3G Healthcare Real Estate · SNFRadar Intelligence
An independent study · September 2026
The Rented Shift
What a building’s reliance on agency nurses says about whether it changes hands. Two federal records that have never been published in one table: who is working the shift, and who owns the building two years later.
The short version
Seven findings, if you read nothing else
- Buildings running the most agency change hands the most. Under 2% of nursing hours worked by agency staff, 6.95% changed owner within two years. At 15% or more, 11.65% did. That is 1.7 times the rate, across 54,847 facility-years.
- It held in every year we could measure, and it widened. In 2018 the two ends were 6.02% and 6.25%, close to nothing. In 2022 they were 8.79% and 14.09%.
- Nobody has to draw a line, because the buildings draw it themselves. Cut the same panel into eight steps of agency reliance and the rate climbs at every one, from 6.62% among buildings that rented no agency hours at all to 14.56% among those renting more than 40% of their nursing hours.
- It is the reliance, not the role. Heavy on registered nurses, 10.87%; on practical nurses, 11.27%; on aides, 11.43%. Three different labour markets, one answer.
- It is not the star rating and it is not the empty beds. Hold the CMS rating still and the gap survives inside every band: at four and five stars, 8.98% of heavy-agency buildings changed hands against 5.98% of the lightest. Hold occupancy still and it survives there too: at 85% full and over, 8.67% against 5.63%.
- Today 1,580 buildings, 11.2% of everyone filing a full year, are above 15% agency. In Vermont it is two thirds of the state; in Pennsylvania and New Jersey, more than a quarter.
- New owners do cut it, and less than it looks. Heavy users that changed hands went from 28.72% to 16.81% agency in a year. Heavy users that did not change hands went from 26.62% to 19.52% over the same window. Most of the fall is what heavy users do anyway.
The rest of the study
Every finding, every chart, and the method behind each figure.
The body of the study opens with an account. It is free, it takes one text message, and it opens every state report we publish along with it.
The state table below stays open to everyone, account or not, and so does the CSV.
Every state · free to use, free to cite
The numbers behind all of it
This is the table we would want if we were writing about this industry, so we are publishing it whole, every state and territory in the panel, above and below the reporting floors. Buildings observed, how much of each state’s history sat at heavy agency reliance, the change-of-ownership rate in the heavy and light buckets, and where the state stands today.
| State | Buildings | Facility-years | Share at 15%+ agency | Obs at 15%+ | Changed hands, 15%+ | Obs under 2% | Changed hands, under 2% | Buildings 2026Q1 | Above 15% now | Share above 15% now |
|---|---|---|---|---|---|---|---|---|---|---|
| AK | 15 | 40 | 17.5% | 7 | n/a | 18 | n/a | 11 | 3 | n/a |
| AL | 224 | 777 | 4.5% | 35 | 5.7% | 634 | 3.0% | 220 | 3 | 1.4% |
| AR | 229 | 759 | 2.0% | 15 | n/a | 663 | 9.7% | 211 | 5 | 2.4% |
| AZ | 150 | 524 | 9.9% | 52 | 11.5% | 305 | 6.6% | 133 | 8 | 6.0% |
| CA | 1,179 | 4,158 | 5.5% | 228 | 11.4% | 2,920 | 7.1% | 1,042 | 42 | 4.0% |
| CO | 230 | 812 | 15.6% | 127 | 24.4% | 375 | 9.1% | 198 | 25 | 12.6% |
| CT | 213 | 736 | 7.1% | 52 | 1.9% | 444 | 5.6% | 188 | 24 | 12.8% |
| DC | 18 | 57 | 5.3% | 3 | n/a | 43 | 7.0% | 15 | 3 | n/a |
| DE | 45 | 164 | 17.1% | 28 | n/a | 96 | 8.3% | 42 | 3 | 7.1% |
