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Census 2025 estimates · CMS September 2026 · CDC 2020

Senior housing development in Tennessee

Tennessee had 575,289 residents aged 75 and older in July 2025, +23.6% since April 2020 (US +23.4%), and 133,326 aged 85 and older (+14.2%). Its 303 certified nursing homes hold 34,613 beds, 259.6 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: not listed.

Age 75+ (2025)
575,289
Growth since 2020
+23.6%
Nursing beds per 1,000 aged 85+
259.6
Assisted living beds per 1,000 aged 75+
34.8

Demand: the older population

Age groupApril 2020July 2025ChangeUS change
75 and older465,366575,289+23.6%+23.4%
85 and older116,776133,326+14.2%+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)34,61360.2259.6CMS, September 2026
Residential care / assisted living20,00034.8150.0CDC 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
Not listed
Notes
2026 SB1369 phases out hospital CON by 2030. Nursing homes are not mentioned

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+
Shelby County60,581+23.7%6.7%14,39025227.2
Davidson County40,475+20.2%5.4%9,91720241.6
Knox County39,510+23.0%7.7%9,71413178.3
Hamilton County33,804+25.2%8.6%8,84111196.2
Rutherford County19,334+36.1%5%4,3078187.1
Williamson County18,996+47.2%7%4,4305115.6
Sullivan County17,551+13.7%10.7%4,2317235.2
Sumner County16,594+29.2%7.7%3,9326192.5
Blount County14,321+23.7%10%3,2336210.6
Washington County13,109+24.1%9.3%3,1818255
Wilson County12,561+37.7%7.2%2,7324185.2
Cumberland County10,808+25.0%16.3%2,1894183.2
Montgomery County10,668+34.5%4.3%2,3245251.3
Bradley County9,801+22.3%8.5%2,2324252.2
Sevier County9,767+23.3%9.6%2,0142108.2
Maury County9,264+42.7%7.8%2,1726304.8
Loudon County8,738+37.7%13.7%1,931193.2
Madison County8,397+20.2%8.3%1,9956323.8
Anderson County7,712+19.1%9.4%1,8985309.8
Greene County7,396+19.3%10%1,5344312.9
Putnam County6,879+21.0%7.9%1,5244337.3
Hawkins County6,226+23.3%10.5%1,3232207.1
Roane County6,165+23.0%10.7%1,5072190.4
Carter County6,108+18.5%10.6%1,4626396
Jefferson County5,857+22.1%9.8%1,4254337.5

Fastest growth in the 75+ population

  1. Williamson County: +47.2% (18,996)
  2. Maury County: +42.7% (9,264)
  3. Wilson County: +37.7% (12,561)
  4. Loudon County: +37.7% (8,738)
  5. Fayette County: +37.0% (4,713)
  6. Rutherford County: +36.1% (19,334)
  7. Cheatham County: +35.3% (3,282)
  8. Montgomery County: +34.5% (10,668)
  9. Sumner County: +29.2% (16,594)
  10. Monroe County: +28.4% (5,075)

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

Fewest nursing beds per 1,000 aged 85+

  1. Loudon County: 93.2 (180 beds, 1,931 aged 85+)
  2. Sevier County: 108.2 (218 beds, 2,014 aged 85+)
  3. Williamson County: 115.6 (512 beds, 4,430 aged 85+)
  4. Knox County: 178.3 (1,732 beds, 9,714 aged 85+)
  5. Cumberland County: 183.2 (401 beds, 2,189 aged 85+)
  6. Wilson County: 185.2 (506 beds, 2,732 aged 85+)
  7. Rutherford County: 187.1 (806 beds, 4,307 aged 85+)
  8. Roane County: 190.4 (287 beds, 1,507 aged 85+)
  9. Sumner County: 192.5 (757 beds, 3,932 aged 85+)
  10. Hamilton County: 196.2 (1,735 beds, 8,841 aged 85+)

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

HUD Section 232 construction in Tennessee

Since fiscal 2001 HUD has insured 29 new construction or substantial rehabilitation loans on care facilities in Tennessee (19 assisted living, 8 nursing homes), $181 million of original principal, 1 of them since fiscal 2016.

  • FY2020: Germantown Plantation Senior Living Community, MEMPHIS, assisted living, $12.2 million

Planning a building in Tennessee? 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.