When Minnesota’s Twin Valley Living Center closed late last year, it took with it dozens of beds intended for the town’s frail and elderly.

But, as with hundreds of other skilled care communities around the country, the nursing home also was reaffirmed as being more than a residence. With 58 jobs in play, it was also one of the town’s largest employers. When its doors closed, spending at the local pharmacy and the Main Avenue hardware store, among other establishments, also declined.

Residents and policymakers alike are hoping to demonstrate to state lawmakers that blows to rural nursing homes also can be devastating hits to entire towns — and, therefore, supporting nursing homes with adequate funding is a worth investment.

Care Providers of Minnesota reports that 31 of 41 Minnesota nursing homes that have closed since 2007 have been in rural locations (communities with populations of 20,000 or less).

Overall, the state has dropped from 45,700 beds in 1995 to 28,486 in 2018. Many that have remained open have downsized or closed off units, CareProviders President and CEO Patti Cullen told McKnight’s.

“We received significant rate increases effective in 2016 with a new value-based payment system — nearly 20% increases in wages happened between passage of the bill and last year,” she said. “Rate increases alone are not enough to address the closures and some of the increases, frankly, came too late.”

That was the case at Twin Valley, which was home to Karen Olson’s mother as she struggled with dementia in her late 80s.

Olson recalled 4½ years of daily visits there in an interview with MPR News. The facility closed in November after giving the final residents two months to relocate. The Olsons had to move their loved ones to a nursing home 20 miles away.

Angie Nelson, executive director of Lutheran Homes, Twin Valley’s operator, told MPR the closure was “heartbreaking” but necessary. The building was at 70% census, and the facility had net losses for three years between 2010 and 2017.

In addition to census, Cullen said closures have resulted from workforce shortages, the need for significant physical plant upgrades, competition from the growing assisted living marketplace and fixed costs “that can’t be covered by smaller facilities.”

Rural nursing homes have long faced dire financial challenges from receiving lower Medicaid payments than their urban competitors. And recent efforts to stabilize funding didn’t come quickly enough, according to state Sen. Kent Eken, a member of the Democratic-Farmer-Labor Party and a Twin Valley native whose father once lived at the nursing home there.

“I felt it early on when I first started serving in the Legislature and when I first saw Dad go into the nursing home, and started to see firsthand that some of the struggles that our nursing homes were going through,” he told MPR. “I was always concerned that we would end up seeing closures if something wasn’t done quickly or soon.”