Trends and Factors in Nursing Home Closures

Area of Science:

• Health Services Research
• Gerontology
• Healthcare Management

Background:

• Nursing home closures disrupt care continuity and disproportionately affect vulnerable populations.
• Understanding closure trends and factors is crucial for policy and resource allocation.
• Mitigating negative effects on residents and the healthcare system requires insight into facility dynamics.

Purpose of the Study:

• To examine US nursing home operational dynamics.
• To identify how facilities transition through openings, closures, and changes of ownership (CHOW).

Main Methods:

• Longitudinal cohort study using 40 years of Centers for Medicare & Medicaid Services data (1985-2025).
• Analysis focused on physical location identifiers to track facility trajectories.
• Assessed facility lifecycle status, CHOW events, capacity changes, and participation in Medicare/Medicaid.

Main Results:

• Nearly half of nursing home entities (46.29%) had entry-exit trajectories without ownership changes.
• A significant portion (20.48%) experienced changes of ownership while remaining active.
• Organizational restructuring and capacity adjustments became more prominent than new entries or exits over time.

Conclusions:

• US nursing home markets exhibit continuous organizational change, with ownership transitions and capacity reconfiguration often replacing facility entry and exit.
• Nursing home closure frequently signifies restructuring within evolving ownership, not just a terminal event.
• Policy and oversight should address ownership transitions and capacity reconfiguration alongside facility entry/exit metrics.