Nursing Home Closures: The Elderly Population is Exploding, Yet Nursing Homes are Closing

Despite a ballooning elderly population in the United States, nursing homes are closing at an alarming rate. We put together this infographic to bring these staggering statistics to light. We encourage you to share this infographic, using the social media icons to help us spread the word about nursing home closures. In addition, you can embed the infographic on your blog or website using the HTML code provided. Please credit Assisted Living Today as the source.

Nursing Home Closures Infographic

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Below, you can read more details about the main findings presented in the above infographic. 

The steady wave of new retirees continues to increase across the globe, but new nursing home construction has continued to slow.

In 2016, the population of elders was 2.78% higher than in 2006, and the number of seniors is expected to double by 2060, to almost 98 million elders in the United States. Meanwhile, the number of licensed nursing home beds has steadily decreased throughout the years- from 2006 to 2016, the numbers decreased by 21,800 beds

Existing nursing homes have been shutting down across the country, hitting rural areas the hardest.

All across the country, nursing homes have been shutting down for the past two decades. Between the years 1999 and 2008, 16% of all certified nursing facilities closed down. While new beds are added with the construction of new facilities, this time period still saw an overall decrease in the number of people that could be cared for in a nursing home. As we approach 2020, the problem has only increased in magnitude, as nursing homes continue to shut down every year, often in places with the most at-risk elders such as low-income and low-access to medical care neighborhoods. According to a recent report by the New York Times, more than 440 nursing homes in rural areas have shut down, causing elderly populations prone to poverty to be left in the cold when they faced a debilitating injury or illness.

Nursing homes are increasingly difficult to get into.

In 1974, the Health Planning Resources Development Act made it possible for states to set regulations regarding the construction of new nursing home facilities. Federal funding towards any construction was restricted to states that were able to provide a certificate of need (CON) for any new nursing home project. This act was repealed in 1987, but as of 2018, 35 states have maintained their CON programs. 

The reasons for this program are founded in strong logic- the economic impact of too many nursing home beds in an area can be positive or negative, but what can’t be argued is that care provided in nursing homes can often be found lacking, due to high occupancy rates and a lack of nursing home specialists and qualified nurses.

There simply aren’t enough skilled nurses and nursing home specialists. 

The nursing shortage across the U.S. is a result of many factors, including an aging workforce, with over a third of nurses being aged 50 and older and many retiring every day. Another reason behind a lack of skilled nurses in certain areas is the high turnover rate due to burnout, especially in a long term care setting- some areas see a turnover rate of 37%.

Due to an imbalance between those needing help and those able to provide the specialized type of care needed, nursing home residents suffer from substandard care. While nursing homes across the country maintain an average occupancy rate of 85.8%, only 21% of nursing home clinicians tending to the elderly occupants have specialized in medicine for hospital residents. 

Current aging projections have remained steady- we still expect to see 27 million people in need of long term care services by 2050, and with more research into the lifestyles of those living in assisted living facilities and nursing homes, we now project that, by 2030:

  • 40% of baby boomers with be living with diabetes
  • 25% will have some type of cancer
  • 43% will have heart disease
  • 75 million elders are expected to have dementia
  • The percentage of Medicare beneficiaries with three or more chronic conditions will increase from its rate as of 2010, 26%, up to 40%

These conditions all require medication management, constant monitoring, and access to blood panels and other tests to make sure the patient stays as healthy and comfortable as possible. When facing diseases like diabetes and dementia, receiving the correct type of care can be critical to comfort as well as longevity. Studies show that nursing home care can be particularly insufficient for those with these aging-related diseases, causing compounding issues such as:

  • Hypoglycemia, reported in one out of every nine diabetic nursing home residents as a result of inappropriate insulin use, administered by insufficiently-trained clinicians
  • Community infections, which commonly occur in nursing homes due to several factors, including the fact that a large population shares many common areas and so contagious illnesses spread fast. This is dangerous because aging often brings a compromised immune system, and a minor illness can quickly become a big problem for a fragile elder (see our article on how to prevent the spread of pneumonia in a nursing home here). 
  • Residents with Alzheimer’s disease and dementia have a much higher chance of needing long term care after a short-term stay in a nursing home due to the providers not offering specialized cognitive programs meant to keep dementia patients healthier.

