Although the nursing home trade associations argue that inadequate reimbursement and a lack of people to hire have led to closures of nursing homes and that closures will become an even greater problem if the Centers for Medicare & Medicaid Services promulgates final rules imposing nurse staffing ratios (see LeadingAge here, American Health Care Association here, here, and here), two recent studies find that nursing home closures have in fact declined and that most facilities that closed were providing very poor care to residents.
“Rates of nursing home closures were relatively stable over the past decade, but warrant continuous monitoring” finds that “Closures decreased again the during the pandemic years of 2020 and 2021, averaging 133 facilities (0.90%),” compared to peak years of closures in the decade, 2018 (143 closure, 0.96%) and 2019 (200 closures, 1.34%). Researchers find that closures were more common in urban areas than in rural areas and among facilities with the lowest inspection survey results.
An analysis by Roll Call, “Data shows nursing home closure often linked to care issues,” also reports that fewer nursing facilities closed from 2011 through 2019 than in the decade before. It similarly finds that facilities that closed “are poor quality,” “were more likely to have had severe inspection violations,” were more likely to be a Special Focus Facility, and “have high staff turnover.” In Ohio, for example, 17 of the state’s 1,000 nursing facilities closed in fiscal year 2023. Four of the facilities were Special Focus Facilities (SFFs) or candidates for the SFF program, meaning that they had many serious deficiencies over a multi-year period. Seven of the 17 facilities that closed had the lowest health inspection rating, one star. The facilities that closed had an average occupancy rate of 60%, “a rate that would make it nearly impossible to be profitable.”
Although additional federal and state funding during the pandemic may have reduced the number of nursing home closures, the studies also recognize that the nursing home industry is changing. As the availability of home and community-based alternatives has increased, the demand for nursing homes has declined.
January 24, 2024 – T. Edelman