Nursing Care Facilities (Skilled Nursing Facilities) — U.S. Industry Primer

NAICS 2022 code 623110

1. Overview

Skilled nursing facilities (SNFs), commonly called nursing homes, provide 24-hour inpatient nursing and personal care for people who cannot live independently. Two very different populations share the same building: frail long-stay residents whose care is mainly custodial, and shorter-stay patients recovering from a hospital surgery, stroke, or serious illness. This is a large, essential, and politically charged corner of health care — roughly 14,700 Medicare- and Medicaid-certified nursing homes house about 1.2 million residents on any given day.[2] National spending at freestanding nursing care facilities reached about $211 billion in 2023 and roughly $220 billion in 2024.[3]

Why it matters to an investor: demand is underpinned by one of the most reliable trends in the economy — an aging population — yet the industry earns most of its revenue from government payers whose rates it does not control, and it runs on thin, labor-heavy margins. The central question is therefore not simply whether demand exists. It is whether an operator can convert occupancy and reimbursement into cash flow after labor, compliance, capital spending, debt, and rent.

There are two distinct ways to get exposure, and both public- and private-market investors participate:

• Operators run the facilities and take on the reimbursement, labor, and occupancy risk.
• Landlords — often real estate investment trusts (REITs) — own the buildings and collect rent under long-term leases.

Public-market investors can own a handful of listed operators or several healthcare REITs. Private capital dominates the sector far more than public capital does: most nursing homes are owned by private companies, families, private-equity (PE) firms, and nonprofits, and the common private routes are direct ownership/operation, real-estate roll-ups, sale-leasebacks, and lending to operators.

2. What it is and how it's structured

The North American Industry Classification System (NAICS) defines code 623110 as establishments primarily providing inpatient nursing and rehabilitative services, generally for extended periods, staffed continuously by registered nurses (RNs), licensed practical nurses (LPNs), and aides.[1] It covers nursing homes, convalescent and rest homes with nursing care, and inpatient-care hospices. A licensed nurse is on site, staff help with activities of daily living (bathing, feeding, mobility), and facilities often provide physical, occupational, and speech therapy.

What it excludes (these are separate, adjacent NAICS industries):

• 623311 Continuing Care Retirement Communities and 623312 Assisted Living Facilities for the Elderly — housing with lighter support, for residents who do not need round-the-clock skilled nursing.
• 623220 Residential Mental Health & Substance Abuse Facilities and 623210 (intellectual/developmental disability facilities).
• 621610 Home Health Care Services — skilled care delivered in the patient's own home, a direct substitute for a nursing home.
• 622 Hospitals, including long-term acute-care hospitals — a higher-acuity setting.[1]

A layered business. A single SNF may serve both short-stay post-acute patients and long-stay custodial residents. Its operating company may own the building, lease it from a REIT, or run a facility owned by yet another investor. Therapy, pharmacy, staffing, and management are frequently supplied by separate affiliated companies — a structure that can obscure where the real economics sit (see Risks).

Ownership mix. About 72% of nursing homes are for-profit, roughly 23% are nonprofit, and about 5–6% are government-owned (county or municipal).[8] Estimates of private-equity ownership range from about 5% (a 2022 Government Accountability Office count of roughly 14,800 Medicare-enrolled homes) up to double digits — the range is wide because ownership chains are complex and Medicare's data were not designed to identify PE reliably.[9] The takeaway: this is a privately dominated industry, and publicly traded operators run only a small minority of the nation's beds.

3. How big it is

The figures below are our federal ground truth. They carry different vintages: County Business Patterns (CBP) is 2023; receipts and market-concentration data are from the 2022 Economic Census.

Undercount caveats. Three gaps are worth flagging:

• The Economic Census generally excludes government-operated establishments, so the ~5–6% of facilities run by counties and municipalities are missing from the $135.4 billion receipts figure. CBP likewise excludes most government employees and nonemployers (though tiny nonemployers are a minor issue here, since SNFs require paid staff).[7]
• The receipts figure ($135.4B) is smaller than the ~$211B of national spending on nursing-care facilities that CMS reports,[3] because the national-spending measure is a broader, later-year category (it bundles in nursing revenue from continuing-care retirement communities).
• The CBP establishment count (18,126) is higher than the ~14,700 CMS-certified nursing homes[2] because it also captures non-certified facilities and separate administrative locations.

