Empty nursing home bed and wheelchair

New federal numbers show that 135 nursing homes closed in 2022, significantly fewer than what was projected by the sector’s largest advocacy group. 

But industry sources said – and the Centers for Medicare & Medicaid Services acknowledged – that the number does not reflect the full reality on the ground. Facilities planning to shutter must submit a closure plan to state regulators and CMS, communicate the information to staff, residents and their families, and then implement that plan after it is approved.

Until the plan is fully executed and all residents have been moved elsewhere, the facility is not listed in the federal database as closed. That can result in a discrepancy between what in-state advocates know what is happening and what CMS shows in its Quality, Certification and Oversight Reports, or QCOR, system. 

In Iowa, for example, CMS data said five facilities closed in 2022, but the state Department of Inspections and Appeals said 17 shut down. In South Dakota, CMS listed three closures, but five facilities closed last year. And in Montana, CMS said one nursing home closed but 11 facilities shut down, which the head of state’s leading nursing home advocate said should be a wakeup call to federal regulators. 

“In some ways, CMS is actually complicit in the closings since they do little to fulfill their responsibilities related to Medicaid rate adequacy,” said Rose M. Hughes, executive director of the Montana Health Care Association. “They should be looking more closely at the assurances made by the state that indicate rates are sufficient for facilities to operate and provide care in compliance with all health and safety standards — and also on what closures do in terms of access to care.”

Becker’s Hospital Review on Wednesday posted a state-by-state list of 2022 closures, based on the latest QCOR information. 

In April, McKnights Long Term Care News reported on findings from the American Health Care Association that an estimated 400 nursing homes would close in 2022. More than 300 facilities closed in 2020 and 2021 because of the COVID-19 pandemic. 

In response to an inquiry from McKnights, a spokesperson for CMS said the agency can only report on the number of facilities that have terminated provider agreements. Nursing homes can stay open without federal certification and operate without Medicare or Medicaid funding. CMS can also terminate a provider, which would disqualify it from receiving federal funds. 

Industry sources said that the additional federal aid directed to providers from various pandemic relief bills may have helped keep facilities that were on the brink of closing open. But now that those aid packages are coming to an end – during a continuing labor crisis and ahead of a looming federal staffing mandate – nursing homes that looked flush are finding themselves struggling unsustainably. 

Mark Deak, executive director of the South Dakota Health Care Association, said not having accurate closure numbers complicates the challenge of pushing lawmakers for more resources. 

“We’ve been underfunded for years, and the closures speak for themselves: It’s coming home to roost,” he said.