Hello Kiwinarz! In the United States, the nursing home industry is highly regulated by the government. In fact, it is probably the most regulated aspect of health care. There are a lot of federal and state regulations that must be met in order to open a nursing home. If one were interested in opening a nursing home in the US, you would first have to know the state regulations. The specific state that you are in would grant the license needed to operate as a nursing home. Once licensure is granted, you can apply to for Medicare certification, which is a federal requirement in order to accept Medicare patients. I hope this is helpful!