| FL | 722 | 2,587 | 11.9% | 308 | 13.3% | 1,586 | 8.0% | 679 | 9 | 1.3% |
| GA | 359 | 1,317 | 13.8% | 182 | 12.1% | 786 | 5.9% | 346 | 16 | 4.6% |
| HI | 43 | 146 | 8.9% | 13 | n/a | 85 | 2.4% | 42 | 9 | 21.4% |
| IA | 443 | 1,574 | 17.2% | 270 | 3.0% | 693 | 7.8% | 377 | 31 | 8.2% |
| ID | 80 | 281 | 6.0% | 17 | n/a | 165 | 6.1% | 76 | 8 | 10.5% |
| IL | 729 | 2,541 | 14.3% | 364 | 17.3% | 1,501 | 12.1% | 652 | 66 | 10.1% |
| IN | 545 | 1,986 | 11.6% | 231 | 5.6% | 1,250 | 3.6% | 494 | 29 | 5.9% |
| KS | 330 | 1,139 | 15.1% | 172 | 4.1% | 627 | 7.3% | 284 | 36 | 12.7% |
| KY | 284 | 1,013 | 12.6% | 128 | 12.5% | 640 | 9.4% | 262 | 17 | 6.5% |
| LA | 270 | 973 | 8.2% | 80 | 16.3% | 617 | 6.5% | 248 | 13 | 5.2% |
| MA | 393 | 1,359 | 16.7% | 227 | 14.5% | 594 | 4.9% | 331 | 38 | 11.5% |
| MD | 225 | 839 | 19.1% | 160 | 15.6% | 429 | 11.9% | 218 | 46 | 21.1% |
| ME | 98 | 333 | 35.4% | 118 | 0.8% | 131 | 0.0% | 72 | 22 | 30.6% |
| MI | 443 | 1,594 | 7.8% | 125 | 7.2% | 1,138 | 2.9% | 398 | 20 | 5.0% |
| MN | 373 | 1,301 | 10.1% | 131 | 7.6% | 790 | 1.8% | 320 | 61 | 19.1% |
| MO | 525 | 1,743 | 11.2% | 196 | 14.8% | 1,182 | 3.8% | 463 | 46 | 9.9% |
| MS | 207 | 761 | 13.4% | 102 | 1.0% | 496 | 2.0% | 194 | 16 | 8.2% |
| MT | 73 | 238 | 37.4% | 89 | 24.7% | 83 | 10.8% | 55 | 16 | 29.1% |
| NC | 418 | 1,536 | 22.6% | 347 | 19.9% | 818 | 7.7% | 401 | 94 | 23.4% |
| ND | 80 | 283 | 26.1% | 74 | 0.0% | 107 | 3.7% | 67 | 26 | 38.8% |
| NE | 203 | 683 | 22.4% | 153 | 9.2% | 285 | 3.5% | 168 | 39 | 23.2% |
| NH | 73 | 278 | 20.1% | 56 | 7.1% | 88 | 4.5% | 69 | 18 | 26.1% |
| NJ | 366 | 1,312 | 20.4% | 268 | 10.4% | 599 | 7.8% | 343 | 92 | 26.8% |
| NM | 75 | 266 | 18.4% | 49 | 16.3% | 105 | 14.3% | 66 | 18 | 27.3% |
| NV | 64 | 219 | 9.1% | 20 | n/a | 141 | 3.5% | 62 | 5 | 8.1% |
| NY | 616 | 2,216 | 28.4% | 629 | 1.1% | 784 | 1.1% | 579 | 112 | 19.3% |
| OH | 983 | 3,476 | 14.3% | 497 | 7.4% | 1,977 | 4.9% | 910 | 74 | 8.1% |
| OK | 296 | 960 | 6.7% | 64 | 20.3% | 712 | 10.4% | 256 | 8 | 3.1% |
| OR | 134 | 457 | 16.2% | 74 | 23.0% | 183 | 6.6% | 121 | 24 | 19.8% |
| PA | 696 | 2,530 | 23.9% | 605 | 17.0% | 1,035 | 5.9% | 635 | 170 | 26.8% |
| PR | 5 | 12 | 0.0% | 0 | n/a | 9 | n/a | 7 | 0 | n/a |
| RI | 82 | 283 | 15.5% | 44 | 20.5% | 155 | 2.6% | 71 | 8 | 11.3% |
| SC | 193 | 694 | 16.9% | 117 | 15.4% | 386 | 6.2% | 180 | 32 | 17.8% |
| SD | 108 | 354 | 18.1% | 64 | 21.9% | 163 | 8.0% | 90 | 22 | 24.4% |
| TN | 318 | 1,173 | 12.6% | 148 | 5.4% | 815 | 6.7% | 294 | 23 | 7.8% |
| TX | 1,252 | 4,237 | 8.5% | 361 | 17.5% | 2,935 | 11.7% | 1,136 | 50 | 4.4% |
| UT | 104 | 377 | 15.4% | 58 | 8.6% | 222 | 4.1% | 95 | 5 | 5.3% |
| VA | 293 | 1,064 | 15.4% | 164 | 14.0% | 604 | 11.9% | 285 | 34 | 11.9% |
| VT | 36 | 130 | 38.5% | 50 | 4.0% | 29 | n/a | 33 | 22 | 66.7% |
| WA | 212 | 728 | 14.4% | 105 | 20.0% | 353 | 9.9% | 184 | 18 | 9.8% |
| WI | 370 | 1,246 | 12.0% | 150 | 6.7% | 673 | 5.6% | 318 | 57 | 17.9% |
| WV | 125 | 454 | 13.2% | 60 | 18.3% | 254 | 9.8% | 120 | 9 | 7.5% |
| WY | 36 | 127 | 11.8% | 15 | n/a | 81 | 9.9% | 34 | 5 | 14.7% |
Buildings and facility-years count the 2018, 2019, 2022 and 2023 observations. A change-of-ownership rate is shown only where its bucket holds 30 or more observations, and a current share only where the state has 30 or more buildings filing a complete trailing year; the counts are published either way so you can compute your own. The last three columns are the trailing four quarters to the first quarter of 2026, which is the most recent published data and has no outcome attached to it yet.
