In 2007 CGR was asked to update a study completed 10 years earlier for the County Nursing Facilities of New York Inc. (CNFNY). The original study resulted in a report, What Should Be Done with County Nursing Facilities in New York State?, which presented factual information about the county facilities in comparison with proprietary and voluntary nursing homes throughout NY. In 2007, CGR presented an updated status report, including challenges and opportunities facing county nursing facilities. As was true 10 years ago, the future viability of many county-operated nursing homes remains in question. Most public nursing homes are considered valuable assets by county leaders because of their historic mission to serve any persons in need of residential nursing care, regardless of need or ability of the resident to cover the costs of the services provided. Nonetheless, despite such praise and historic support, many county facilities face serious questions about their future. The 2007 report outlines strategies and recommendations for state and individual county consideration and action.