More Than Two-Thirds of Nursing Homes Fear Closures as Almost All Cite Challenges Recruiting Staff

Despite ongoing investments from operators, the nursing home industry is struggling to rebuild its workforce and recover from the pandemic. Meanwhile, operators are concerned that the federal minimum staffing proposal, once finalized, will make operational challenges worse even as nursing homes limit admissions and are concerned about closures.

Such findings were outlined in the American Health Care Association’s (AHCA) 2024 State of the Sector report released on Tuesday. The association surveyed 441 nursing home providers.

Currently, 94% of nursing homes say it’s difficult to recruit new staff, with 67% citing a lack of interested or qualified candidates as a huge obstacle. Meanwhile, 99% of nursing homes are hiring.


A concerning 66% of facilities said they may have to close their buildings if workforce challenges continue in the same vein, and 45% are currently operating at a loss or negative total margin. Meanwhile, 56% of providers are struggling with occupancy.

In terms of access to care, the report found that 46% of nursing homes have limited new admissions – 38% have had to turn away residents on a weekly or monthly basis, and 7% have had to turn residents away daily.

And, more than half of nursing homes have a waiting list. About 18% of providers say their wait is on average a few days, 13% say that wait is a week, while 16% say residents need to wait multiple weeks on average. About 10% of providers said their waiting lists are between one month and multiple months.


Moreover, nearly 20% of nursing homes have had to close a unit, wing or floor because of labor challenges, according to the AHCA report.

The report “demonstrates clearly what nursing home providers across the country already know: the ongoing labor shortage is nothing less than a crisis for our sector,” Mark Parkinson, president and CEO of AHCA, said in a statement.

Difficulty filling positions despite higher wages

The nursing home sector saw the worst job losses out of all other health care sectors, the AHCA report found. Another 130,000 workers are still needed to return to pre-pandemic levels. Currently, 95% of nursing homes said they have open certified nursing assistant (CNA) positions, 89% have registered nurse positions (RN) open, 85% are hiring for licensed practical nurses (LPNs) and 58% are hiring for “other” positions within the nursing home.

“Nursing homes want to strengthen their workforce, but they cannot do it alone. We need collaborative solutions, not one-size-fits-all mandates, to protect access to care for all seniors,” said Parkinson.

If the staffing proposal is finalized as is, the sector would need to inject 100,000 more staff into the workforce at an annual cost of $7 billion, according to the report. AHCA anticipates 280,000 residents will be displaced – that’s nearly one-quarter of all residents – since facilities would be forced to downsize or close in the wake of the staffing rule.

About 96% of nursing homes are concerned about meeting the proposed staffing mandate, the report found.

Staffing difficulties persist, despite 90% of nursing homes increasing wages in the past six months, according to the report. About 78% of providers say they continue to offer bonuses, including sign-on bonuses.

AHCA found that 70% providers are promoting staff from within, and 69% have paid for staff training and education.

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