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The Crisis of Nursing Home Closures and What Needs to Be Done

Analysis  |  By Jasmyne Ray  
   March 16, 2023

Since 2015, more than 1,000 nursing homes have ceased operations.

Besides intensifying a workforce shortage, the COVID-19 pandemic exacerbated another issue in healthcare: the closing of nursing homes.

More than 1,000 nursing home have closed since 2015—776 of which occurred prior to the pandemic, and 327 during, according to a 2022 report by the American Health Care Association.

"Before the pandemic we had chronic staffing shortages, we had chronic Medicaid underfunding, we had these huge systemic issues in long-term care that we knew were mounting," Rachel Monger, CEO of LeadingAge Kansas, said. "And we're waving the red flags and trying to get attention to the sector to very little avail."

LeadingAge is an association made up of nonprofit, mission-based providers of aging services, including skilled nursing facilities. Monger added that overall, healthcare was unprepared for the impact the pandemic would have, but the added financial burden and persisting workforce shortage made things worse.

A former administrator for Bloomfield Healthcare and Rehabilitation Center in Iowa, which closed its doors in April 2022, attributed it to the pandemic, the workforce shortage, and the facility's need for repairs.

"[The] reality is that we would have had to build a new one. They'd done cost analysis, whether it'd be cost effective to build a new building, and it [would've been]," the administrator told the report's authors. "But the staffing issues made the county board decide against it."

Staffing issues forced Bethel Home & Services in Viroqua, Wisconsin to cease operation as a skilled nursing facility and pivot to a community-based residential facility in early 2021, despite raising wages to compete in the labor market. In coming to terms with the changes, Debbie Stout-Tewalt, Bethel Home's CEO, viewed it not as a failure, but as "facing reality."

Once a facility makes the decision to close, the administration must find other facilities for their current residents, which is not without its own difficulties. In areas like rural Kansas, where Monger said the nearest facility could be 30-40 minutes away, residents are having to move away from family who wouldn't be able to visit and advocate for them as much as they were used to.

"It's very hard, and it's hard on the community where the nursing home closes," she said. "Those jobs, that tax base, is also really important to rural communities. Almost all the time, once you lose a service in a rural community, the chances of getting it back are almost zero."

HealthLeaders has previously reported how 20% of the nation's population will be over the age of 65 by 2030, with the demand of aging services to continue to steadily increase. Monger, alongside many of LeadingAge's state partners, have advocated before their state legislatures to bring policymakers’ attention to the crisis in the nursing home sector.

However, despite their best efforts and putting forth proposals at federal level to invest in workforce, training, and developing talent pipelines, she fears that the government may not act until the situation becomes truly dire.

"Part of getting more workers is making it an attractive field and job," Monger explained. "We cannot do that without adequate funding."

Most care older adults receive is through Medicaid, and aging services providers have long called for reimbursement rate reforms. As more older adults begin to consider their long-term care options and find that they're unable to find quality care in their communities, Monger hopes to see more advocacy from their side as well.

In the meantime, she urges providers to pay attention to the systems and tools they use and ensure they're doing what needs to be done for government ratings. She also encourages providers and facilities alike to develop a social media presence to help educate the public as more people look into these services.

"We've seen a much bigger focus on social media  and web presence, even for the kind of homes that LeadingAge Kansas represents, which tend to be small and rural," Monger said. "You don't have to be in an urban setting anymore to know that social media and web presence is a big thing no matter where you are in the sector."

“Before the pandemic we had chronic staffing shortages, we had chronic Medicaid underfunding, we had these huge systemic issues in long-term care that we knew were mounting, and we're waving the red flags and trying to get attention to the sector to very little avail.”

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 


Nursing home closures were already becoming an issue prior to the pandemic.

In addition to the pandemic, factors contributing to the current wave of closures include the workforce shortage, cost of operations, and facility upkeep.

To help inform the public of their services, Monger recommends that facilities establish a presence on social media or the internet.

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