Census 2025 estimates · CMS September 2026 · CDC 2020
Senior housing development in Missouri
Missouri had 525,265 residents aged 75 and older in July 2025, +18.3% since April 2020 (US +23.4%), and 133,254 aged 85 and older (+8.1%). Its 487 certified nursing homes hold 50,053 beds, 375.6 for every 1,000 people 85 and older, more than the US ratio of 222.6. Certificate of need for nursing home beds: yes; for assisted living: yes.
- Age 75+ (2025)
- 525,265
- Growth since 2020
- +18.3%
- Nursing beds per 1,000 aged 85+
- 375.6
- Assisted living beds per 1,000 aged 75+
- 42.8
Demand: the older population
| Age group | April 2020 | July 2025 | Change | US change |
|---|---|---|---|---|
| 75 and older | 443,926 | 525,265 | +18.3% | +23.4% |
| 85 and older | 123,249 | 133,254 | +8.1% | +11.3% |
Nationally, the Census Bureau's 2023 projections have the 75+ population growing 21% from 2025 to 2030 and the 85+ population 59% from 2025 to 2035. The bureau publishes those projections for the US only, not by state.
Supply: licensed beds
| Setting | Beds | Per 1,000 aged 75+ | Per 1,000 aged 85+ | Source |
|---|---|---|---|---|
| Nursing homes (Medicare or Medicaid certified) | 50,053 | 95.3 | 375.6 | CMS, September 2026 |
| Residential care / assisted living | 22,500 | 42.8 | 168.9 | CDC survey, 2020 |
US: 222.6 nursing beds and 170.1 assisted living beds per 1,000 aged 85+. Assisted living beds are CDC's 2020 survey estimate, its latest with state detail, set against 2025 population, so the ratio understates any supply added since.
Certificate of need
- Nursing home beds
- Yes
- Assisted living
- Yes
- Notes
- Lists "Residential care facilities. Assisted living facilities." Mo. Rev. Stat. § 197.300
From NCSL's certificate of need table (updated April 29, 2025, covering January 2025) with later changes checked on state sites on October 24, 2026. "Not listed" means NCSL does not name assisted living, not that it is exempt. Confirm with the state health planning agency before relying on it. HUD requires a state CON for nursing home beds where the state has one (Handbook 4232.1, 2.5.EE).
Counties
The 25 counties with the most residents aged 75+, with certified nursing home beds per 1,000 aged 85+.
| County | Age 75+ | Since 2020 | Share of population | Age 85+ | Nursing homes | Beds per 1,000 aged 85+ |
|---|---|---|---|---|---|---|
| St. Louis County | 93,929 | +15.6% | 9.5% | 25,716 | 69 | 364.8 |
| Jackson County | 52,527 | +18.9% | 7.2% | 13,438 | 39 | 342.7 |
| St. Charles County | 34,085 | +29.7% | 8% | 8,501 | 15 | 174.6 |
| Greene County | 26,140 | +19.2% | 8.5% | 6,660 | 21 | 348.5 |
| Clay County | 19,137 | +30.2% | 7.2% | 4,497 | 9 | 209.7 |
| Jefferson County | 17,260 | +28.5% | 7.4% | 3,568 | 11 | 379.2 |
| St. Louis city | 16,689 | +17.5% | 6% | 3,951 | 13 | 421.2 |
| Boone County | 12,723 | +37.5% | 6.6% | 3,172 | 9 | 254.4 |
| Cass County | 9,821 | +23.5% | 8.5% | 2,474 | 8 | 375.9 |
| Franklin County | 9,711 | +22.4% | 9% | 2,488 | 7 | 276.9 |
| Jasper County | 9,445 | +15.4% | 7.4% | 2,475 | 7 | 285.7 |
| Platte County | 8,360 | +33.9% | 7.3% | 1,981 | 4 | 245.8 |
