Decades-long data on nursing home closures reveals that ownership changes have become an increasingly important pathway for facilities to remain open, while homes that don’t undergo a change in ownership may be more likely to close.
While nearly half of nursing homes from 1985 to 2025 followed a simple entry-to-exit pathway, one-fifth remained open via ownership changes, according to a report published late July in the Journal of the American Medical Association (JAMA) Health Forum.
And ownership transitions increased over time, representing 16.26% of closures as part of such transitions. In fact, facilities that didn’t see a change of ownership were more likely to close, JAMA found, suggesting that weaker facilities might exit if they aren’t acquired.
Government entities should look beyond simple facility counts and track ownership changes, organizational restructuring, and capacity changes to more accurately capture how the nursing home sector is evolving, researchers said, and to better understand closures and access issues.
Tracking bed count might actually be a better way to monitor access instead of closures. Texas, for one, showed particularly large bed count growth, adding about 18,000 certified beds between 1985 and 2025.
Researchers found that closure isn’t always permanent failure in the nursing home world – administrative closures represent consolidation, reclassification, restructuring or eventual reentry.
A total of 1,440 nursing homes closed in the last decade, JAMA found in a separate closure report conducted in June which tracked licensed beds. This report found that 849 new operations opened during the same time frame which offset half of the closures.
But geographical regions played a big role in access issues.
Rural closures and what lawmakers are doing
Of note: some areas have seen closures at an even faster pace, including rural areas. Chautauqua County, a rural area of New York, has seen four facilities close since 2023, a total of 240 beds, according to a report from the Post-Journal which covered the JAMA report.
Rural closures resulted in no nursing home within 10 miles in some cases, JAMA reported, and for 14.4% of closures, nearby facilities couldn’t absorb displaced residents. This resulted in access shortages in about 29% of closures.
NY Gov. Kathy Hochul said the Medicaid reimbursement level isn’t enough to keep nursing homes going, and that a lot of facilities are losing money that they used to count on from the federal government.
Health care workers and lawmakers in the state warned in March that the $2 billion in cuts would worsen staffing shortages and speed up closures in the state. At that point, Kaleida Health facilities were already downsizing and closures were announced at Weinberg Campis and Eastern Niagara Hospital.
Gov. Hochul said the plan in NY is to try facility consolidation and have closure be a last resort. Health systems like Kaleida need to step up and help protect access for communities, rural or otherwise, she said.
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