Treat the federal receipts figure as a conservative floor for the industry's economic footprint. Note also that these federal statistics do not provide nationwide beds, occupancy, payer mix, expenses, or all-payer margins — those metrics appear below only where separately sourced.

4. The investable universe

The listed universe splits into operators (they run facilities and carry reimbursement and labor risk) and landlord REITs (they own the real estate and lease it to operators, typically under long-term "triple-net" leases, where the tenant pays taxes, insurance, and upkeep). The operator group is unusually thin for an industry this large, precisely because most owners are private. Facility and bed counts below are from companies' latest (year-end 2025) SEC filings.

Approximate July 2026 market caps (relative scale only; they move daily): Ensign ~$9.8B, Omega ~$15.3B, CareTrust ~$9.5B, Sabra ~$5.1B, National Health Investors ~$3.7B.[19]

A caution on PACS Group. PACS grew explosively by acquisition but has faced a short-seller report, delayed regulatory filings, and scrutiny of its billing and skilled-mix practices, all disclosed in its own filings — a reminder that reported growth in this industry can outrun the quality of its accounting. Read the filings carefully.[12]

Major private and nonprofit owners. The largest chains are mostly private:

• Genesis HealthCare — a private holding company whose subsidiaries operate roughly 200 skilled-nursing and senior-living centers across 17 states; it filed for Chapter 11 bankruptcy in July 2025 under more than $1 billion of debt.[20][21]
• Life Care Centers of America — privately held; 200+ skilled-nursing, rehab, Alzheimer's, and senior-living campuses in 27 states.[22]
• PruittHealth — a private, family-run platform with 195+ locations across six states, spanning SNFs, home health, and hospice.[23]
• CommuniCare Health Services and Signature HealthCARE — private, multi-state post-acute operators.

For private investors, the practical routes are direct facility ownership/operation, private-equity roll-ups, buying the real estate (often leased back to an operator), and private credit to operators.

5. How the money works

An SNF's revenue is, at its core, patient-days × the daily rate for each payer, so three levers drive the business.

1. Occupancy (census). Fixed costs are high, so filling beds is everything — and occupancy is measured against operational beds, not merely licensed beds. National occupancy was about 84% in October 2024, recovering from pandemic lows; MedPAC noted that some providers were closing beds or denying admissions because they could not staff them.[26]

2. Payer mix / "skilled mix." Who pays matters far more than how many beds are full. The major payers are Medicaid, Medicare, Medicare Advantage, other managed care, and private pay.

• Medicaid (the joint federal-state program for low-income people) finances most of the long-term-care days in SNFs — roughly three-fifths of resident-days — but pays at or below the cost of care. It is the low-margin "base load."[26][27]
• Medicare (federal coverage for those 65+) pays for short post-acute rehab. Coverage generally requires a medically necessary inpatient hospital stay of at least three days and can run up to 100 days per spell of illness; Medicare pays in full for the first 20 days, after which a daily copay applies (days 21–100 = $209.50 in 2025).[24] Medicare and Medicare Advantage plans pay much higher daily rates than Medicaid.

The share of days paid by these higher-rate sources is the skilled mix, and it is the single biggest swing factor in profitability. MedPAC's 2023 data illustrate the spread starkly: a 22% fee-for-service Medicare margin against a 0.4% all-payer margin.[26] A facility can be completely full and still lose money if its skilled mix is too low.

3. Reimbursement rates. Medicare pays under a prospective payment system (PPS): a per-day rate adjusted for geography and patient complexity through the Patient-Driven Payment Model (PDPM), which sets pay based on the patient's clinical characteristics (nursing, therapy, and non-therapy ancillaries) rather than the volume of therapy delivered.[25] CMS updates rates annually — a +4.2% net increase took effect for federal fiscal year 2025, followed by a +3.2% increase (an estimated $1.16 billion) for fiscal year 2026.[28][29] Medicaid rates are set state by state, and many states top them up through provider-tax-funded supplemental-payment programs.

Cost side. Labor is the dominant expense — typically well over half of costs — and reliance on expensive temporary agency staff is the swing cost that separates strong operators from weak ones. The strong-operator playbook (Ensign is the archetype) is to buy underperforming facilities cheaply, then lift occupancy, skilled mix, and staffing efficiency to expand margins.[11] For operators, earnings before interest, taxes, depreciation, and amortization (EBITDA) should be judged after lease expense and maintenance capital spending, not before.

