Nearly 3,000 Nursing Homes Closed From 1999-2008; Where Will We Find Long-Term Care?

Nursing Home Man WalkerIt seems that finding a quality nursing home in the U.S. will become tougher and tougher in the not-too-distant future unless current trends and policies change. These are the basic conclusions of a new study that analyzed data regarding nursing-home closures.

The study found that 2,902 nursing homes (1,776 stand-alone and 1,126 hospital-based) went out of business between 1999 and 2008, which eliminated more than 184,000 beds. New facilities that opened during that timeframe replaced more than 87,000 of the lost beds. But the net loss of nearly 97,000 beds accounted for 5% of all beds lost during that decade.

This news comes at a time when the population of the U.S. is becoming older and older. Consider that the number of persons at least 65 years of age is expected to increase from 35 million in 2000 to 71 million in 2030. People who are at least 85 years of age are expected to number more than 19 million in 2050 – a figure that stood at only 3 million in 1994.

Nursing Home Old ManPerhaps the most troubling information to be gleaned from the study is that nursing homes in the most economically challenged parts of the U.S. are disappearing at a much faster rate. The study’s lead author, Zhanlian Feng with Brown University, noted that minority populations in the U.S. are aging at a steeper rate compared with the white population. This means that long-term care is rising fastest in minority communities.

That information makes the following numbers even more bothersome. The study found that nursing homes in the 25% of ZIP codes with the highest poverty rate were twice as likely to shut their doors, as compared to nursing homes located in the 25% of ZIP codes with the least poverty. Likewise, nursing homes in ZIP codes with the highest number of African Americans per capita were 38% more likely to shut down than those in ZIP codes with the fewest blacks. Those corresponding ZIP code figures stood at 37% for Latinos.

What does this mean for the long term? The researchers say it raises concerns about how far seniors will have to go to access senior care. Not only that, but the quality of the care in the facilities that remain is also a concern. Medicaid recipients, many of whom live in low-income areas, may receive reimbursements lower than the fees of private-pay long-term care patients. Therefore, Medicaid patients are most likely to be among those who suffer most from a nursing home shortage, as well as lower-quality care from facilities that are not funded by privately paying patients.

Nursing Homes Women Seated in LineAlthough home care, assisted living and senior day care have helped to prohibit a shortage of nursing home beds in the present, this is expected to change, according to the researchers.

Dr. Mitchell H. Katz, director of the Los Angeles County Department of Health Services, wrote an accompanying editorial to the research article. He stated that one of two things should happen:  either the federal government should increase the reimbursement rate for nursing home services, or state and federal policies should fund less expensive — and perhaps more preferable lifestyle — options, such as assisted living.

“That would be sensible, and should not cost more, but it requires a more far-seeing policy approach than what we have now,” he said.

Otherwise, as Newsweek/Healthday points out, only the wealthy will have access to nursing homes, the authors said.

The research report was published in the Jan. 10 online edition, as well as the May 9 print issue, of the Archives of Internal Medicine.

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