| Cape Girardeau County | 7,624 | +20.0% | 9.1% | 2,161 | 8 | 391 |
| Christian County | 7,590 | +30.0% | 7.8% | 1,731 | 3 | 153.1 |
| Buchanan County | 7,087 | +12.7% | 8.5% | 1,865 | 6 | 361.9 |
| Cole County | 6,806 | +28.3% | 8.7% | 1,668 | 8 | 431.7 |
| Taney County | 6,115 | +19.1% | 10.7% | 1,508 | 3 | 232.1 |
| Newton County | 5,614 | +20.6% | 9% | 1,358 | 5 | 366.7 |
| St. Francois County | 5,481 | +13.5% | 8.1% | 1,453 | 8 | 588.4 |
| Camden County | 5,454 | +27.0% | 12.4% | 1,045 | 5 | 317.7 |
| Stone County | 4,479 | +21.0% | 13.8% | 955 | 0 | 0 |
| Howell County | 4,029 | +11.7% | 9.9% | 1,024 | 5 | 560.5 |
| Lincoln County | 3,996 | +23.2% | 6% | 964 | 3 | 286.3 |
| Butler County | 3,792 | +12.8% | 9% | 919 | 5 | 525.6 |
| Phelps County | 3,695 | +11.6% | 8.2% | 1,011 | 6 | 462.9 |
Fastest growth in the 75+ population
- Boone County: +37.5% (12,723)
- Platte County: +33.9% (8,360)
- Clay County: +30.2% (19,137)
- Christian County: +30.0% (7,590)
- St. Charles County: +29.7% (34,085)
- Jefferson County: +28.5% (17,260)
- Cole County: +28.3% (6,806)
- Camden County: +27.0% (5,454)
- Callaway County: +26.3% (3,573)
- Cass County: +23.5% (9,821)
Counties with at least 2,000 residents aged 75+.
Fewest nursing beds per 1,000 aged 85+
- Christian County: 153.1 (265 beds, 1,731 aged 85+)
- St. Charles County: 174.6 (1,484 beds, 8,501 aged 85+)
- Clay County: 209.7 (943 beds, 4,497 aged 85+)
- Taney County: 232.1 (350 beds, 1,508 aged 85+)
- Platte County: 245.8 (487 beds, 1,981 aged 85+)
- Boone County: 254.4 (807 beds, 3,172 aged 85+)
- Franklin County: 276.9 (689 beds, 2,488 aged 85+)
- Jasper County: 285.7 (707 beds, 2,475 aged 85+)
- Camden County: 317.7 (332 beds, 1,045 aged 85+)
- Jackson County: 342.7 (4,605 beds, 13,438 aged 85+)
Counties with at least 1,000 residents aged 85+.
HUD Section 232 construction in Missouri
Since fiscal 2001 HUD has insured 27 new construction or substantial rehabilitation loans on care facilities in Missouri (9 assisted living, 18 nursing homes), $499.2 million of original principal, 7 of them since fiscal 2016.
- FY2021: McKnight Place Assisted Living & Memory Care, St Louis, assisted living, $58 million
- FY2021: Levering Regional Health Care Center, Hannibal, nursing home, $10.4 million
- FY2021: The Bridge at Garden Plaza, Florissant, nursing home, $16.5 million
- FY2020: Parc Provence, CREVE COEUR, assisted living, $33.1 million
- FY2019: Kingsland Walk Senior Living, ST. LOUIS, assisted living, $11.7 million
- FY2017: Gatesworth at McKnight Place AL & Memory Care, ST. LOUIS, assisted living, $58 million
- FY2016: Christian Care Home, Ferguson, nursing home, $15.3 million
Planning a building in Missouri? Model the budget, lease-up and a HUD 232 construction loan.
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Sources: Census Bureau Vintage 2025 county population estimates; CMS Nursing Home Provider Information (September 2026); CDC/NCHS National Post-acute and Long-term Care Study (2020); HUD Office of Healthcare Programs endorsement database (data run 07/08/2026); NCSL. Absorption is operated by Janover Capital LLC and is not affiliated with any of them. Methodology.