The property angle (for real-estate investors). Many operators separate the business from the building: a REIT or private landlord owns the real estate and leases it back under a long-term triple-net lease. The landlord's key metrics are the rent-coverage ratio (operator cash flow relative to rent — the cushion against tenant distress) and lease duration. Sector REITs typically carry investment-grade-adjacent "BBB−" credit and weighted-average lease terms of roughly 9–10 years.[32] The landlord's return is contractual rent plus escalators; its main risk is a tenant that can't pay — as Genesis's landlords learned.

6. What drives demand

• Demographics (the long tailwind). The U.S. population aged 65+ reached 61.2 million — 18.0% of the country — in 2024, and Census projects older adults will outnumber children by 2034.[34] The 85-and-older group most likely to need nursing care is projected to rise from roughly 9 million around 2030 to about 14 million by 2040.[33] This is the industry's central bull case.
• Hospital activity (the short-stay driver). Profitable post-acute rehab admissions follow hospital discharges — surgeries, strokes, joint replacements, infections — so short-stay demand tracks the broader health system's volume.
• Substitution and steering (the headwind). Home health care, assisted living, hospital-at-home programs, and especially Medicare Advantage plans increasingly divert or shorten nursing-home stays to control costs. This pressures both volume and length of stay.
• Workforce as a ceiling. Demand does not automatically become revenue: labor shortages can prevent a facility from admitting patients even when beds are physically open.[26]
• Acuity mix. Patients are arriving sicker, which raises reimbursement per day but also raises staffing and clinical costs.

7. Regulation

Regulation is the industry's defining feature because the government both pays and polices it.

• Payment is policy. The Centers for Medicare & Medicaid Services (CMS) sets Medicare rates annually and certifies facilities to participate in Medicare and Medicaid; states set Medicaid rates. A rate decision in Washington or a state capital moves the industry's revenue directly.
• Quality oversight. Facilities undergo state health inspections (surveys), report clinical data through the Minimum Data Set, and are graded on CMS's public Five-Star Quality Rating system, published on Care Compare. The Quality Reporting Program (QRP) can dock the annual payment update by two percentage points for non-compliant facilities, and the Value-Based Purchasing (VBP) program ties some Medicare payment to performance.[29][31] Serious deficiencies can trigger fines, admissions holds, or loss of certification.
• Ownership transparency. CMS now publishes SNF ownership and enrollment data, including PE and REIT involvement, though layered structures still limit its usefulness.[31]
• The staffing-mandate saga (a live example). In 2024 CMS finalized a first-ever federal minimum-staffing rule requiring 3.48 nurse hours per resident-day (including 0.55 hours of RN care and 2.45 hours of nurse-aide care) plus an RN on site 24/7. A federal court in Texas vacated the core provisions in April 2025; the 2025 budget-reconciliation law (the "One Big Beautiful Bill Act," P.L. 119-21) imposed a 10-year moratorium on the mandate; and CMS/HHS formally repealed it in December 2025.[30] The reversal removed a major cost threat operators had warned was unaffordable amid nursing shortages — but investors must still track state staffing laws and facility-specific survey history.
• Barriers to entry. Many states use Certificate of Need (CON) laws that cap new nursing-home beds, constraining supply and protecting incumbents in those markets.

8. Competitive dynamics and consolidation

At the national level the industry is strikingly fragmented. The four largest firms account for just 6.8% of receipts, the top eight for 10.3%, the top 20 for 16.5%, and the top 50 for 25.2%; the Herfindahl-Hirschman Index (HHI) — a standard concentration gauge on a 0–10,000 scale — is essentially zero at 21.[5] No operator dominates nationally.

But competition is local. Patients pick facilities near family, and referrals come from nearby hospitals, so market power is regional — an operator with tiny national share can still be dominant in a single county or hospital-referral network. Scale advantages that do matter are largely local or back-office: recruiting and retaining clinical staff, purchasing and insurance, centralized billing and compliance, hospital and managed-care relationships, and the capital to renovate and absorb distressed facilities. Leading operators such as Ensign deliberately cluster facilities within states rather than chase national reach.

