The Effects of Declining Nursing Home Capacity on Post-Acute and Long-Term Care Access and Health Outcomes among Older Adults and their Caregivers

Nursing homes are cornerstones of the US post-acute and long-term care systems, serving over 4 million older adults, more than half of whom have Alzheimer’s Disease or Alzheimer’s Related Dementias (AD/ADRD). Despite their importance, older adults’ access to these facilities may be approaching a state of crisis. Recent market conditions disrupted the nursing home industry and resulted in historic and persistent staffing shortages, raising concerns that many facilities may be forced to reduce capacity or close entirely. Our preliminary data analyses indicate these concerns are well-founded. We estimate that functional nursing home capacity has declined by nearly 10% since 2019, with nearly 40% of US counties experiencing a decline of 15% or more. The implications of these capacity declines are not well understood but have the potential to be catastrophic. For example, inadequate nursing home capacity may result in disrupted care transitions and slowed recovery following hospitalization, patients languishing in hospitals while awaiting a nursing home bed, increased risk of injuries from inadequate personal care, and increased strain on family caregivers who often fill in the gaps when care is provided at home. There are several tools available to stabilize or expand the nursing home market, including increasing payment rates, removing barriers to new market entrants, and increasing financial incentives to provide care in shortage areas and/or to patients with reduced access. However, there is a glaring evidence gap regarding the need to intervene, the types of interventions needed, and where these interventions should be targeted. Our proposal will close this knowledge gap with rigorous quantitative analyses that will determine the effects of reduced nursing home capacity on three populations. In Aim 1, we will use Centers for Medicare and Medicaid Services (CMS) administrative data and hospital-level variation in the extent of nursing home capacity declines to estimate effects on the care transitions and recovery of hospitalized patients, with and without AD/ADRD, with intensive post-acute care needs. In Aim 2, we will use similar data and county-level variation in capacity declines to estimate effects on care access and injury risk for community-dwelling older adults with increasing long-term care needs, as signified by a new AD/ADRD diagnosis. Aim 3 will estimate spillover effects on spousal caregivers of older adults with post-acute or long-term care needs. It will use household-level survey data linked with CMS data to identify couples and track spousal care delivery and health outcomes following a partner’s hospitalization or diagnosis of a chronic condition, including AD/ADRD. Geographic information will be used to identify exposure to post-2019 nursing home capacity loss. Results from this proposal will provide a comprehensive portrait of current US nursing home capacity and the ability of this market to meet the institutional care needs of an aging population. Results will also support efforts to ensure access to nursing home care, regardless of geography or patient type. Project Number: 1R01AG096598-01 | Fiscal Year: 2025 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Brian McGarry | Institution: UNIVERSITY OF ROCHESTER, ROCHESTER, NY | Award Amount: $641,856 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-P (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11230854