In a study of county-owned nursing homes throughout New York State, CGR found 92% of homes outside NYC lost money in 2010, and without significant changes in how they operate, most have little chance to survive. Historically, counties have considered the homes to be an important part of their missions, and have cited their role in providing care to indigent, behaviorally challenged and other “hard-to-place” residents. The study, released in August 2013, also documented the experience of six counties that closed or sold their homes, finding mixed results ranging from improvements in care to state closure of one poorly performing homes. To complete the study, funded by the New York State Health Foundation, CGR contacted officials in all counties that own, or have owned, county nursing homes. CGR, which has conducted two previous statewide nursing home studies and related assessments for a number of counties, led the project. LeadingAge New York, which represents more than 600 public, nonprofit and other providers of long-term care, provided objective historical data analyses of nursing home trends across NY over the past 10 years.