Consolidation is steady and is being redistributed toward the well-capitalized. Distressed sellers — bankruptcies like Genesis, nonprofits exiting the business, and health systems shedding SNFs — feed acquisitive operators. Ensign completed 51 acquisitions in 2025 (roughly 40 of them stand-alone skilled-nursing operations), adding several thousand SNF beds.[11][10] But acquisition quality varies widely: roll-ups can hide survey liabilities, deferred maintenance, weak local labor markets, and overestimated synergies. Private equity remains an active but controversial buyer, drawing regulator and researcher scrutiny over care quality and financial engineering.[9]

9. Risks

• Reimbursement and policy risk (the biggest one). Revenue depends on government rates the operator can't set. Medicaid is subject to state budgets, and federal Medicaid changes — including limits on the provider-tax mechanisms states use to fund supplemental SNF payments — could cut effective rates just as demand rises. This is the sector's dominant uncertainty.
• Labor. Chronic shortages of nurses and aides drive wage inflation, overtime, turnover, and costly agency use; staffing is simultaneously the largest cost and a quality-and-liability pressure point.
• Occupancy. Low census reduces revenue while most labor and building costs stay fixed.
• Leverage and rent burden. Thin margins plus heavy debt or fixed triple-net rent leave little cushion; a weak operator can become a distressed tenant even when the underlying building is sound. Genesis's 2025 bankruptcy is the cautionary tale.[21]
• Payer steering. Rising Medicare Advantage penetration compresses both length of stay and per-day rates for the profitable short-stay business.
• Quality, litigation, and reputation. Deficiencies, preventable harm, infection outbreaks, fraud investigations, and lawsuits can hit cash flow and reputation at once.
• Ownership opacity. Related-party leases, therapy and management-fee arrangements, and layered property ownership can make a facility's true economics hard to assess.
• For REIT investors specifically: tenant credit risk (an operator that can't pay rent) and interest-rate sensitivity, since REIT valuations and dividends are rate-sensitive.

10. How to invest and the outlook

Public routes — separate the two businesses:

• Operators — Ensign Group (ENSG) is the sector's standout compounder; PACS Group (PACS) is a fast-growing but scrutinized peer; National HealthCare (NHC) is a smaller, long-established operator-owner. Watch same-facility occupancy, payer/skilled mix, revenue per patient-day, labor and agency cost, quality scores, lease-adjusted leverage, and acquisition returns. These carry the full operating exposure.
• Landlord REITs — Omega Healthcare (OHI), CareTrust (CTRE), Sabra (SBRA), National Health Investors (NHI), and LTC Properties (LTC) offer rent-based income and typically higher dividend yields, with risk concentrated in tenant health rather than daily operations. Watch rent coverage, tenant concentration, lease escalators and maturities, funds from operations (FFO), and dividend coverage. This is the more income-oriented, lower-operational-risk way in.

Private routes. Because so few public operators exist, most capital enters privately: direct ownership and operation, operating-company acquisitions, buying SNF real estate to lease back, private credit to operators, and ancillary services. These offer more control and potentially higher returns but demand hands-on operating and regulatory expertise. Due diligence should include CMS Care Compare records, ownership filings, Medicaid rate history, staffing/agency dependence, licenses and survey deficiencies, capital needs, real-estate condition, and related-party contracts.

Outlook (forward-looking judgment). The demographic tailwind is close to a certainty — the 85-plus population roughly doubles by 2040[33] — and new supply is constrained by CON laws and years of underbuilding, so occupancy and pricing power should firm over time. The repeal of the federal staffing mandate lifted a major cost overhang.[30] But the cash-flow outlook is uneven: the central near-term risk is Medicaid funding — federal and state budget pressure and limits on provider-tax financing could squeeze the low-margin base of the business. Expect continued consolidation, with strong, well-capitalized operators taking share from distressed and nonprofit sellers. In short: a durable demand story wrapped around persistent, policy-driven margin risk — rewarding to disciplined operators and landlords, unforgiving to the over-leveraged.

