Geographic Concentration and Correlates of Nursing Home Closures: 1999-2008

Abstract

Background While demographic shifts project an increased need for long-term care for an aging population, hundreds of nursing homes close each year. We examine whether nursing home closures are geographically concentrated and related to local community characteristics such as the racial and ethnic population mix and poverty. Methods National Online Survey Certification and Reporting data were used to document cumulative nursing facility closures over a decade, 1999 through 2008. Census 2000 zip code level demographics and poverty rates were matched to study facilities. The weighted Gini coefficient was used to measure geographic concentration of closures, and geographic information system maps to illustrate spatial clustering patterns of closures. Changes in bed supply due to closures were examined at various geographic levels. Results Between 1999 and 2008, a national total of 1776 freestanding nursing homes closed (11%), compared with 1126 closures of hospital-based facilities (nearly 50%). Combined, there was a net loss of over 5% of beds. The relative risk of closure was significantly higher in zip code areas with a higher proportion of blacks or Hispanics or a higher poverty rate. The weighted Gini coefficient for closures was 0.55 across all metropolitan statistical areas and 0.71 across zip codes. Closures tended to be spatially clustered in minority-concentrated zip codes around the urban core, often in pockets of concentrated poverty. Conclusions Nursing home closures are geographically concentrated in minority and poor communities. Since nursing home use among the minority elderly population is growing while it is declining among whites, these findings suggest that disparities in access will increase.

Growth Of Racial And Ethnic Minorities In US Nursing Homes Driven By Demographics And Possible Disparities In Options

“…Yet between 1999 and 2008, nearly 16 percent of all nursing homes certified by Medicare or Medicaid closed, resulting in a net loss of more than 5 percent of beds. 13 More important, these closures were concentrated in minority and poor communities.…”

“…As recent studies of nursing home closures have found, the numbers of closures are higher in communities characterized by high rates of poverty, higher proportions of racial and ethnic minority residents, and very few new nursing home openings. 13 The geographic distribution of newer forms of long-term care is still largely unknown; whether such services are moving into communities that have lost nursing homes is unclear.…”

Social Activity Decreases Risk of Placement in a Long-Term Care Facility for a Prospective Sample of Community-Dwelling Older Adults

“…Extending the time that older adults remain in the community setting could decrease personal and public financial burden (H. S. Kaye, Harrington, & LaPlante, 2010), and alleviate the projected shortage of available long-term care placements (Feng et al, 2011). Prolonging care in the community may also decrease the risk of negative outcomes for older adults that are associated with placement, such as loneliness (Pinquart & Sörensen, 2001), and malnutrition (Kaiser et al, 2010).…”

Post-acute integration strategies in an era of accountability

“…In the decade after introduction of SNF prospective payment system (PPS), the number of hospital-based SNFs dropped from about 2,500 to about 1,000, since hospital-based SNF costs were generally much higher than SNF PPS rates [24] . As a result, hospitals and health systems will cautiously pursue a full integration post-acute strategy.…”