The evidence for holding 2024 back
Changes of ownership by the month they took effect, over the final two years of the record. The count falls away toward the end, which is what an enrollment file looks like while filings are still working through. A 24-month window opened in mid-2024 would run into that tail and read it as a market going quiet, so 2024 is not in the panel.
| Month | Changes of ownership |
|---|---|
| 2024-02 | 41 |
| 2024-03 | 46 |
| 2024-04 | 40 |
| 2024-05 | 46 |
| 2024-06 | 65 |
| 2024-07 | 41 |
| 2024-08 | 100 |
| 2024-09 | 68 |
| 2024-10 | 45 |
| 2024-11 | 57 |
| 2024-12 | 108 |
| 2025-01 | 53 |
| 2025-02 | 41 |
| 2025-03 | 25 |
| 2025-04 | 31 |
| 2025-05 | 42 |
| 2025-06 | 71 |
| 2025-07 | 23 |
| 2025-08 | 28 |
| 2025-09 | 26 |
| 2025-10 | 25 |
| 2025-11 | 17 |
| 2025-12 | 14 |
| 2026-01 | 2 |
| 2026-02 | 1 |
For journalists and researchers
Use this. We would rather you did.
Every figure in this study comes from public federal records, and the whole state table above is free to reproduce. We are not asking for anything in exchange for it.
Press access. We will give reporters the underlying data behind any figure here, the full methodology, and where useful a cut we have not published: by county, by ownership type, by chain, by bed size, or the buildings behind a state number. We can usually turn that around the same day.
We are also available as a source on skilled nursing labor, transactions, valuations and closures. We represent sellers, exclusively in this asset class, which is a position worth knowing when you weigh what we say, and it is also why our read on who is selling and why tends to be early.
To request data or an interview: Stan Klos III for interviews and comment, [email protected]. Christian Patrick for data requests and methodology, [email protected]. We will say plainly when we do not know something, which is most of the reason to call us.
Cadence. The staffing and agency figures here are refreshed each quarter, against the next Payroll-Based Journal release CMS publishes. Ask either of us and we will send the update when it lands.
3G Healthcare Real Estate / SNFRadar Intelligence, “The Rented Shift: what a building’s
reliance on agency nurses says about whether it changes hands,” September 2026.
About
Who published this
3G Healthcare Real Estate is a brokerage that represents sellers of skilled nursing facilities, exclusively. SNFRadar is the research operation behind it: a continuously updated record of staffing, quality, financial condition and transactions across every skilled nursing facility in the United States.
We publish work like this because the data we maintain to do our job answers questions the industry cannot otherwise get answered, and because being useful in public is a better introduction than a cold call. If you own or operate a facility and want your own building’s numbers, its agency reliance over the trailing year and how that compares in its state, we will put them together and walk you through them, whether or not you are thinking about selling.
3G Healthcare Real Estate · Exclusively SNF Sell-Side Advisors · SNFRadar Intelligence
The Rented Shift · An independent study · September 2026 · Free to cite with attribution
Sources: CMS Payroll-Based Journal daily nurse staffing, all published quarters 2017 to 2026; CMS
provider enrollment change-of-ownership record. Both are public federal data.
No individual, owner or operator is identified in this study. No private or client information was used.