Kelly Hughes, Zhanlian Feng, Qinghua Li, Micah Segelman, Iara Oliveira, & Judith Goldberg Dey
Abstract
For years, nursing home closures have been a concern for the industry, policymakers, consumer advocates, and other stakeholders. We analyze data from 2011 to 2021 and did not find persistent increases in the closure rates. Closures were relatively stable from 2011 to 2017, averaging 118 facilities (0.79 percent) a year and increasing to 143 (0.96 percent) in 2018 and 200 (1.34 percent) in 2019. Closures decreased during the COVID-19 pandemic, averaging 133 facilities in 2020 and 2021 (0.90 percent). Medicaid-only nursing facilities had higher closure rates than Medicare-only skilled nursing facilities and dually-certified nursing homes. The census regions (divisions) of South (West South Central) and Northeast (New England) had the highest closure rates, while the South (South Atlantic and East South Central) had the lowest rates. Facility characteristics associated with increased closure risk include smaller size; lower occupancy rate; urban location; no ownership changes; lower inspection survey ratings; higher staffing ratings; higher percentages of non-white residents and Medicaid residents; lower percentages of Medicare residents and residents with severe acuity; and location in states with more nursing home alternatives. Additional research should examine the impact of closures on resident outcomes and access to care.