Trends in Nursing Home Closures in Metropolitan and Nonmetropolitan Counties in the United States, 2008-2018


Many states have expanded efforts to rebalance long-term services and supports (LTSS) by promoting home- and community-based services over institutional care in settings such as nursing homes. However, there is widespread concern that alternative providers of LTSS are limited in rural areas, and even when available, these providers may be too far from rural residents to have meaningful access to LTSS. Given the limited availability of alternative providers of LTSS, rural residents are more likely to utilize nursing home care, underlining the importance of nursing homes in rural areas.

With the closures of rural nursing homes, residents living in rural areas may not have adequate access to LTSS. This study looks at the availability of LTSS in rural areas by examining three key issues. First, it documents trends in nursing home closures over time and compares the characteristics of open and closed nursing homes in metropolitan and nonmetropolitan counties. Second, it identifies counties without any nursing homes, i.e., nursing home deserts. Finally, it describes the population characteristics of counties with and without nursing homes.

RUPRI Center for Rural Health Policy Analysis
Hari Sharma, Redwan Bin Abdul Baten, Fred Ullrich, A. Clinton MacKinney, Keith Mueller