The US Senior Care Gap: America must roughly double its nursing home beds by 2040 just to stand still.
The US population aged 85 and over is projected to roughly double by 2040, while the certified nursing home bed supply has stayed close to flat. Holding today's provision rate would take on the order of 1.57 million additional beds, roughly a doubling of the national stock. This analysis sets the federal count of every certified nursing home against US Census population figures and projections.
Key findings
The demand curve is set, and it only steepens
The US population aged 85 and over is roughly 6.7 million today and is projected to roughly double, to around 13 million, by 2040 on US Census Bureau projections. Unlike most forecasts, this one is close to locked: nearly everyone who will be 85 in 2040 is alive today. The question for operators and developers is not whether demand rises, but where the current bed base falls furthest behind it.
Supply has not kept pace
Set that against supply. The Centers for Medicare and Medicaid Services (CMS) publishes every Medicare or Medicaid certified nursing home in the country: about 14,700 homes and about 1.57 million certified beds. Dividing beds by the 85+ population gives a national provision rate of roughly 24 certified beds per 100 residents aged 85+. Simply holding that rate as the 85+ population doubles would require the bed base to double too, on the order of 1.57 million additional beds by 2040.
The bed figures here are the real count from the CMS provider file (14,695 certified nursing homes, 1,568,348 certified beds, June 2026 release); the 85+ population is the published US Census figure. It is a national estimate: it holds today's provision rate and today's bed base flat, a deliberately conservative baseline that assumes no growth in the rate and no net closures. The local picture is what decides individual sites, and it varies enormously. That area-by-area analysis, metro by metro, is what Threshold US puts on a map.
Two honest caveats
- Nursing homes, not all senior housing. CMS covers certified nursing homes. Assisted living and independent living are licensed state by state with no single federal register, so they are not in this national figure. Total senior housing demand is larger than the certified nursing home slice shown here.
- A provision-rate model, not a forecast. Holding today's rate is a planning assumption, not a prediction of how care is delivered. Care models shift over time. The point is the scale of the gap that opens if the bed base stands still while the 85+ population doubles.
Quotable summary
"The US population aged 85 and over is projected to roughly double by 2040, but the certified nursing home bed base has stayed close to flat. Just to hold today's provision rate of about 24 beds per 100 older residents, the country would need on the order of 1.57 million more beds, roughly a doubling of the stock, and the places that look comfortably supplied on today's snapshot are often the ones facing the sharpest reversals."
Method
- Supply: certified nursing home bed counts from the CMS Care Compare / Provider Information dataset, which lists every Medicare or Medicaid certified nursing home in the US (about 14,700 homes, about 1.57 million certified beds).
- Demand: US population aged 85 and over from the US Census Bureau (American Community Survey age tables and national population projections), roughly 6.7 million today and projected to roughly double by 2040.
- The rate: about 24 certified beds per 100 residents aged 85+ is computed from the two published aggregates (total certified beds divided by the 85+ population), not assumed.
- The gap: beds needed in 2040 equals the projected 85+ population times today's rate; the shortfall is that figure minus today's bed base. Both the rate and the bed base are held flat, a conservative baseline.
- Scope: this is a national estimate from federal aggregates. It is not a bottom-up, area-level model. The metro and state level analysis is delivered in the Threshold US tool.
All source data is US federal public information (CMS and the US Census Bureau). Figures are statistical estimates for research and analysis; they are not investment advice and take no view on individual operators.
How to cite
Journalists and researchers are welcome to republish the figures and findings on this page with attribution and a link. For state or metro level figures and custom cuts of the data as the tool comes online, contact us through the waitlist.
Explore Threshold US
Threshold US is live now. The same engine that maps the bed gap area by area across the UK now covers the United States: senior housing demand, nationally from CMS and Census data, and residential land, in Florida, Maryland, Massachusetts, Connecticut, New York, North Carolina and Colorado. Start a 7-day free trial, no card.
Published July 2026. Data: CMS Care Compare / Provider Information (certified nursing home beds); US Census Bureau American Community Survey and national population projections (population aged 85+). US federal public information. Threshold is a James Hayes Consulting product.