Research Alert: May 19, 2026

Changes in Staffing, Resident Health, Closure, and Financial Performance of Rural Nursing Homes From 2017 to 2022

This policy brief summarizes staffing, resident health, mortality, closures, and financial performance of nursing homes in small or isolated rural towns, micropolitan, and metropolitan areas between 2017 to 2022.

Key Findings:

• From 2017 to 2022, average staffing hours per resident-day in nursing homes decreased for certified nursing assistants and licensed practical nurses but increased for registered nurses across small or isolated rural towns, micropolitan, and metropolitan areas.
• A higher percentage of nursing home residents in small or isolated rural towns have depression and psychiatric needs in 2019 and 2022, compared to micropolitan and metropolitan areas.
• A lower percentage of nursing home residents have activities of daily living (ADL) limitations in 2019 and 2022 in small or isolated rural towns compared to metropolitan areas.
• Between 2017 and 2022, nursing home closures were more common in small or isolated rural towns (10.3 percent) than in micropolitan (7.9 percent) or metropolitan (8.5 percent) areas.
• Average nursing home occupancy rates dropped significantly from 2017 to 2021, particularly in small or isolated rural towns; occupancy increased slightly in 2022.
• Since 2020, total profit margins, and especially profit margins from patient care services, have declined substantially across small or isolated rural towns, micropolitan, and metropolitan areas.

Additional Resources of Interest:

• More FORHP-funded research on Aging, Long-term care
• More information about the RUPRI Center for Rural Health Policy Analysis
• More information from the Rural Health Information Hub's topic guide: Long-Term Care Facilities