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Sources

1. U.S. Census Bureau, 2022 NAICS Definition — 623110 Nursing Care Facilities (Skilled Nursing Facilities). https://www.census.gov/naics/?details=623110&input=623110&year=2022
2. Centers for Medicare & Medicaid Services, Nursing Homes / Minimum Staffing Standards Final Rule fact sheet (≈1.2 million residents; ≈14,695 certified facilities), 2024. https://www.cms.gov/medicare/health-safety-standards/certification-compliance/nursing-homes
3. Centers for Medicare & Medicaid Services, National Health Expenditures 2024 Highlights (nursing care facilities ≈$211.3B in 2023; ≈$219.9B in 2024), 2025. https://www.cms.gov/files/document/highlights.pdf
4. U.S. Census Bureau, County Business Patterns: 2023 — NAICS 623110 (establishments, employment, annual and Q1 payroll), 2025. https://www.census.gov/data/datasets/2023/econ/cbp/2023-cbp.html
5. U.S. Census Bureau, 2022 Economic Census — Establishment and Firm Size / Concentration, NAICS 623110 (receipts, firms, CR4/CR8/CR20/CR50, HHI). https://api.census.gov/data/2022/ecnsize.html
6. U.S. Small Business Administration, Table of Size Standards, NAICS 623110 ($34M average annual receipts), 2023. https://www.sba.gov/document/support-table-size-standards
7. U.S. Census Bureau, CBP Methodology and Economic Census Coverage (undercoverage; exclusion of government-operated establishments and most nonemployers), 2026. https://www.census.gov/programs-surveys/cbp/technical-documentation/methodology.html
8. U.S. Dept. of Health & Human Services, ASPE Data Brief, Ownership of Skilled Nursing Facilities (≈72% for-profit / ≈23% nonprofit / ≈5–6% government), 2024. https://aspe.hhs.gov/sites/default/files/documents/fd593ae970848e30aa5496c00ba43d5c/aspe-data-brief-ownership-snfs.pdf
9. U.S. Government Accountability Office, Nursing Homes: Limitations of Using CMS Data to Identify Private Equity and Other Ownership, GAO-23-106163 (PE ≈5% of ≈14,800 Medicare-enrolled homes in 2022; data incomplete), 2023. https://www.gao.gov/products/gao-23-106163
10. U.S. Securities and Exchange Commission, The Ensign Group 2025 Form 10-K (373 skilled-nursing operations; ≈37,911 operational SNF beds; ≈40 stand-alone SNF operations added), 2026. https://www.sec.gov/Archives/edgar/data/1125376/000112537626000007/ensg-20251231.htm
11. The Ensign Group, Inc., Fiscal Year and Fourth Quarter 2025 Results (≈$5.06B revenue; occupancy; 51 acquisitions), 2026. https://investor.ensigngroup.net/news/news-details/2026/The-Ensign-Group-Reports-Fiscal-Year-and-Fourth-Quarter-2025-Results-Issues-2026-Annual-Earnings-and-Revenue-Guidance/default.aspx
12. U.S. Securities and Exchange Commission, PACS Group 2025 Form 10-K (321 post-acute facilities; ≈32,854 SNF beds; billing/filing disclosures), 2026. https://www.sec.gov/Archives/edgar/data/2001184/000200118426000005/pacs-20251231.htm
13. PACS Group, Inc., Fiscal Year and Fourth Quarter 2025 Results (≈$5.29B revenue), 2026. https://www.stocktitan.net/news/PACS/pacs-group-inc-reports-fiscal-year-and-fourth-quarter-2025-767enzhwe0jl.html
14. U.S. Securities and Exchange Commission, National HealthCare 2025 Form 10-K (80 SNFs; 10,329 licensed beds), 2026. https://www.sec.gov/Archives/edgar/data/1047335/000143774926005910/nhc20251231_10k.htm
15. U.S. Securities and Exchange Commission, Omega Healthcare Investors 2025 Form 10-K (1,027 operating healthcare facilities; long-term-care focus), 2026. https://www.sec.gov/Archives/edgar/data/888491/000088849126000008/ohi-20251231x10k.htm
16. U.S. Securities and Exchange Commission, CareTrust REIT 2025 Form 10-K (407 properties; ≈37,628 operational beds/units), 2026. https://www.sec.gov/Archives/edgar/data/1590717/000162828026007664/ctre-20251231.htm
17. U.S. Securities and Exchange Commission, Sabra Health Care REIT 2025 Form 10-K (210 SNF/transitional-care facilities within a 360-property portfolio), 2026. https://www.sec.gov/Archives/edgar/data/1492298/000149229826000008/sbra-20251231.htm
