Rural Nursing Home Closures - Trends, Characteristics, and Impact on Access

Research center:
Lead researcher:
Project funded:
September 2019
Project completed:
February 2021

A series of recent newspaper articles had highlighted a growing post-acute/long-term care access problem created by rural nursing home closures. Our initial analysis using the Medicare Provider of Services file suggested that more than 500 nursing homes in the rural areas had either closed or merged between 2008 and 2018. If there are no other nursing homes nearby, closure can affect residents' access to nursing homes, a much bigger policy problem.

Recently, there has been an effort to rebalance long-term services and supports by promoting home- and community-based services over institutional care. Compared to rural areas, residents living in urban areas may have access to a number of alternatives to nursing home care, including assisted living facilities and adult day care centers. However, there is widespread concern that supply-side barriers may limit access to such services in the rural areas.

Given the limited availability of community-based services, rural residents are more likely to utilize nursing home services, underlining the importance of nursing homes in rural areas. Since many hospitals have closed in rural areas, the distance to the closest hospital with swing beds may also be increasing in rural areas. Yet, we do not have a good understanding of access to post-acute/long-term care services in rural areas.

From a policy standpoint, it is important to document nursing home closures, evaluate their impact on access, and examine the availability of alternative providers of post-acute/long-term care in rural areas. In this project, we began to fill the gap by documenting nursing home closures and identifying nursing home deserts, summarizing the organizational, financial, and market characteristics of open vs. closed nursing homes, and evaluated a number of measures of access to post-acute/long-term care in rural areas. To improve policy understanding of the current post-acute and long-term care access problem created by increasing nursing home closures, we created a database of nursing home closures in both rural and urban areas. We created a measure of access by evaluating the changes in distance that residents need to travel to get to the closest nursing home and/or alternatives.