Rural Nursing Homes Closing at an Alarming Rate, Scattering Residents and Disrupting Families

When I was the Chief Medical Officer of one of the nation’s largest nursing home chains, people would often ask me ‘what keeps you up at night?’  My answer was always the same: that rural facilities - those that often depend on a single physician, that provide dozens of jobs for local residents, and that allow families to keep their loved one’s with advanced dementia nearby - that these facilities would be unable to provide care for one reason or another, and would have to close.  These are facilities far afield from urban centers, medical schools, and value-based demonstration projects.  Where physicians were mostly shutting practices down, not starting new ones.  Unfortunately these fears were well founded.

There were over 16,800 skilled nursing facilities (SNF’s) in the US back in 2000, just as I became interested in geriatrics, dementia and long-term care.  Today there are 1,200 fewer SNF’s;  thousands of beds have been taken out of circulation, especially in rural areas.  While some close for safety/quality reasons, the majority shut their doors for financial reasons.

In rural states these closures create undue burdens on pateints with dementia and their families.  An article in the NYT a few weeks back describes the scattering of residents when very rural nursing homes close their doors for good.  In one case a resident was relocated 220 miles away, across state lines, in an effort to find a new ‘bed’ that could care for him, by any measure an unacceptable situation.  The patient traveled seven hours across state lines only to pass away three days later.  That an older adult with advanced dementia should suffer the same fate from a man-made ‘eviction’ as folks do after hurricanes and other natural disasters is shocking to me.

States should provide better rates to SNF’s that care for our most vulnerable elders.  Some state rates are barely enough to keep the lights on.  South Dakota is a case in point, with the lowest rate in the nation.  At $131 per day facilities loose money on every resident.  Think about the last time you paid less than that for just a hotel room, forgetting for a moment the personal care, the medications, the social activity and of course three square meals a day.  Where rural SNF’s are in danger, underwriting or subsidizing partnerships with local entities might help.  Loosening zoning restrictions to allow mixed-use healthcare enterprises can attract local investment, allowing for satellite rehabilitation facilities or clinics.  

Rural communities are already hurting in many ways. SNF closures add insult to injury, increase unemployment, penalize the elders who poured their hearts into those communities over a lifetime, and can inadvertantly rip families apart.  Surely we can do better.