If you have tried finding a decent nursing home spot for an aging parent in New York City lately, you already know the harsh truth.
There is nowhere for them to go.
In neighborhoods across the state, the doors to long-term elder care are slamming shut faster than anyone wants to admit and this is leaving Black families in The Big Apple scrambling to shoulder around-the-clock care on their own.
But this only feels like an isolated local headache until you zoom out and realize that New York is simply the flashing red siren for a full-blown national emergency.
Across the country, nursing home networks are unraveling. And the fallout is landing squarely in the living rooms of households forced to make miracles out of zero support.
Here’s what’s going on.
Since 2020, New York State has seen the unfortunate closure of 24 nursing homes, leading to an unbelievable loss of over 3,000 licensed beds, as reported by The New York Times. This troubling trend, highlighted by LeadingAge New York—a group dedicated to supporting nonprofit senior living facilities—raises serious concerns about care availability for vulnerable populations. As the population ages, shrinking nursing home capacity complicates access to essential services for seniors who rely on these facilities for proper care and support.
This reflects a trend seen across the country. Back in 2015, the Centers for Medicare and Medicaid Services approved a whopping 15,648 nursing homes, but fast forward 10 years, and that number has plummeted by over 900. With the oldest baby boomers reaching 80 this year, a stage where the need for long-term care skyrockets, researchers are starting to worry about whether we’ll have enough nursing home beds to accommodate our rapidly aging population.
“We’re seeing a serious problem and it’s heading in the wrong direction,” David Grabowski, a health policy researcher at Harvard Medical School, told The Times. He also co-authored a study in JAMA Internal Medicine that found a 5% decrease in national nursing home capacity from 2019 to 2024.
“As you look at the demographics, this is only going to get worse, maybe a lot worse,” he warned. This is especially true with the upcoming Trump administration policies on immigration and Medicaid funding.
Why is America’s nursing home footprint shrinking?
Follow the money. Providers like ArchCare have been screaming into the void for years about inadequate state Medicaid reimbursements. Medicaid is the main source of income for these facilities and it’s supposed to cover the bill for the majority of long-term care, but it’s failing to do the bare minimum. According to Clif Porter, chief executive of the American Health Care Association, the government is paying less than the actual daily cost of patient care. It’s a financial chokehold and if something doesn’t change, the safety net for our elderly is going to snap completely.
Many nursing homes, especially for-profit ones, try to bring in short-term patients with Medicare because it pays better than Medicaid. If they can’t attract these patients, Vincent Mor, a health researcher from Brown University, points out that it’s very difficult for them to succeed unless they are either very greedy or very efficient. He emphasizes that the financial situation just doesn’t make sense.
These facilities have also faced staff shortages for many years, leading to closures or reductions in their services. Additionally, nursing aides often have tough jobs that pay poorly, resulting in high turnover rates. Last year, their average pay was $20.67 per hour, according to data from PHI, a group that supports direct care workers.
Although wages have increased over the last ten years, around 40% of nursing home aides still need some kind of public assistance, such as Medicaid or food stamps.
Last year, Medicare inspectors discovered that 27% of nursing homes had at least one serious quality issue that could put residents at risk, according to a report by KFF, a nonprofit organization focused on health policy research.
In recent years, new options have emerged that allow patients to avoid nursing homes. Currently, around one million older adults live in assisted living facilities. Plus, a policy change known as “rebalancing” has helped more Medicaid recipients receive care at home, which is where many prefer to be, instead of in nursing homes.
In 1988, just 10% of Medicaid spending for long-term services went to home and community-based care, while the majority was used for institutional care. By 2020, over 60% of this spending was directed towards home and community services, according to Priya Chidambaram, a senior policy manager at KFF who focuses on Medicaid.
“It’s more difficult to staff a rural nursing home,” Ms. Chidambaram explained. “Labor pools are smaller, and it’s hard to get people to take lower-paid or part-time jobs if they have to travel long distances.”
Hospitals are also facing problems due to a lack of available beds. Dr. Grabowski’s team found that when nursing homes have fewer spaces, patients stay in hospitals longer because they can’t find care after leaving. In many cases, they have to travel further to get to other facilities. “It slows down the whole system,” Dr. Grabowski said.
Experts say that two policies from the Trump administration could make this even situation worse. Removing legal status for certain immigrant groups has made staffing shortages even more severe.
So far, “we’re not seeing a significant impact across the country,” Mr. Porter said. But the effects are being felt in specific locations, including Florida, New York and Massachusetts. With further revocations and deportations, “a lot fewer older adults are going to have caregivers,” Dr. Grabowski warned.
The administration’s plan to slash over $900 billion from Medicaid over the next decade could have some pretty serious repercussions as well. As states continue to struggle with tighter budgets, experts predict that home and community services will feel the pinch first, potentially leaving many individuals without the support they need to stay in their own homes.
The initial impact might seem manageable, but the ripple effects could be major. If those who rely on home care lose access to these services, they may eventually find themselves in nursing homes, which could lead to increased pressure on these facilities.
Essentially, while the immediate cuts might target community services, the long-term fallout could push more people into nursing homes, which could strain resources and care quality there as well.
The Final Takeaway
Nobody wants to sit around the kitchen table talking about what happens when Grandma can’t walk up the front porch steps anymore. But dodging the conversation isn’t going to build a new wing at the local facility either.
The beds are disappearing, the staff is burning out and when the squeeze tightens, history shows us exactly which neighborhoods get locked out first.
Waiting for a sudden hospital discharge to figure out long-term care isn’t just risky — it’s a setup. Call the family meeting this weekend, look at the finances and decide right now who holds the keys and what the plan is.
Because when the doors close, the only safety net left will be the one we build ourselves.
