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Record numbers of nursing homes are shutting down in New England
The economic fallout of the closures ripples beyond the patients in their care and into the larger health care system and communities.
Samantha Jones’s mother first entered a nursing home in 2020, just when everything went into lockdown due to the COVID-19 pandemic. Her father followed suit after a bad fall and entered in February 2022 following a stint at a hospital.
“We moved heaven and earth to have them go to the same nursing home,” said Jones. “They were together for three weeks before she passed. So we were thankful for that.”
But the headaches of dealing with nursing homes only began. Jones’s parents stayed at the Seaport Village Healthcare facility in Ellsworth, Maine. The facility closed last December as it transitioned into an assisted living facility.
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However, her father, 81, still needed more care, so they moved him to a nursing home in Milbridge, Maine.
Her visits to see her father went from every other day in a half-hour commute to an hour and 20 minutes away, once a week.
Less than a year later, the Narraguagus Bay Health Care facility in Milbridge announced its closure last week, setting off another desperate search to place her father in the care he needs.
Her dad had to spend his entire life savings on care, about $400,000.
“And now he’s being treated like this,” Jones said. “He gets moved around, shuffled around like an object.”
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The nursing home closures affect not only the patients, like Jones’s father, but also the larger health care system and local communities they serve. Experts in the field say the loss of long-term care facility beds has led to backups in emergency rooms, and family members are leaving the workforce to care for the elderly or sick. As New England ages, where and how they will receive the care they need will only worsen.
Nursing homes close at a record clip
According to a Boston Federal Reserve report, there were 150 less nursing facilities in New England at the end of fiscal year 2023 than there were at the beginning of 2010, a 15 percent decrease.
Nursing homes, which have not been able to recover the workforce since the pandemic, are significant employers in some communities, providing jobs for more than 200,000 people across the region, the report said.
The report found that in Massachusetts alone, 1,200 people lie in hospital beds daily instead of recovering at skilled nursing facilities due to the closures and staffing shortages. Hospital stays are not only more expensive, but they also drive up hospitals’ wait times and reduce their capacity to provide treatments to other patients.
Last year, the median nursing facility in each New England state operated at a loss as employment in the industry declined.
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The report found that the biggest contributors to the closures were low reimbursement rates from Medicaid and Medicare and high operating costs. More will follow unless significant changes occur.
“If there were no policy changes or structural changes to how (nursing homes are) operating, they can’t sustain losses year after year like that without closing,” said Riley Sullivan, a senior policy analyst with the Federal Reserve Bank of Boston and the author of the report. “So, something has to change.”
Sullivan said that as the share of the population who are 75 and older is growing in the region, such as in Maine, New Hampshire, and Vermont, which now have the three oldest median ages in the U.S., that subset will most likely need long-term care.
“It’s concerning that those two trends are moving in opposite directions,” he said.
Residents transitioning to at-home care closes critical nursing facilities
On the outside, it might seem reasonable for these closures to happen as people choose at-home care over long-term facilities. However, those in the field say the demand remains for nursing homes, especially since it is so difficult to find affordable at-home care.
“The reality is absolutely nobody, nobody wants to live and/or die in a nursing home,” said Jess Maurer, the Maine Council of Aging executive director. “That’s not on anybody’s bucket list, right?”
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However, most people realize that they might need that kind of care at some point, whether long-term rehab or daily assistance, she said.
“When you squeeze the air in a balloon, it’s gotta go somewhere,” Maurer said. “We have a whole lot of people who need care at some level, either home or facility-based care.”
In Connecticut, they are leaning toward what people want — staying at home. Through a state program called Community First Choice, a person can pay a family member or friend to provide them with care at home.
Beginning in 2016, Connecticut started to see more people choose at-home care than go to a nursing facility, which has resulted in some closing.
The biggest barrier in the state is accessible housing, said Mairead Painter, the Connecticut State Long Term Care Ombudsman.
“We can work out finding family members, and we’re looking at how technology can support individuals and other alternatives,” she said. “But I would say, hands down, what I hear from the individuals we serve the most is that having accessible housing in their communities of origin is the biggest barrier for them.”
Vermont also saw a decline in nursing homes before the pandemic due to a similar program called Choices for Care, which allowed residents to get at-home care through Medicaid funding.
However, the pandemic led to a sharp decline in nursing home occupancy due to staff shortages, and the state has since reinvested in them to help free up hospital beds.
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“We’re hoping that some of this financial stability we provide will put those nursing homes on a better footing,” said Megan Tierney-Ward, the deputy commissioner of the Vermont Department of Disabilities, Aging & Independent Living.
Maine is the litmus test for the rest of the Northeast and country
However, Maine, the oldest state in the country, has seen the most nursing home closures over the past decade in the Northeast.
According to Angela Westhoff, the president and CEO of the Maine Health Care Association, which oversees 200 long-term care facilities in Maine, 26 have closed since 2014, with 12 of those closing since 2020.
In April, Maine passed a one-time payment of $26 million to help nursing homes cover the gaps between reimbursement rates and care costs until higher reimbursement rates occur.
However, as Westhoff pointed out, it is only one-time funding. In 2022, Maine had a $97 million shortfall for nursing homes.
“Ironic isn’t even the best word,” said Westhoff. “It’s a shame, truthfully, that beds continue to dwindle as adults age in Maine because facilities are forced with limited options, no staff, and insufficient reimbursement. It’s hard to run a business that way. Whether you’re for-profit or nonprofit, at the end of the day, you have to pay your staff.”
In a statement to the Maine Committee on Appropriations and Financial Affairs to get additional funding for nursing homes, Jessica Duffy, a registered nurse in the state since 2002, wrote that her colleagues in long-term care facilities are “physically and emotionally exhausted.”
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Staff get calls daily to cover shifts because facilities are short-staffed, Duffy wrote.
It leaves “caregivers who are working parents to choose between staying for a longer shift to care for their 50-100 residents who need them, or going home to make dinner for their kids, help them with their homework, and put them to bed,” she wrote. “We can stand around all day pointing fingers and talking about what is wrong in long-term care. But here’s the fact — we need bold action from lawmakers in Augusta because we are at the brink.”
For Jones, the continuing closures keep her on edge as she prepares to place her dad in an even farther away facility.
She questions what will happen as the rest of the population ages, and funding runs short.
“We’re not going to have a place to die,” said Jones. “End-of-life care is really important, and nobody wants to face it. That’s, I think, one of the biggest reasons why there’s no money.”
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