knee replacement
77
Hospital
SNF-relevant discharges
30-day HF readmissions
CHRISTIANA HOSPITAL · NEWARK
5,450
20.2%
BEEBE MEDICAL CENTER · LEWES
1,832
20.0%
BAYHEALTH MEDICAL CENTER, KENT CAMPUS · DOVER
1,737
21.4%
BAYHEALTH HOSPITAL, SUSSEX CAMPUS · MILFORD
1,045
21.8%
TIDALHEALTH NANTICOKE, INC. · SEAFORD
637
20.7%
ST FRANCIS HOSPITAL · WILMINGTON
194
20.5%
Traditional Medicare discharges, federal fiscal 2024, in the diagnosis groups that most often discharge to skilled care. CMS withholds any line under 11 discharges, so every figure is a minimum. Readmission rates: CMS Care Compare, three-year window; n/a means CMS reports too few cases.
Medicare Readmission Penalty
68%
of graded facilities are cut this year
0.6%
average cut across the graded set
28 of Delaware's 41 graded skilled nursing facilities (68%) are taking a live Medicare payment cut this federal fiscal year under CMS's SNF Value-Based Purchasing program, which blends readmissions, infections, staffing and turnover into one multiplier and applies it to every Medicare day a building bills. The graded set averages a 0.6% cut across the whole state. A federal number like that says little read alone, which is why we check it against the fuller financial and operational record we hold on every building before it reaches a report: the buildings already under pressure elsewhere are the ones a payment cut actually threatens.
CMS SNF Value-Based Purchasing, FY2026 determination, published February 2026. The multiplier blends readmissions, infections, staffing and turnover and applies to every Medicare day a facility bills; below 1.0 is a live payment cut, not a one-time fine.
Medicare Advantage Penetration
32.7%
of the state's Medicare population is in Medicare Advantage plans
Medicare Advantage now covers 32.7% of Delaware's Medicare population, as of April 2026. That is up 2.9 points in three years. Kent County runs highest in the state at 34.7%. An MA member typically draws fewer skilled-nursing days per admission than traditional Medicare, so the counties at the top of that list are the ones structurally losing SNF days first, whatever the raw discharge count says.
County
Medicare Advantage share
Kent County
34.7%
New Castle County
33.9%
Sussex County
30.4%
CMS Medicare Monthly Enrollment, county grain, April 2026. An MA member typically draws fewer skilled-nursing days per admission than traditional Medicare, so a rising share is a structural headwind on SNF demand, not a one-quarter blip.
Market Observations
Beds concentrate where the population does: New Castle County with 25 facilities and 2,504 beds, Sussex County with 12 facilities and 1,407 beds, Kent County with 7 facilities and 806 beds.
Legislative & Regulatory Watch
In effect
Federal: Staffing Mandate (Oct 2026)
Operator implication: Staffing floors bind hardest on buildings already below the state average on hours per resident, which is where distressed sales start.
Operator implication: Staffing floors bind hardest on buildings already below the state average on hours per resident, which is where distressed sales start.
Amid changes to federal oversight of nursing homes during the Trump administration -- including rescinding the nursing home staffing rule issued by the Biden administration, prioritizing inspections that are triggered by complaints over routine inspections, and suspending the deadline to report detailed ownership information -- this issue brief provides an overview of the nursing home inspection process and the types
If a county-level Delaware breakdown, or the ownership and capital-structure detail behind any facility in it, would be useful, a short confidential conversation is the fastest way to get it. There is no cost and no obligation, and the buyer you select covers our fee.
CMS Provider Information / Care Compare: facility counts, licensed beds, occupancy, Five-Star ratings, staffing, nurse turnover, fines and Special Focus status, processed 2026-09-01.
CMS Payroll-Based Journal: nurse staffing hours and turnover.
Federal ownership filings: PECOS Form 855A indirect-owner tree and HCRIS cost-report related parties.
County property and mortgage records via the 3G real-estate-ownership resolution layer.
3G Healthcare Real Estate proprietary warehouse, resolved as of the date shown above.
Delaware does not publish facility-level Medicaid rates in an obtainable form; no per-facility rate data is presented for this state.
State and federal legislative and regulatory tracking via the 3G intelligence scan, with the source for each item linked in that section.
CMS Medicare inpatient claims (fiscal 2024): hospital discharge volumes by diagnosis group, traditional Medicare only; CMS withholds lines under 11 discharges, so volumes are minimums. Readmission rates from CMS Care Compare's three-year measure window.
CMS SNF Value-Based Purchasing facility-level file, FY2026 determination (published February 2026): readmission, infection, staffing and turnover measures rolled into one Medicare payment multiplier per facility.
CMS Medicare Monthly Enrollment: Medicare Advantage penetration by county, April 2026.
Medicare cost reports (CMS HCRIS), FY2024 to FY2026: 39 filings from 39 Delaware skilled nursing facilities, one full-year report each, loaded 2026-10-06. Occupancy, patient days by payer, patient revenue, operating expense and net income as each facility filed them.
3G Healthcare Real Estate is a brokerage firm specializing exclusively in skilled
nursing facility real estate. We do not provide legal, financial, or tax advice.
3G Healthcare Real Estate, 456 N. Meridian St #441332, Indianapolis, IN 46204.
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