Tulsa, Oklahoma — They’re not just places where older adults receive care. In rural Oklahoma, nursing homes are often the largest employers in town, the anchor of local economies, and for many small communities, a lifeline that’s quietly doing enormous financial work behind the scenes.
A new study commissioned by Care Providers Oklahoma puts hard numbers to what industry leaders have long suspected: rural long-term care facilities in the state generate more than $1.8 billion in total economic activity and support over 10,300 jobs, the vast majority in communities where good-paying, stable work is hard to come by.
“Rural nursing homes are a hidden economic engine,” said Steve Buck, CEO and President of Care Providers Oklahoma, which represents a significant share of the state’s nearly 300 nursing homes. “Policymakers need to understand that so that as they make decisions, those decisions do not undermine what is already the fabric of the community.”
What the Numbers Show
The report, prepared by economist Dr. Russell Evans using data from CMS, the Bureau of Labor Statistics, and the American Health Care Association, found that long-term care facilities deliver $939 million in direct health care services to rural Oklahomans annually. The direct household labor income for facility workers totals more than $510 million — or roughly $49,500 per job.
That’s not pocket change in communities where median incomes run well below the state average. For many rural residents, a job at the local nursing home is one of the most consistent, well-compensating positions available.
Beyond wages, these facilities keep money circulating locally — buying food, medical supplies, and services from nearby businesses. That ripple effect is what pushes the economic impact past $1.8 billion.
A Care Desert Is Already Forming
The demographic backdrop makes the stakes even higher. Rural Oklahoma counties average just two nursing facilities each, compared to eight in urban counties. Meanwhile, Oklahomans 65 and older are disproportionately concentrated in rural areas — and that population is set to grow, projected to outnumber children for the first time by 2034.
The study also flags a troubling pattern: when rural residents need post-acute or rehabilitative care, they’re frequently transferred to urban facilities — and they often don’t come back. Specialty providers tend to keep patients close, which effectively strips rural nursing homes of the skilled-care demand and higher reimbursement rates they’d otherwise receive.
“It removes the patient from their home community and can leave them isolated from their family, friends, and home congregation,” the study notes.
Medicaid Cuts Could Change Everything
Buck said the report was timed, in part, to inform Oklahoma’s participation in the federal Rural Health Transformation Program — a five-year, $50 billion investment in rural health infrastructure. Oklahoma received one of the highest national awards through that program.
But looming over that investment is a stark counterweight: an estimated $911 billion in federal Medicaid reductions over the next decade. For rural nursing homes that already operate on thin margins and depend heavily on Medicaid reimbursements, those cuts aren’t an abstraction. They’re an existential threat.
The same financial pressures building across the country — detailed in recent reporting on the long-term care affordability crisis — are hitting rural communities first and hardest, where there’s no safety net when a facility closes.
“A lot of middle-aged career earners have left the rural communities, leaving an aging population that still wants to live there, that wants to be cared for there,” Buck said. “For those who make that choice, it’s important that there be this vibrant network of long-term care facilities available.”
Whether that network survives the coming funding pressures may depend on whether lawmakers grasp what’s actually at stake — not just for residents, but for entire communities built around these facilities.
