Hari Sharma, Redwan Bin Abdul Baten, Fred Ullrich, A. Clinton MacKinney, Keith J. Mueller
Abstract
Purpose
This policy brief examines trends in nursing home closures and characteristics of open and closed
nursing homes in nonmetropolitan and metropolitan counties. For this analysis, nursing homes
are facilities dually certified by Medicare and Medicaid or facilities certified by only Medicaid. We
excluded facilities certified only by Medicare since they cater to skilled nursing care and our focus
in this study was on long-term care services. We considered a nursing home closed if the provider
of services (POS) file from the Centers for Medicare & Medicaid Services (CMS) indicated that the
facility was closed in its entirety or if the facility no longer had Medicaid certification. Documenting
nursing home closures is important because it will allow examination of the impact of closures on
access and availability of alternative providers of post-acute/long-term care in nonmetropolitan
areas. In this project, we document nursing home closures, identify areas without nursing homes,
and summarize the characteristics of open and closed nursing homes.
Key Findings
• Between 2008 and 2018, 472 nursing homes in 400 nonmetropolitan counties and 783
nursing homes in 368 metropolitan counties closed in the U.S.
• As of 2018, 7.7 percent of the 3,142 counties in the U.S. had no nursing homes (nursing
home deserts); 10.1 percent of the 1,976 nonmetropolitan counties and 3.7 percent of the
1,166 metropolitan counties were nursing home deserts.
• Of the 243 counties with no nursing homes, 44 were newly created nursing home deserts
because of nursing home closures between 2008 and 2018; about 91 percent of these new
nursing home deserts (n = 40) were in nonmetropolitan counties.
• On average, closed nursing homes had lower bed size and lower occupancy levels compared
with open nursing homes; among the facilities that closed, nursing homes in nonmetropolitan
counties had lower average bed size and occupancy levels compared with nursing homes in
metropolitan counties.