Nationwide nursing-home picture comes into focus with new analysis

Recent years have brought numerous warnings about impending mass closures of U.S. nursing homes. New research suggests the fears may have been overblown.

At the same time, “access deserts” have arisen and are, in places, hard to solve. 

The team behind the study offers two plausible explanations for the relative health of the overall nursing home industry in 2026:

Either the observers issuing the warnings overstated the risk of widespread closings—or COVID-era emergency funds succeeded in heading off a calamity of national proportions. 

Of course, both these explanations may be true, the team allows.

The research was conducted by Andrew Olenski, PhD, of Lehigh University and Rachel Werner, MD, PhD, of the University of Pennsylvania. Both are affiliated with the private, nonprofit National Bureau of Economic Research (NBER) in Cambridge, Mass. 

The Journal of the American Medical Association published their paper online June 17.

Openings compensate for closings—but only somewhat 

For the project, Olenski and Werner measured nursing home closures using CMS’s Provider of Services (POS) and Nursing Home Compare (NHC) files from 2016 through 2025. 

Their investigation also included the use of facility-level public health emergency receipts as reported in NBER’s Healthcare Cost Report Information System. Here they compared closures for facilities receiving above- vs below-median emergency funding and assessed the relationship between pandemic-era financial support and closure.

Among the key findings in the Olenski-Werner study report:

• A total of 1,440 facilities closed between 2016 and 2025. 
   
• Annualized closure rates were similar before and during the pandemic. 
   
• Some 849 new facilities opened during this period, offsetting about half of the closures.
   
• Cumulative closure rates from 2021 to 2025 were lower among facilities receiving above-median public health emergency funding ($1 million on average in 2020) compared with those receiving below-median funding ($113,000 on average). 
   
• Closures were disproportionately concentrated among low-quality facilities: One-star facilities accounted for 24.2% of closures despite representing 17.1% of all nursing homes, and their proportion grew over time

A question of access for displaced patients 

Olenski and Werner further report that, despite stable rates of closure across the study period, access worsened.

A total of 14.5% of closures resulted in no nursing home within 10 miles, the researchers found, and for an additional 14.4% of closures, nearby facilities had insufficient capacity to absorb displaced residents. 

This resulted in access shortages in nearly 29% of closures.

The authors note that these effects were concentrated in rural communities in the Midwest and Great Plains, where nearly 37% of closures resulted in access shortages compared with 22% elsewhere.

Policy prescription for isolated communities 

In their discussion, Olenski and Werner note the consistency of their findings with prior research showing a correlation between nursing home quality and closure rates.

This association is “encouraging only if displaced residents can access higher-quality alternatives,” they comment.  

The present analysis, they underscore, indicates that some 29% of closures leave residents with no nearby alternatives—and it was not possible to track where displaced patients ended up. 

“These access deserts are concentrated in rural communities that already face limited healthcare infrastructure,” the researchers remark. “Moreover, because licensed beds can exceed practically available staffed beds, these findings may understate access shortages.”

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‘Policymakers should consider targeted interventions, such as enhanced payments and workforce supports, that ensure that facilities serving geographically isolated communities are both financially viable and equipped to deliver high-quality care.’