Most people don’t have a lot of assets. Medicare pays a decent reimbursement rate that declines over time. Medicare also pays for rehab tied to outcome, and nursing homes tend to have bad outcomes so they only get 90-180 days of that.

Once you’re off Medicare, if you cannot private pay (or once you run out of cash), you go on Medicaid. The county seizes your remaining assets and pays a very low reimbursement.

The ideal nursing home patient either has cash or requires short term rehab, and either leaves or dies in <180 days. The old ladies watching judge Judy or playing checkers are low margin.