Skilled nursing sector’s growing (or shrinking) problems get new attention

by Jessica R. Towhey

For the second day in a row, a major US newspaper Tuesday highlighted problems in the long-term care sector. 

The Wall Street Journal used a series of charts to tell the story of the declining number of nursing home beds at a time when there is a rapidly growing population of seniors. It also explored the impact of people wanting to stay in their homes, and discharge delays from hospitals to post-acute care facilities as some states see access shrink.

The newspaper’s data, from January 2017 through  July 2023, showed what is largely well-known to stakeholders in the skilled nursing sector. But the starkness of the presentation, one made to such a business-focused mainstream audience, was bold and likely influential to the general public.

One of the Journal’s charts, citing federal data, highlights that more than 4,000 nursing home beds lost in each of four states – Kansas, Massachusetts, Ohio, and Wisconsin – from January 2017 to July 2023.

“The shrinkage was decades in the making,” the Journal article explained. “Most older people would prefer to stay in their homes and more Medicaid spending on long-term care has gone to home- and community-based services rather than institutions such as nursing homes since 2013. Those forces contributed to a net loss in nursing-home beds that has hit almost every state.”

In Ohio, the heads of the Ohio Health Care Association and LeadingAge Ohio both lamented the loss of beds there, and mentioned the longer-term trends of drops in facility occupancy and closing entire buildings without suitable replacements being available, especially in rural areas. 

“Even preceding the COVID pandemic, nursing home occupancy had been depressed nationwide,” LeadingAge Ohio President/CEO Susan V. Wallace noted to McKnight’s on Tuesday. “Of course, the policy decisions during COVID—including mandatory closures, limited visitation, distancing and masking protocols – caused the public to choose other care settings for rehabilitation and long-term care.”

Are beds right-sized or not?

The phrase “right-size” has become common in the sector for facilities that convert spaces to assisted living or other uses, or relinquish their bed licenses. Others, Wallace reminded, “are simply closing.”

In 1992, Ohio had 91,500 nursing home beds in service with a facility occupancy rate of 92%, per information shared by Wallace. In 2001, the number of beds was up to 94,200, but the occupancy rate had dropped to 83%. By 2019, the number of beds in service was down to just below 89,000, and with an occupancy rate of 80%.

Peter Van Runkle, executive director of the Ohio Health Care Association, said the average occupancy rate in the state is now below 80%.

He noted, however, that the bigger impact for aging seniors is the loss of facilities with what he called “special characteristics.” Two long-standing SNFs in Lima, a small city between Dayton and Toledo, recently closed along with two county-run homes in Greene and Butler counties, both located in the southwest part of the state. A historic, Black-operated nursing center in Cleveland has also closed. 

“We are concerned that if the trend of losing whole buildings without a replacement continues, access problems could result, especially in rural and inner-city areas,” Van Runkle said. “From a resident standpoint, any closure — even when a replacement facility is involved — can be difficult because people are forced to move from their home.”

Another major trend discussed in the Wall Street Journal article is the growing difficulty finding beds for patient transfers from hospitals to post-acute care facilities. The report noted that, in Massachusetts, 563 patients per month, on average, are stuck in hospitals due to a lack of available beds. The longest waits there have been six months or more, but most patients remain in the hospital for at least a month, the Journal noted. 

“Massachusetts, like all states across the country, have had a decline in nursing home beds,” Tara Gregorio, president of the Massachusetts Senior Care Association, affirmed to McKnight’s on Tuesday. “This is not a new phenomenon …. Twenty-five facilities have closed in Massachusetts since the start of the pandemic.”

Gregorio added that more than half of LTC facilities there have had to deny admissions over the last year. She pointed to staffing shortages and inadequate Medicaid funding as the primary reasons. 

“Medicaid funding still does not cover the true costs of resident care,” she said. “For the safety and wellbeing of our residents and their caregivers, we urgently need a federal response to require all states to adopt basic, but essential reimbursement policies that fully recognize the current cost of quality resident care and vital investments in our deserving workforce.”

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Skilled nursing sector’s growing (or shrinking) problems get new attention