As the oldest Baby Boomers turn 80, the country’s nursing homes are bracing for an anticipated surge. The number of people who need help with dementia, disabilities and the activities of daily living is growing at a time when the number of nursing home beds is shrinking. Nearly 10% of nursing homes in the United States closed between 2011 and 2021. In addition, direct care providers are leaving the industry in droves.
In a perspective published July 4 in the New England Journal of Medicine, Dr. Mark A. Unruh and Dr. Hye-Young Jung, both associate professors of population health sciences at Weill Cornell Medicine, along with Dr. Vincent Mor of Brown University, warn that the mismatch between need and capacity will strain families, hospitals and healthcare systems across the country if nothing is done to reverse it. They also offer insights and recommendations to help solve what they call a serious and unprecedented healthcare crisis.
“We hope the article will increase awareness of an important issue that will affect many families across the country in the coming years but has received little attention,” Dr. Jung said.
Finding the Right Solutions
Only a year ago 14,742 nursing homes provided care to 1.24 million Americans, with average occupancy at 84%. However, the number of Americans aged 80 or older is projected to increase by more than 45% over the next decade—from less than 15 million this year to about 22 million by 2036. With fewer care providers coming into the field, experts project a shortage of people able to care for the growing population.
Dr. Hye-Young Jung
The perspective details five recommendations to help improve nursing home capacity while bringing more workers into the field. This is especially crucial for the millions of people diagnosed with dementia, the authors said.
First, the authors say that just looking at the number of licensed beds available at nursing homes doesn’t reflect the true picture. A nursing home might be licensed for a certain number of beds, but if there aren’t enough registered nurses, licensed practical nurses or certified nursing assistants to care for residents, the number of beds noted on paper will not translate to available patient beds, Dr. Unruh said.
With this in mind, the Centers for Medicare & Medicaid Services can incorporate targeted stabilization adjustments into the Medicaid payment policy and restructure Medicare and Medicaid payments to encourage investments in care workers including higher wages, upskilling, and training. These moves may help keep nursing homes open—particularly in rural communities where few other options exist—and encourage staffers to remain in their jobs.
Dr. Mark A. Unruh
The authors also recommend supporting access to nursing homes and other long-term services for people diagnosed with dementia—the majority of nursing home residents—by increasing Medicare and Medicaid payments for such care and encouraging states and healthcare systems to develop hospital-nursing home partnerships. These partnerships would include staffing pooling and sharing cross-trained staff.
Hospitals, state and federal agencies and healthcare systems are already focusing on some of these strategies to solve other healthcare issues, Dr. Unruh said. More work needs to be done, though, especially for nursing homes that have a higher number of Medicaid residents, who generate less income.
“We need to help these nursing homes, especially those that have lower revenue streams due to high Medicaid census, to keep them from closing,” he said. “That would be particularly devastating in rural communities where there might only be one nursing home for a large area. If that nursing home closes down, what options will people have? Figuring out where the money is going to come from is difficult, but these are tough questions that need answering. The problem will only be magnified the longer that policy makers wait to do something.”
