In case you missed it, a recent
study published in JAMA Internal Medicine confirms an alarming trend seen during and in the aftermath of the COVID-19 pandemic: an access to care crisis in America’s nursing homes. Between 2019 and 2024, researchers estimate the operating capacity of skilled nursing facilities (SNFs) declined by at least five percent, with a quarter of counties experiencing declines of more than 15 percent. The study uniquely examined SNF capacity compared to the licensed number of beds, which declined by 2.5 percent during the same time period, demonstrating that access to care may have been worse than
previously estimated.
Researchers found that SNF capacity declines were larger in counties with more frequent reports of staffing shortages. Due to the pandemic, SNFs experienced historic workforce losses, worse than any other health care sector. Despite relentless recruitment and retention efforts, including the highest increases in wages among all health care sectors, SNFs have struggled to find qualified caregivers. As a result, many facilities have made the difficult decision to reduce the number of beds they can safely operate.
When SNFs are forced to close or limit admissions due to caregiver shortages, the impacts are immeasurable on residents and their families. In addition, the study found that declines in SNF capacity led to longer hospital stays and longer travel distances for patients trying to access needed SNF care.
“This study confirms what we have been saying for years—that when nursing homes can’t find caregivers, residents and families must wait longer or look farther for the care they need,” said Clif Porter, president and CEO of the American Health Care Association (AHCA). “Now we have numbers behind the countless stories we heard, but it may be worse than we thought. The rippling effect on families, hospitals, and rural communities is real. This should be a signal to policymakers that when nursing homes say they need help with workforce challenges, believe them.”
Key Findings from the Study
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Operating capacity declined five percent nationwide. Estimated operating capacity declined five percent compared to a 2.5 percent decline of licensed SNF beds nationwide between 2019 and 2024. In one in four counties, operating capacity fell nearly 15 percent or more.
- Rural areas are hit hardest. Counties experiencing the largest declines were more likely to be rural, where labor shortages are the worst.
- SNF capacity declines led to hospital bottlenecks and seniors traveling farther for care. The study revealed a strong correlation between reductions in nearby SNF capacity and increases in hospitals’ mean length of stay, the percentage of stays lasting 28 days or more, and distance traveled to admitting SNFs.
These findings underscore an ongoing systemic challenge in long term care that goes far beyond individual facilities. Providers remain unwavering in their commitment to quality care, but when labor market challenges and insufficient government support converge, SNFs face an untenable situation. Reducing operating capacity becomes not a choice but a necessity in order to maintain a high standard of care.
These findings are reinforced by data from AHCA’s recent Nursing Home Workforce Report, which shows that while nursing homes are making progress in strengthening their workforce, the long term care profession continues to face a growing caregiver shortage. Meanwhile, new evidence indicates that proper Medicaid funding can help nursing homes invest in their workforce and improve their staffing ratings.
To help address workforce challenges, AHCA introduced Caregivers for Tomorrow, a component of AHCA’s forward-looking policy agenda, The Better Way. The initiative calls on policymakers to invest in building up the caregiver pipeline, recruitment and retention efforts, and expanding career pathways.
Policymakers must take strategic and supportive action to strengthen the long term care workforce. As the Baby Boomer generation ages and the demand for long term care services surges, now is the time to act. A lack of adequate care capacity creates a domino effect across the entire health care system – straining hospitals, overwhelming families, and leaving vulnerable populations stranded. Meaningful investments in long term care will ensure access to care for the millions of seniors and individuals with disabilities who rely on it – and is now more essential than ever before.
Read the full JAMA Internal Medicine study HERE.
Learn more about Caregivers for Tomorrow HERE.