The United States is facing an escalating crisis in access to nursing home health care, with a troubling new report from the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) highlighting the severity of the situation.
The report, titled "2024 Access to Care," reveals that nursing homes across the country are closing at an unprecedented rate, primarily due to economic pressures and severe workforce shortages. This crisis is expected to worsen, particularly in the wake of new federal staffing mandates.
Alarming Closure Rates and Bed Reductions
The report documents that between February 2020 and July 2024, at least 774 nursing homes have shut their doors, displacing more than 28,000 residents. These closures have also led to a significant reduction in available nursing home beds, with 62,567 fewer beds available since 2020. This reduction has left thousands of elderly and vulnerable residents without adequate care, exacerbating the already dire situation.
Moreover, nearly half of the nation's nursing homes (46%) have been forced to limit new admissions, while 57% have established waiting lists for potential residents. The shortage of staff has been so severe that 20% of facilities have closed sections or entire wings, further limiting access to care.
Workforce Shortages: A Persistent Challenge
The labor shortages that plagued the nursing home industry even before the COVID-19 pandemic have only worsened in its aftermath. The report reveals that more than 66% of facilities are concerned they may have to close if these workforce challenges persist. The situation is so critical that many nursing homes are struggling to maintain even basic operations, let alone provide high-quality care.
Impact of the Federal Staffing Mandate
Adding to the industry's woes is the recently finalized federal staffing mandate from the Biden Administration, which has been met with significant criticism. According to AHCA/NCAL, the mandate could potentially displace nearly 300,000 residents, as it requires nursing homes to hire an additional 102,000 nurses and aides—a daunting task given the current workforce shortages.
Mark Parkinson, president and CEO of AHCA/NCAL, voiced serious concerns about the mandate's impact. "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 stated. He warned that the mandate could force many nursing homes to reduce their resident counts further or even shut down entirely.
Legal and Legislative Pushback
In response to the staffing mandate, lawsuits have been filed in Texas courts, aiming to dismiss the requirement. Various healthcare advocacy groups are also rallying against the mandate, citing the ongoing access crisis. These efforts underscore the industry's concern that the mandate, while well-intentioned, may worsen the already precarious situation.
The Decline in New Nursing Home Health Care Amid Growing Demand
Despite the increasing demand for long-term care driven by an aging population, the number of new nursing homes opening each year has sharply declined. In 2023, only 37 new facilities began operations, marking a significant drop from previous years. This decline is particularly alarming, given the growing need for skilled nursing care across the country.
Rural Areas Hit Hardest
The access crisis is especially acute in rural areas, where the lack of skilled nursing facilities 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. The competition for qualified caregivers in these regions is fierce, making it even more challenging to provide adequate care.
Closures Across All Facility Types
The 2024 Access to Care report also highlights that closures have affected facilities with high-quality ratings, including those with 4- and 5-star rankings. Both nonprofit and for-profit providers have been impacted, and the closures have occurred in both urban and rural communities. This widespread nature of the closures underscores the systemic challenges facing the nursing home industry.
Conclusion
As the crisis in nursing home care access deepens, it is clear that without significant intervention from policymakers, the situation will continue to deteriorate. The combination of facility closures, workforce shortages, and new federal mandates presents a formidable challenge that threatens the well-being of thousands of residents across the United States.
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