Low Medicaid, Higher Acuity Behind 6 Nursing Home Closures, 100-Plus Resident Relocations in RI

The threat of closure is ever present for nursing home operators, with low Medicaid reimbursements and workforce shortages amid a growing population of higher acuity patients complicating care.

Since the start of the pandemic, six nursing homes in Rhode Island have closed their doors, forcing the relocation of more than 100 residents, Gov. Dan McKee told the Brown Daily Herald. Operators point to inadequate Medicaid reimbursement, with high turnover among staff as a result.

Nursing homes like Bethany Home of Rhode Island have managed these challenges by admitting more patients with fewer complications, and those with access to Medicare or private insurance, the report found.


It’s a story not unlike what leaders at Linn Health & Rehabilitation faced in the last couple years, with the operator opting for more assisted living and memory care patients. The margin between what the state Medicaid program pays for assisted living and costs required to operate are much closer to breakeven than Medicaid nursing home revenue and required costs, Aldersbridge Communities CEO Richard Gamache told Skilled Nursing News. Linn Health is an Aldersbridge community.

Nonprofit association R.I. Alliance for Better Long-Term Care, meanwhile, is working to relocate residents as many other nursing homes downsize to stay afloat. The issue with low Medicaid, among other industry challenges, disproportionately affects residents of color and those with disabilities, the association said.

Rhode Island was among a number of states to enact a minimum staffing law as well, signed by Gov. McKee in 2021 and requiring monetary penalties to be paid by facilities unable to meet the minimum staffing numbers.


The mandate wasn’t enforced as the nursing home workforce shortage continued well into 2023.

Ultimately, providers and patient advocates in the state say increased Medicaid rates, higher wages and more opportunities for staff, particularly nurses, may help alleviate industry challenges.

Strong organizational leadership would also help improve nursing home staffing, Brown University assistant professor of health services, policy and practice Elizabeth White told the Herald.

White added that in the long term, the industry needs entirely new models of care, referencing the Green House model. The space will need really innovative solutions to solve very complex issues, she said.

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