18. U.S. Securities and Exchange Commission, LTC Properties 2025 Form 10-K (68 SNF properties; ≈8,196 SNF beds within a 186-property portfolio), 2026. https://www.sec.gov/Archives/edgar/data/887905/000110465926019178/ltc-20251231x10k.htm
19. Market-capitalization data (Ensign, Omega, CareTrust, Sabra, National Health Investors), stockanalysis.com, July 2026. https://stockanalysis.com/stocks/ensg/market-cap/
20. Genesis HealthCare, About Genesis HealthCare (≈200 skilled-nursing and senior-living centers across 17 states), 2026. https://www.genesishcc.com/about-us/
21. Private Equity Stakeholder Project, Genesis Healthcare Files for Bankruptcy (Chapter 11, July 2025, >$1B debt), 2025. https://pestakeholder.org/news/genesis-healthcare-files-for-bankruptcy/
22. Life Care Centers of America, About Life Care (200+ campuses in 27 states), 2026. https://lcca.com/about/
23. PruittHealth, Our Company (195+ locations across six states), 2026. https://www.pruitthealth.com/our-company
24. Medicare.gov, Skilled Nursing Facility Care (3-day qualifying hospital stay; up to 100 days; $209.50/day copay days 21–100 in 2025), 2026. https://www.medicare.gov/coverage/skilled-nursing-facility-care
25. Centers for Medicare & Medicaid Services, Skilled Nursing Facility Prospective Payment System / Patient-Driven Payment Model, 2026. https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf
26. Medicare Payment Advisory Commission, Chapter 6: Skilled Nursing Facility Services, March 2025 Report to Congress (occupancy 84% Oct 2024; 22% FFS Medicare margin, 0.4% all-payer margin; Medicaid finances most SNF long-term care), 2025. https://www.medpac.gov/wp-content/uploads/2025/03/Mar25_Ch6_MedPAC_Report_To_Congress_SEC.pdf
27. ACPlus, 2025 Skilled Nursing Facility Industry Outlook (payer mix ≈62% Medicaid resident-days), 2025. https://acplus.com/blog/industry-insights/2025-skilled-nursing-facility-industry-outlook/
28. Centers for Medicare & Medicaid Services, FY 2025 SNF Prospective Payment System Final Rule (CMS-1802-F) (+4.2% update; PDPM), 2024. https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-skilled-nursing-facility-prospective-payment-system-final-rule-cms-1802-f
29. Centers for Medicare & Medicaid Services, FY 2026 SNF Prospective Payment System Final Rule (CMS-1827-F) (+3.2%, ≈$1.16B; QRP; VBP), 2025. https://www.cms.gov/newsroom/fact-sheets/fy-2026-skilled-nursing-facility-snf-prospective-payment-system-final-rule-cms-1827-f
30. U.S. Dept. of Health & Human Services / Federal Register, Repeal of Minimum Staffing Standards for Long-Term Care Facilities (3.48 HPRD incl. 0.55 RN + 2.45 aide, 24/7 RN; Texas court vacatur Apr 2025; P.L. 119-21 10-year moratorium; CMS repeal Dec 2025). https://www.federalregister.gov/documents/2025/12/03/2025-21792/medicare-and-medicaid-programs-repeal-of-minimum-staffing-standards-for-long-term-care-facilities
31. Centers for Medicare & Medicaid Services, Skilled Nursing Facility Ownership & Enrollment Data / Care Compare, 2026. https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/skilled-nursing-facility-all-owners
32. Fitch Ratings / The Globe and Mail, Healthcare REITs, Skilled Nursing Real Estate… (BBB− ratings; ≈9.5-year weighted-average lease terms), 2025. https://www.theglobeandmail.com/investing/markets/stocks/SBRA/pressreleases/363079/healthcare-reits-skilled-nursing-real-estate-gain-momentum-amid-aging-demographics-and-stable-income-growth/
33. U.S. Census Bureau, Population Projections (population aged 85+ ≈9.1M in 2030, ≈14.4M in 2040), 2020. https://www.census.gov/programs-surveys/popproj.html
34. U.S. Census Bureau, Older Adults Outnumber Children in 11 States and Nearly Half of U.S. Counties (65+ = 61.2M / 18.0% in 2024; older adults outnumber children by 2034), 2025. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html