My mother spent the last two years of her life in a nursing home. The secure wing of the facility where she lived was newer than the wing housing the other half of the facility. The older wing was due to be torn down, due to updated state regulations that made half of the nursing home obsolete. One of the updated regulations stood out: the hallways were deemed too narrow to accommodate wider gurneys needed for increasingly obese Americans. The doorways were also deemed too narrow. So instead of segregating slender and obese residents in different wings, the state wanted half the rooms torn down and replaced. This is nothing new. Years ago, a friend was employed in selling and leasing medical real estate. All kinds of medical facilities were being made obsolete due to updated regulations, including elevators that could not handle larger gurneys.
The New York Times reports that nursing homes are reducing capacity in New York State and across the nation. A recent study found a 5 percent decrease in national nursing home capacity from 2019 to 2024.
Across New York State, 24 nursing homes have closed since 2020, resulting in a loss of more than 3,000 licensed beds, according to LeadingAge, which represents nonprofit senior living organizations.
That mirrors a national trend. In 2015, the Centers for Medicare and Medicaid Services certified 15,648 nursing facilities. A decade later, that number had fallen by more than 900.
Senior housing, assisted living and nursing homes would seem to be an area of rapid growth. The Baby Boom generation is aging, the oldest of which turns 80 this year. Just over 60 million Americans are age 65 or older, a figure that is expected to rise to 82 million by 2050. Yet, nursing home beds are not rising to meet the need.
One reason for the loss of nursing home beds is labor costs and high staff turnover. Other problems include rising costs and increased regulations. However, the primary reason experts cite is inadequate funding. Medicaid pays nearly two-thirds (62%) of nursing home care. Medicaid reimburses far less than those with commercial insurance and few families have the money to pay $100,000 per year for long term care.
Nursing homes supplement their incomes by caring for Medicare patients. Medicare does not pay for custodial care, rather it pays for short term stays for seniors who are recovering from surgery or an illness. Medicare covers only a limited number of days, however. The federal health care program pays 100% of the first 20 days of long-term care for qualifying patients. It requires a patient copay of $217 per day beginning on day 21. For that reason, most Medicare stays last only about 22 days. Medicare stops paying entirely after 100 days in a benefit year.
Nursing home occupancy is around 80% but that does not mean 1-in-5 beds set empty awaiting an occupant. Many are decommissioned internally due to staff shortages or awaiting the right customer. Forty-six percent of nursing homes limit new admissions, while 57% have a waiting list. What this means is that nursing homes reserve beds for short stay Medicare patients while limiting new custodial care admissions (mostly) to those who can afford to pay.
One solution is assisted living, where residents are expected to provide some of their own care. Another is home and community-based services. The problem is that in-home care is of no use for seniors once they become fully dependent on care givers. Another problem is that in-home care is still expensive and in also short supply.
Most people cannot afford institutional long-term care. Yet many will need some type of help. A family member remained in her home for seven or eight years after her husband died. What allowed her to live semi-independently was a daughter who lived with her. Her daughter’s help with cooking, shopping and companionship allowed her to remain in her own home for years longer than would have occurred without simple help. Her last two years were spent in assisted living, funded by the sale of her house. Without resources it would have been much more difficult to find a facility willing to admit her.
Old age care is a continuum. Policymakers increasingly need to address the growing shortage of senior housing, assisted living and in-home community care. They will need to think outside the box and look for solutions that meet the needs of an aging population in all phases of their golden years. They better get started.
Read more at NYT: Nursing Home Beds Are Disappearing. That’s a Problem.