The crisis of access to nursing home care across the United States has deepened – and is projected to get worse.
A new report from the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released Thursday shows that nursing homes have shut down at an alarming rate, driven by economic pressures and workforce shortages, with the recent federal mandate only threatening to exacerbate the situation.
The 2024 Access to Care report notes that at least 774 facilities closed their doors between February 2020 and July 2024, displacing over 28,000 residents.
The closure of these facilities, coupled with a significant reduction in available nursing home beds, which are down by 62,567 since 2020, has left many residents without adequate care.
Moreover, nearly half, or 46%, of nursing homes have had to limit new admissions, and over half, or 57%, have waiting lists for new residents. Additionally, 20% of facilities have closed sections or entire wings due to staff shortages, further limiting available care.
Labor shortages that existed prior to the COVID-19 pandemic worsened in its aftermath. Now, more than 66% of facilities are concerned that if their workforce challenges persist they may have to close their facility, the report states.
Adding to these challenges, the Biden Administration’s finalized federal staffing mandate has been criticized for its potential to deepen the crisis further, with the nursing home advocacy group projecting that it could displace nearly 300,000 residents.
The mandate is expected to necessitate the hiring of 102,000 additional nurses and aides, according to AHCA/NCAL.
Access ‘under threat’
Mark Parkinson, president and CEO of AHCA/NCAL, warned that the mandate could force nursing homes to reduce their resident counts further or even shut down entirely.
“It’s not hyperbole to say access to care is a national crisis. Nursing homes are closing at a rate much faster than they are opening, and yet with each passing day, our nation grows older,” Parkinson said. “Providers are doing everything they can to protect and expand access to care, but without support from policymakers, access to care remains under threat.”
Lawsuits to dismiss the staffing mandate have been filed in Texas courts. Meanwhile, along with legislative efforts to defeat the mandate, various health care advocacy groups are lending their voice to to fight it, citing the access crisis.
And despite the growing demand for long-term care due to an aging population, the number of new nursing homes opening each year has declined significantly. In 2023, only 37 new facilities began operations, a sharp drop from previous years.
The access crisis is particularly grave in rural areas, where the lack of skilled nursing has created so-called nursing home deserts. Since February 2020, 40 counties have become nursing home deserts, with 85% of these located in rural areas where competition for qualified caregivers is high.
The 2024 Access to Care report also shows that since 2020, closures have involved facilities with 4- and 5-star rankings, both at nonprofit and for-profit providers, and across urban and rural communities.
