The Nursing Home ‘Closure Crisis’ That Never Came: What a New JAMA Study Reveals

Philadelphia, Pennsylvania — When COVID-19 slammed into America’s nursing homes, industry groups issued dire warnings. Falling occupancy and worker shortages would force hundreds of facilities to close, they predicted, leaving seniors without care and families scrambling for alternatives.

It never happened.

New research published in JAMA and conducted by experts at the University of Pennsylvania’s Leonard Davis Institute of Health Economics tells a different story. Nursing home closures held steady during the pandemic years, defying predictions of a mass exodus from the sector.

But here’s the catch: while the overall numbers stayed flat, the pain didn’t distribute evenly.

The Rural Access Crisis

Researchers Rachel Werner and Andrew Olenski analyzed data from CMS Provider of Services and Nursing Home Compare, identifying 1,440 nursing home closures between 2016 and 2025. The closure rate barely budged — averaging 0.9% annually from 2016 to 2019 and 1.1% from 2020 to 2025.

Federal provider relief funds likely helped keep facilities afloat during the worst of the pandemic. Yet nearly 29% of closures created genuine access shortages — leaving communities without a nursing home within 10 miles or placing displaced residents in facilities that lacked capacity to absorb them.

The geographic disparities are stark. Access shortages concentrated heavily in rural communities across the Midwest and Great Plains, where facility closures have been reshaping long-term care access for decades.

What This Means for Policymakers

The findings carry clear implications for federal and state officials. Targeted interventions — enhanced payments and workforce supports specifically for rural facilities — could help ensure geographically isolated communities maintain both financial viability and quality care.

The research also challenges assumptions about what drives closures. While financial stress matters, the data suggests that targeted support during crisis periods can prevent facility exits that would otherwise strand vulnerable populations.

For families in rural America, the study confirms a reality they’ve long experienced: the nursing home down the road might not be there tomorrow, and the next option could be an hour’s drive away.