A Resident’s View: The Current State of the Nursing Home Industry in the United States

The nursing home industry in the United States has become increasingly complex and challenging, with private equity investments, concerns about quality of care, and a range of issues related to staffing, funding, and training. As a resident or patient in a nursing home, these issues can significantly impact one’s quality of life and well-being. This article examines the current state of the nursing home industry from a resident’s perspective, highlighting the prevalence of bedsores, falls, infections, and other serious injuries, as well as the underlying factors that contribute to these problems.

Private Equity in the Nursing Home Industry

In recent years, private equity firms have become significant players in the nursing home industry, acquiring facilities across the country. According to a study published in JAMA Network Open, between 2000 and 2017, private equity firms acquired over 1,700 nursing homes, which accounted for 11% of all nursing homes in the United States. Private equity investments in the sector reached an all-time high in 2017, with a total transaction value of $5.3 billion.

While private equity investments can bring new resources and management expertise to nursing homes, there are concerns about their profit-driven approach. A study published in the National Bureau of Economic Research found that nursing homes acquired by private equity firms saw a 10% increase in operating margins, but these gains were not necessarily accompanied by improvements in quality of care. In some cases, nursing homes operated by private equity firms experienced higher patient mortality rates and lower staffing levels.

Prevalence of Bedsores, Falls, Infections, and Other Serious Injuries

The quality of care in nursing homes is a critical concern for residents and their families. Bedsores, falls, infections, and other serious injuries can have severe consequences, leading to hospitalization, long-term health problems, or even death. According to the Centers for Disease Control and Prevention (CDC), approximately 1.4 million Americans reside in nursing homes, and many of these residents are at risk for these complications:

  1. Bedsores: Also known as pressure ulcers, bedsores are a common problem in nursing homes. The National Pressure Ulcer Advisory Panel estimates that between 2% and 28% of nursing home residents have bedsores, with a median prevalence rate of 10%.
  2. Falls: Falls are a leading cause of injury and death among older adults in the United States. The CDC reports that each year, about half of all nursing home residents experience a fall, with 10% to 20% of these falls resulting in serious injuries.
  3. Infections: Infections are a significant concern in nursing homes, as residents often have weakened immune systems and are more susceptible to infections. The CDC estimates that between 1.6 and 3.8 million infections occur in nursing home residents annually, with urinary tract infections, respiratory infections, and skin infections being the most common types.

Staff Turnover, Understaffing, Underfunding, and Under-Training

Many factors contribute to the prevalence of bedsores, falls, infections, and other serious injuries in nursing homes. Among these factors, staff turnover, understaffing, underfunding, and under-training are particularly notable: 

  1. Staff turnover: High staff turnover is a significant issue in the nursing home industry, with an annual turnover rate of approximately 50% for Certified Nursing Assistants (CNAs) and 36% for Registered Nurses (RNs), according to a study published in Health Affairs. High turnover rates can lead to a lack of continuity in care and lower quality of care fro residents.
  2. Understaffing: Adequate staffing levels are crucial for ensuring the quality of care in nursing homes. According to a study published in Health Services Research, facilities with higher staffing levels had lower rates of bedsores, falls, and hospitalizations. Despite this, many nursing homes in the United States are understaffed. A report by Kaiser Health News found that 70% of nursing homes self-reported that they had fewer nurses and direct care staff than the Centers for Medicare and Medicaid Services (CMS) determined were necessary for adequate care.
  3. Underfunding: Insufficient funding is another challenge facing the nursing home industry. Many facilities rely heavily on reimbursements from Medicare and Medicaid, which may not always cover the full cost of care. A report by the American Health Care Association found that in 2019, Medicaid reimbursement rates were, on average, $29 per day less than the cost of providing care, resulting in a total funding shortfall of $7.7 billion. This underfunding can lead to cost- cutting measures that negatively impact staffing levels, staff training, and overall quality of care.
  4. Under-training: Proper training and education for nursing home staff are crucial for ensuring that residents receive high-quality care. However, many nursing homes struggle to provide adequate training for their employees, particularly in the face of high staff turnover and tight budgets. A study published in Geriatric Nursing found that only 57% of nursing homes provided ongoing in-service training for CNAs, with the majority of training focused on basic care skills rather than specialized topics such as dementia care or fall prevention.

Where Does the Nursing Home Industry Go from Here?

The nursing home industry in the United States faces numerous challenges, with private equity investments, staffing issues, and funding constraints shaping the experiences of residents and patients. As a result, many nursing home residents are at risk for bedsores, falls, infections, and other serious injuries. To address these issues and improve the quality of care in nursing homes, it is crucial to examine the underlying factors contributing to these problems, such as staff turnover, understaffing, underfunding, and under-training. By addressing these issues, we can work towards creating a nursing home environment that prioritizes the well-being and safety of its residents.

Schedule a Free Consultation