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Census 2025 estimates · CMS September 2026 · CDC 2020

Senior housing development in South Carolina

South Carolina had 503,436 residents aged 75 and older in July 2025, +34.1% since April 2020 (US +23.4%), and 109,745 aged 85 and older (+21.6%). Its 187 certified nursing homes hold 19,589 beds, 178.5 for every 1,000 people 85 and older, fewer than the US ratio of 222.6. Certificate of need for nursing home beds: yes (nursing homes only); for assisted living: no.

Age 75+ (2025)
503,436
Growth since 2020
+34.1%
Nursing beds per 1,000 aged 85+
178.5
Assisted living beds per 1,000 aged 75+
36.0

Demand: the older population

Age groupApril 2020July 2025ChangeUS change
75 and older375,416503,436+34.1%+23.4%
85 and older90,244109,745+21.6%+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

SettingBedsPer 1,000 aged 75+Per 1,000 aged 85+Source
Nursing homes (Medicare or Medicaid certified)19,58938.9178.5CMS, September 2026
Residential care / assisted living18,10036.0164.9CDC 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 (nursing homes only)
Assisted living
No
Notes
2023 law kept CON only for nursing homes and a few hospital items. 2026 H4799 (veterans' nursing homes exemption) passed the House and is pending

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+.

CountyAge 75+Since 2020Share of populationAge 85+Nursing homesBeds per 1,000 aged 85+
Horry County52,670+59.6%12.3%9,764884.4
Greenville County47,494+32.3%8.1%11,21619167.4
Charleston County37,612+37.1%8.6%8,79911141.5
Beaufort County30,491+38.5%14.9%6,415782.8
Richland County29,637+34.6%6.8%6,65414279.4
Spartanburg County27,828+28.3%7.3%6,23615204.9
Lexington County26,135+30.9%8.2%6,0397141.7
York County22,511+38.3%7.3%4,7038143.1
Anderson County19,092+22.1%8.7%4,2755196.3
Berkeley County18,095+49.4%6.6%3,6154114.8
Aiken County18,089+27.9%10%4,0296206.3
Dorchester County12,604+40.6%7.1%2,5284123.4
Lancaster County12,528+46.7%11%2,4122113.6
Florence County12,367+26.3%8.9%2,8319292.5
Pickens County11,923+24.1%8.6%2,9765120.6
Georgetown County10,041+38.7%15.2%2,0613124.2
Oconee County9,742+26.5%11.6%2,1272118.5
Sumter County9,051+20.3%8.6%2,2003186.4
Orangeburg County8,292+18.1%10%1,9414197.3
Greenwood County7,084+25.4%10.1%1,6654199.4
Laurens County6,322+22.1%8.8%1,4274280.3
Kershaw County6,177+30.4%8.4%1,2942216.4
Darlington County5,851+22.7%9.3%1,2304339.8
Cherokee County4,823+26.1%8.3%1,0893307.6
Newberry County4,044+25.2%10.2%9852261.9

Fastest growth in the 75+ population

  1. Jasper County: +77.3% (3,949)
  2. Horry County: +59.6% (52,670)
  3. Berkeley County: +49.4% (18,095)
  4. Lancaster County: +46.7% (12,528)
  5. Edgefield County: +40.7% (2,665)
  6. Dorchester County: +40.6% (12,604)
  7. Georgetown County: +38.7% (10,041)
  8. Beaufort County: +38.5% (30,491)
  9. York County: +38.3% (22,511)
  10. McCormick County: +37.6% (2,014)

Counties with at least 2,000 residents aged 75+.

Fewest nursing beds per 1,000 aged 85+

  1. Beaufort County: 82.8 (531 beds, 6,415 aged 85+)
  2. Horry County: 84.4 (824 beds, 9,764 aged 85+)
  3. Lancaster County: 113.6 (274 beds, 2,412 aged 85+)
  4. Berkeley County: 114.8 (415 beds, 3,615 aged 85+)
  5. Oconee County: 118.5 (252 beds, 2,127 aged 85+)
  6. Pickens County: 120.6 (359 beds, 2,976 aged 85+)
  7. Dorchester County: 123.4 (312 beds, 2,528 aged 85+)
  8. Georgetown County: 124.2 (256 beds, 2,061 aged 85+)
  9. Charleston County: 141.5 (1,245 beds, 8,799 aged 85+)
  10. Lexington County: 141.7 (856 beds, 6,039 aged 85+)

Counties with at least 1,000 residents aged 85+.

HUD Section 232 construction in South Carolina

Since fiscal 2001 HUD has insured 5 new construction or substantial rehabilitation loans on care facilities in South Carolina (4 assisted living, 1 nursing homes), $19.2 million of original principal.

Planning a building in South Carolina? 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.