Nursing homes are closing across the country, but some communities are hit harder than others

Nursing homes are shutting down across the country – but not in a uniform pattern that spreads the burden evenly across all sectors of society, according to a new report.

Researchers from Brown University in Providence, R.I., and Drexel University in Philadelphia examined government data on nursing home closures in the U.S. between 1999 and 2008. During that decade, 2,902 nursing homes went out of business, eliminating 184,264 beds. Though new facilities made 87,362 additional beds available in that period, the net loss of 96,902 amounted to a 5% reduction in total supply.

The closure rate was highest in the South, with 18% of nursing homes shutting down during that period. The West came in a close second, losing 17% of its nursing homes. Among individual states, Oklahoma took the biggest hit, losing 30% of its nursing homes. (At the other end of the spectrum, Wyoming and South Dakota each lost “only” 5%.) Among cities, Boston topped the list of most closures with 87 (amounting to 25% of all nursing homes in the area). Other hard-hit cities included the Los Angeles-Long Beach area (62 closures, or 14% of facilities) and Chicago (49 closures, or 13% of facilities).

Though closures occurred from coast to coast, there were clear patterns with respect to income, race and ethnicity. For instance, nursing homes in the 25% of ZIP codes with the highest poverty rate were twice as likely to go out of business as nursing homes located in the 25% of ZIP codes with the least poverty, the researchers found. Facilities in ZIP codes with the greatest proportion of African Americans were 38% more likely to shut down than those in ZIP codes with the fewest blacks, while facilities in ZIP codes with the highest concentration of Latinos were 37% more likely to close their doors than those in ZIP codes with the fewest Latinos.

“The hardest hit communities with multiple closures were often those with the greatest concentration of racial and ethnic minority populations and poverty,” the researchers concluded. “This phenomenon, arguably, resembles similar dynamics of inequalities in public schools, housing, environmental decline, and other sectors.

The analysis was published online Monday in Archives of Internal Medicine.

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