Alternatives to nursing homes have been increasing in recent years.

Community-based services such as adult day centers provide daily social interactions, meals, and respite for family caregivers, and can help people live in their communities much longer. In 2016, there were 4,600 adult day centers in the US, the majority of which are run by state and non-profit organizations that offer free and reduced prices on services for community members. Those at the end of their lives can also avoid inpatient medical care by utilizing one of the 4,300 hospice organizations across the country- 37% of which are not-for-profit and may offer financial assistance to elders in need. Home health agencies have also begun to increase in popularity, now numbering over 12,200, helping those with homes age in place with access to in-home care for their needs. 

States that have been hit hardest by nursing care shortages like California (where the elderly population has increased by 2.6 million residents in the past decade) have seen an increase in the development of home health care agencies by 89% in the years between 1998 and 2011. In Chicago, there were 725 shutdowns of nursing homes, but the home health industry increased by 75%. Boston was hit hard as well, losing 383 nursing homes, but Massacheucettes increased their home health care agencies by 13% in the same time period, creating a buffer for those impacted elders. 

Texas elders lost nursing home availability, but home health care in this state increased by 50%. Heavily impacted rural areas also saw improvements in home health care over the past decade- Missouri gained 188% more home health providers in the same amount of time, North Carolina’s home health industry grew by 135%, and Utah gained 105% more providers in that time. Overall, across the country, there has been an increase in care agencies of 50% since 1998, in response to the aging crisis.

People needing a long term care facility are moving from nursing homes to assisted living, independent living, and other retirement settings.

Nursing home closures are a big deal for people who need around-the-clock medical care for chronic conditions as well as physical therapy and short-term treatment for acute illnesses or injuries. However, the old model of nursing homes created an environment that led to many cases of medical malpractice, substandard health and food safety practices, neglect, and even elder abuse. In addition to the difficulty nursing home directors have had in managing care and good policies, insurance companies don’t always want to pay out for nursing home care costs. 

Enter assisted living facilities and independent living retirement communities, which can also be combined with memory care facilities in what are called Continuum of Care Retirement Communities (CCRCs). In 2016, there were only 15,600 Medicaid certified nursing homes across the country, with 1.7 million beds (and dropping every year), but retirement communities have continued to spring up and fill the gap left behind in aging services. As of 2016, there are 28,900 residential care communities serving over 800,000 elders, and counting. 

There are many differences between these retirement settings, but the main reasons for moving into one of these communities are the same:

  • Social isolation can be avoided when you live in an area full of your peers, and these communities make it a point to fill residents’ days with fun activities and day trips to explore the larger community with neighbors and friends.
  • Daily chores like loading the dishwasher and doing laundry can become difficult as we get older and experience more debilitating symptoms of aging, like fatigue and swollen joints. Home health aides can help you age in place with help, and these communities usually handle all the chores for residents, as well as provide healthy meals.
  • Medical access is available in these facilities, provided by gerontological specialists who are well educated in the issues that affect seniors and how to improve their quality of life
  • Arranged transportation is provided for scheduled shopping trips and appointments, as well as community trips and whenever residents want to get out and do their own thing.
  • Secured courtyards and facilities designed to keep those with dementia from becoming lost or confused using tactics like painting exits to look like fireplaces and gardens.

Assisted living facilities offer a great place to live and thrive, and it is designed to keep elders safe and healthy as long as possible. Nursing homes, on the other hand, were designed for rehabilitation, not long-term residency. 

While the trend of nursing home closures may seem dire, keep these other options in mind. In many cases, alternative options like assisted living and in-home health care can provide similar care and a higher quality of life than one would find in a nursing home.

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