The San Vicente de Pa\u00fal Nursing Home in the South Bronx hasn\u2019t admitted a patient since December 2024. ArchCare, which operates the facility, has reduced its capacity from 120 available beds to 53 and plans to shrink it further.<\/p>\n
Another ArchCare nursing home, on Staten Island, has shut down a full floor. North of the city, in Dutchess County, its Ferncliff Nursing Home has contracted from 309 available beds to 196.<\/p>\n
The eight nursing homes owned by ArchCare, a nonprofit that provides eldercare through the Archdiocese of New York, have 269 fewer usable beds than they did 18 months ago, a nearly 12% decline, creating waiting lists for patients seeking long-term care.<\/p>\n
Across New York state, 24 nursing homes have closed since 2020, resulting in a loss of more than 3,000 licensed beds, according to LeadingAge New York, which represents nonprofit senior living organizations.<\/p>\n
That mirrors a national trend<\/a>. In 2015, the Centers for Medicare & Medicaid Services certified 15,648 nursing facilities. A decade later, that number had fallen by more than 900.<\/p>\n With the oldest baby boomers turning 80 this year, an age when the need for long-term care climbs sharply, researchers are sounding alarms. Will there be enough nursing home beds for a rapidly graying nation?<\/p>\n \u201cWe\u2019re seeing a serious problem and it\u2019s heading in the wrong direction,\u201d said David Grabowski, a health policy researcher at Harvard Medical School. He is an author of a study in JAMA Internal Medicine that found a 5% decrease<\/a> in national nursing home capacity from 2019 to 2024. \u201cAs you look at the demographics, this is only going to get worse, maybe a lot worse,\u201d he said, especially given looming Trump administration policies on immigration and Medicaid financing.<\/p>\n The reasons for the shrinkage?<\/p>\n ArchCare blames inadequate state reimbursement for Medicaid, a perennial industry complaint. The primary payer for nursing home care, Medicaid provides less than the daily cost of care, said Clif Porter, chief executive of the American Health Care Association, an industry trade group.<\/p>\n \u201cBefore the pandemic and inflation, the losses were sustainable,\u201d said Jason Hutchens, ArchCare\u2019s chief operating officer. More recently, he said, \u201cwe were running at an unsustainable loss \u2014 we had no choice.\u201d<\/p>\n Nursing homes, most of them for-profit<\/a>, try to compensate by attracting short-stay patients covered by Medicare, which pays higher rates than Medicaid. When they can\u2019t, \u201cunless you\u2019re extremely rapacious or extremely efficient, you\u2019re not going to make it,\u201d said Vincent Mor, a health services researcher at the Brown University School of Public Health who is an author of an article, published in the New England Journal of Medicine, raising concerns<\/a> about reduced capacity. \u201cThe numbers don\u2019t add up.\u201d<\/p>\n Staff shortages, which have plagued nursing homes for decades, have also caused contractions and closures. Nursing home aides work stressful, low-paying jobs with historically high turnover rates. Their median hourly wage last year was $20.67, according to federal data compiled by PHI<\/a>, a research and advocacy group for direct care workers. Although pay has risen over the past decade, about 40% of nursing home aides rely on some form of public assistance, such as Medicaid or the Supplemental Nutrition Assistance Program, PHI reported.<\/p>\n The number of nursing home aides has rebounded from the covid pandemic, according to PHI, but fewer are working than in 2015. And while hiring and retention have improved, Porter said, \u201cthere\u2019s still a significant gap between demand, especially future demand, and where the workforce currently is.\u201d<\/p>\n National occupancy rates, which fell sharply during the pandemic, have returned to a more typical 80%.<\/p>\n That figure can be misleading; it doesn\u2019t mean 1 bed in 5 sit empty, awaiting a patient. Occupancy counts state-licensed beds, but the more meaningful number is operating beds \u2014 how many are actually available depending on a facility\u2019s staffing and other factors.<\/p>\n That number is usually lower and, in many cases, sinking. The American Health Care Association reported in 2024 that almost half of nursing homes were limiting admissions<\/a> and 57% had waiting lists for new residents.<\/p>\n It\u2019s possible, of course, that they also face financial losses because of lower demand. \u201cNursing homes close because people don\u2019t want to go to nursing homes,\u201d said Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care, an advocacy group. \u201cThe quality is so low that people avoid them like the plague.\u201d<\/p>\n Last year, Medicare inspectors found at least one quality violation serious enough to harm or jeopardize residents in 27% of nursing homes, according to an analysis by KFF, a health information nonprofit.<\/p>\n In recent decades alternatives emerged that diverted patients from nursing homes. About a million older adults currently live in assisted living facilities. And among Medicaid recipients, the ongoing policy shift called \u201crebalancing\u201d has enabled more people to receive services at home (where most want to be<\/a>) rather than in nursing homes.<\/p>\n In 1988, only 10% of Medicaid expenditures for long-term services went to home- or community-based services; the rest paid for institutional care. By 2020, more than 60% of expenditures funded home and community care, said Priya Chidambaram, a KFF senior policy manager specializing in Medicaid, citing a staff analysis.<\/p>\n How big a problem these trends pose depends partly on geography. The decline in the number of nursing homes in rural locations \u2014 about 10% from 2015 to 2025 \u2014 was much greater<\/a> than the national drop of about 6%.<\/p>\n \u201cIt\u2019s more difficult to staff a rural nursing home,\u201d Chidambaram said. \u201cLabor pools are smaller, and it\u2019s hard to get people to take lower-paid or part-time jobs if they have to travel long distances.\u201d<\/p>\n Bed shortages are also creating bottlenecks at hospitals. Where nursing home capacity declined, Grabowski\u2019s team found, patients stayed in hospitals longer because they couldn\u2019t locate posthospital care. They often had to travel farther to find facilities. \u201cIt gums up the entire system,\u201d Grabowski said.<\/p>\n On two fronts, Trump administration policies could make matters worse, experts said. Revoking legal status for certain immigrant groups has worsened staffing shortages<\/a>.<\/p>\n So far, \u201cwe\u2019re not seeing significant impact across the country,\u201d Porter said. But the effects are being felt in specific locations, including Florida, New York, and Massachusetts, he confirmed. With further revocations and deportations, \u201ca lot fewer older adults are going to have caregivers,\u201d Grabowski said.<\/p>\n The administration\u2019s more than $900 billion in cuts to Medicaid over a decade are also expected to exact a toll. As states grapple with reduced funding, analysts expect home and community services to take a greater initial hit than institutional care. But that could increase pressure on nursing homes if patients who lose home care turn to institutions instead.<\/p>\n Less of these services \u201cmeans more nursing home entry,\u201d Grabowski said.<\/p>\n As policy ideas circulate \u2014 with calls for better data tracking, special visas for immigrant health workers, and targeted grants for nursing homes serving high-cost populations \u2014 researchers, advocates, and families are waiting to see what unfolds.<\/p>\n \u201cSo much of this is speculative,\u201d Chidambaram said. \u201cWe don\u2019t know what states will decide. We don\u2019t know how the market will react. We\u2019re in new territory here.\u201d<\/p>\n The New Old Age is produced through a partnership with <\/em>The New York Times<\/em><\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" The San Vicente de Pa\u00fal Nursing Home in the South Bronx hasn\u2019t admitted a patient since December 2024. ArchCare, which operates the facility, has reduced its capacity from 120 available beds to 53 and plans to shrink it further. Another ArchCare nursing home, on Staten Island, has shut down a full floor. 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