Federal government data shows that 188 nursing homes shut down permanently across the U.S. in fiscal 2023, with some 40% of the closed facilities carrying a four- or five-star rating.
This is according to an analysis by CQ Roll Call published on Thursday.
About 31% of shuttered skilled nursing facilities (SNFs) were one-star rated or part of the special focus facility (FFS) program, compared with 23% of facilities overall.
The facilities that closed were more likely to have had severe inspection violations and had accumulated fines. Some even faced wrongful death lawsuits and had ceased to pay bills, the article states.
About 50% of the closed facilities received immediate jeopardy due to deficiencies related to resident health and safety, compared with 11% of facilities overall, the government data showed.
Meanwhile, 10% of facilities that closed in fiscal 2023 had been cited for abuse, compared with 6% of facilities overall. Also, 13% of closed facilities were participants in or candidates for the FFS program, compared with 3.5% of facilities overall.
To enforce nursing home regulations, Centers for Medicare & Medicaid (CMS) can deny Medicare payment if facilities fail to fix deficiencies, and in 2023, 22% of facilities that closed had received at least one payment denial, compared with 13% overall.
A deeper look at the data shows that the 2023’s closures aren’t as dire compared to years prior to the Covid-19 pandemic, although at first glance it may seem that way.
“We’re having less closures than we did a decade ago,” Kelly Hughes, a research economist at RTI International, told CQ Roll Call.
The data shows there have been no persistent increases in closure rates from 2011 through 2019, although there were increases in 2018 and 2019, she said.
Usually, the number of new facilities that open every year offset the closures, Hughes noted, adding that the impact of the pandemic is still unfolding.
Of the 188 nursing homes that closed in fiscal 2023, about 47% were in rural counties.
“[W]hen it’s a high-quality facility in a more rural area without any other option” it’s more concerning, David Grabowski, professor of health care policy at Harvard Medical School, told CQ Roll Call. “When it’s a closure in a more densely populated area of a lower-quality facility, that is actually good for the health of the residents,” he said.
Efforts to increase nursing homes should be targeted at those that need it, especially in rural communities, Grabowski said.
While staffing and reimbursement issues have contributed to closures in some cases, especially for smaller, rural facilities, other experts in the article emphasized that many facilities that closed were poor quality with high staff turnover and had low census. Moreover, they were located in areas with many nursing homes as well as assisted living facilities (ALFs). Also, some of the closed nursing homes were converted into ALFs, the article states.
However, nursing home advocates argue that the closures are more from lack of funding and staffing shortages, a problem that will worsen if the federal government’s proposed minimum staffing mandate is implemented.
“We believe that if the Biden staffing mandate is finalized, that it will accelerate the closures of buildings,” Mark Parkinson, president and CEO of the American Health Care Association (AHCA), told the news outlet.
“Very good nursing homes are closing because they can’t find workers and the reimbursement isn’t enough. And for people to just be out there making these subjective statements that it’s just poor buildings that are closing, it’s just not accurate. It leads policymakers to potentially make poor decisions, and it has real impacts on people’s lives,” Parkinson said.
There are about 15,000 nursing homes nationwide. Closures of facilities accelerated during the pandemic although emergency aid to the industry minimized the pace. However, ongoing staffing shortages, wage pressures, high operational costs amid high interests and inflation, along with low reimbursement rates have caused nursing homes, particularly in rural communities, to continue to shutter their doors.
In taking a closer look at Ohio’s nursing homes, the CQ Roll Call article states that of the nearly 1,000 nursing homes in Ohio, about 17 closed and a majority had a low census. These facilities had an average occupancy rate of 60%, a rate that would make it nearly impossible to be profitable, the article notes.
Also, four of the closed Ohio facilities were in the FFS program or candidates for the program. Meanwhile, seven Ohio facilities had a one-star rating.