Average capacity is just over 100 so there are about 1.7 million nursing home beds. See ahcpr long-term care info for more info. Nursing home care and administration is very challenging for this reason. Many want to tell nursing homes how to do their job, but few want to actually do it. This is important because many people assume medicare covers nursing homes, but it dos not.
Private insurance pays for a fraction of one percent of nursing home costs.
What usually happens is that a person comes in, pays until they have no more money and then medicaid takes over. Medicaid is administered by the states, so the eligibility and rules governing how much the spouse gets to keep etc. are specific to each state and very complicated. The average elderly person has enough money for 6 months of private pay. Medical directors of nursing homes is a job which is often offered to new doctors. If you decide to accept the job, you should know that it entails more than meets the eye and that pressure is being put on nursing homes for it to entail even more.