As the oldest baby boomers turn 80, the nation’s nursing homes are bracing for the expected increase. The number of people with dementia, disabilities, and needing assistance with activities of daily living is increasing while the number of nursing home beds is decreasing. Nearly 10% of U.S. nursing homes closed between 2011 and 2021. Additionally, direct care providers are exiting the industry in droves.
In an opinion published July 4 in the New England Journal of Medicine, Dr. Mark A. Unruh and Dr. Hyeyoung Jeong, associate professors of population health sciences at Weill Cornell Medical College, along with Dr. Vincent Moe of Brown University, warn that the mismatch in needs and capabilities will strain families, hospitals, and health systems across the country if nothing is done to reverse it. They will also provide insights and recommendations to help resolve what has been described as a serious and unprecedented healthcare crisis.
We hope this article raises awareness of an important issue that will affect many families across the country in the coming years, but receives little attention. ”
Dr. Hyeyoung Chung, Associate Professor of Population Health Sciences, Weill Cornell University
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Just one year ago, 14,742 nursing homes provided care for 1.24 million Americans, with an average occupancy rate of 84%. However, the number of Americans 80 and older is projected to increase by more than 45% over the next decade, from less than 15 million this year to nearly 22 million by 2036. Experts predict that with fewer care providers entering the field, there will be a shortage of people to care for the growing population.
This perspective details five recommendations to increase nursing home capacity while bringing more workers onto the scene. This is especially important for the millions of people diagnosed with dementia, the authors said.
First, the authors say that simply looking at the number of licensed beds available in nursing homes does not reflect the true picture. A nursing home may be licensed with a certain number of beds, but if there isn’t a shortage of certified nurses, certified practical nurses or certified nursing assistants to care for residents, the number of beds on paper won’t translate to available patient beds, Dr. Unruh said.
With this in mind, the Centers for Medicare and Medicaid Services could incorporate targeted stabilization adjustments into Medicaid payment policies and restructure Medicare and Medicaid payments to encourage investments in care workers, such as higher wages, upskilling, and training. These moves could help keep nursing homes open and encourage staff to stay on the job, especially in rural communities where there are few other options.
The authors also recommend increasing Medicare and Medicaid payments for such care and encouraging states and health systems to develop hospital-nursing facility partnerships to help people diagnosed with dementia, who make up the majority of nursing home residents, access nursing homes and other long-term services. These partnerships include pooling talent and sharing cross-trained staff.
Hospitals, state and federal agencies, and health systems are already focusing on some of these strategies to solve other health care problems, Dr. Unruh said. But more needs to be done, especially in nursing homes where many Medicaid residents have low incomes.
“We need to help keep these nursing homes from closing, especially those that have fewer sources of income because of the high Medicaid census,” he said. “That would be especially devastating in rural communities where there may be only one nursing home in a large area. If that nursing home closes, what options do people have? It’s hard to know where the money will come from, but these are tough questions that need answers. The longer it takes policymakers to do something, the bigger the problem will be.”
