Nursing home beds fell pre-pandemic, even as aged population exploded: researchers

As the number of nursing home beds in the country has declined, so, too, has the number of highly rated beds according to new research. The shifting numbers have produced concern among researchers about the availability of high-quality care.

A study published in JAMA Network Wednesday looked at how the supply of nursing home beds in US counties compared to the demand from 2011 to 2019. What the three University of Pennsylvania-affiliated researchers found was not good news for a growing population of seniors and their caregivers.

“The broad decline in nursing home bed supply, which intensified during the COVID-19 pandemic, may impede access to care and contribute to worsening outcomes for the growing population that relies on nursing homes for postacute care after hospitalization,” the study said. “If access to nursing home care is not commensurate with population-level postacute care needs, older adults may be at greater risk for rehospitalization and other adverse outcomes.”

Using a number of federal sources for data, the researchers found that the number of beds declined from 1,670,000 in 2011 to 1,644,000 in 2019 — a decrease of 1.5%. 

Meanwhile,  the population of seniors 65 and older increased by 28.2% — from more than 39,600,000 to nearly 51,000,000. 

Losses were recorded in 86.4% of US counties.

Areas that saw a decrease had a lower percentage of older adults at the study’s start, a lower percentage of older adults living in poverty, tended to have a higher percentage of seniors enrolled in Medicare Advantage, and were located “disproportionately in metropolitan counties.”

The declining number of beds also was not evenly distributed throughout nursing homes. In counties that experienced an increase in the number of beds, it was a relatively small growth of 2.3 percentage points in for-profit beds yet a decrease of 5.5 percentage points in 4- and 5-star rated beds. 

“There is a body of evidence that suggests there is cause for concern about the availability of long-term care supports and equitable access to high-quality, long-term care,” said lead author Katherine E. M. Miller, PhD, with the Division of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania. “I hope this study brings attention to the need to continue to invest in policies to support access to high-quality nursing home care.”