As we wrap up November 2024, it’s time for our monthly deep dive into what’s happening in nursing homes across America. This is likely the last update for 2024, as CMS has not published an update in December for the past several years. If you’ve got a loved one in a nursing home or are considering one for the future, these numbers tell an important story about the state of long-term care in our country. Let’s break down what’s changed and what it means for residents and families.
The Big Picture: Fewer Facilities, But How Much Does It Matter?
Here’s something interesting to consider: we’re continuing to see a gradual decrease in the number of nursing homes across the country. As of November, we’re down to 14,807 facilities nationwide – that’s 7 fewer than just last month. While this might sound alarming at first, let’s put it in perspective. We’re talking about a very small month-to-month change, but it’s part of a longer trend that’s worth watching. Back in January 2014, we had 15,653 homes, so we’ve lost about 846 facilities over the past decade.
This decline isn’t happening uniformly across the country. Rural areas have been hit particularly hard, with some communities losing their only nursing home facility. Urban areas, on the other hand, often maintain multiple options for residents, though they too have seen consolidations and closures. The reasons behind these closures are complex, ranging from staffing challenges and financial pressures to increased competition from alternative care options like assisted living facilities and home health care services.
The total number of beds has also dropped slightly, with 1,438 fewer certified beds compared to October. Currently, we’re sitting at 1,581,039 beds nationwide. But here’s the really important number: occupancy rates are holding steady at 77.5%, just a tiny tick up from 77.4% in October. This occupancy rate tells an interesting story: while we have fewer beds overall, we’re not using all the ones we have. This could indicate several things: some families may be choosing alternative care options, some facilities might be operating below capacity due to staffing constraints, or there might be a mismatch between where beds are available and where they’re needed most.
Quality Ratings: A Game of Musical Chairs
The Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system to help families evaluate nursing homes, and November brought some interesting shifts. It was almost like watching a perfectly balanced scale: 404 nursing homes saw their ratings improve, while 403 received downgrades. Talk about equilibrium!
Understanding how these ratings work is crucial for families. The five-star system considers three main components: health inspections, staffing levels, and quality measures. A change in any of these areas can trigger a rating change. For example, a facility might see its rating improve if it hires more registered nurses or reduces the number of resident falls, while issues like medication errors or inspection violations can lead to downgrades.
Let’s break down how the ratings look right now:
- 2,677 homes earned the coveted five-star rating
- 2,497 achieved four stars
- 2,889 maintained a middle-ground three-star rating
- 3,071 received two stars
- 3,530 homes have one star
- 143 homes are too new to have a rating (CMS needs about two years of data to assign a rating)
What does this mean for families? While it’s encouraging to see as many upgrades as downgrades, it’s concerning that the largest single group falls into the one-star category. This suggests there’s still significant room for improvement in quality of care across the industry.
Inspections: The Covid Hangover Continues
Here’s something that might raise eyebrows: only 50 new inspections were conducted in November. This is part of an ongoing challenge that dates back to the Covid-19 pandemic. While CMS is supposed to conduct annual health inspections, this requirement has been difficult to meet since Covid disrupted normal operations. Many facilities haven’t seen an inspector for more than a year, which makes it harder for families to get current, reliable information about facility conditions.
The inspection backlog has real consequences for residents and families. These inspections are meant to identify problems before they become serious issues. They check everything from kitchen sanitation and medication management to emergency preparedness and resident care practices. When inspections are delayed, problems might go unnoticed longer than they should. This makes it even more important for families to be vigilant and involved in their loved ones’ care.
Staffing Levels: The Numbers Behind the Care
One of the most crucial aspects of nursing home care is staffing levels – after all, it’s the staff who provide the hands-on care that residents need. The Department of Health and Human Services has been pushing for increased registered nurse time per resident, and the numbers tell an interesting story.
Currently, residents receive an average of:
- 0.668 hours per day from registered nurses
- 2.290 hours from nursing aides
- 3.837 hours of total staff time
These numbers have remained remarkably stable compared to last month, and they’re slightly up from last year when we saw 0.660 hours from RNs, 2.250 from aides, and 3.790 total hours. While any increase in care time is positive, these small improvements suggest that staffing remains a persistent challenge in the industry.
To put these numbers in perspective, many experts recommend a minimum of 4.1 total care hours per resident per day for basic care, with higher levels needed for residents with more complex needs. The current average of 3.837 hours falls short of this recommendation. This gap between recommended and actual care hours can affect everything from how quickly call bells are answered to how often residents are helped with positioning and personal care.
What This Means for Families
If you’re currently navigating the nursing home system or planning for the future, these numbers highlight several key points to consider:
- While the number of facilities is declining slowly, there’s still adequate capacity in the system overall.
- Quality varies significantly across facilities, making it crucial to research your options thoroughly.
- Don’t rely solely on old inspection data – make personal visits and ask about recent changes or improvements.
- Pay attention to staffing levels during your visits, as they’re a crucial indicator of care quality.
When visiting facilities, don’t be afraid to ask specific questions about staffing ratios, turnover rates, and how they handle staff shortages. Look for signs of adequate staffing during your visits: Are residents’ needs being met promptly? Do staff members seem rushed or overwhelmed? How do current residents and their families feel about the care they receive?
Remember, these numbers are averages and aggregates – individual facilities may differ significantly. The best approach is to use this data as a starting point for your research, but combine it with personal visits, conversations with staff and residents, and careful observation of the facility you’re considering.
We’ll keep tracking these numbers and bringing you monthly updates on the trends that matter most to nursing home residents and their families. Stay tuned for our December report, where we’ll look at how the year ends for nursing home care in America.