As America's population ages, one healthcare challenge is becoming impossible to ignore: the growing demand for nursing home care. With the oldest Baby Boomers now reaching their 80s, more older adults will require long-term care for dementia, chronic illnesses, and assistance with daily living. Unfortunately, the nursing home system isn't expanding to meet those needs, it's shrinking.
A recent perspective from researchers at Weill Cornell Medicine warns that the United States is heading toward a significant long-term care crisis unless policymakers, healthcare organizations, and providers begin thinking differently about how nursing home care is funded, staffed, and delivered.
The Demand for Long-Term Care Is Rising
Today, more than one million Americans live in nursing homes, but that number is expected to grow dramatically over the next decade. Researchers estimate that the population of adults aged 80 and older will increase by more than 45% by 2036, creating unprecedented demand for skilled nursing services. At the same time, nearly 10% of U.S. nursing homes closed between 2011 and 2021, leaving fewer facilities available to care for a growing number of older adults.
This growing imbalance means many families may struggle to find appropriate long-term care when they need it most.
The Workforce Shortage Is More Than a Staffing Problem
While discussions about nursing homes often focus on the number of available beds, the real issue is the people needed to care for residents.
A facility may technically have licensed beds available, but without enough registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs), those beds cannot safely be occupied. Staffing shortages directly limit access to care, increase workloads for existing staff, and contribute to burnout across the workforce.
For nurses working in long-term care, this reality is already familiar. Many have experienced:
- Higher patient assignments
- Difficulty recruiting and retaining staff
- Increased overtime
- Emotional exhaustion
- Challenges providing the level of individualized care residents deserve
Dementia Care Will Drive Much of the Need
People living with dementia make up a large percentage of nursing home residents, and that number will continue to rise as the population ages.
The researchers emphasize that improving access to quality dementia care should be a national priority. Without adequate nursing home capacity, hospitals may experience longer stays for patients awaiting placement, while families face increasing caregiver responsibilities at home.
Five Strategies That Could Help
Rather than simply calling for more funding, the researchers propose several practical approaches to strengthen long-term care.
1. Invest in the Workforce
Competitive wages, career advancement opportunities, and ongoing education can improve recruitment and retention for nurses, nursing assistants, and other direct care professionals.
2. Modernize Payment Models
Current Medicare and Medicaid reimbursement structures often make it difficult for nursing homes, particularly those serving large Medicaid populations, to remain financially stable. Updating payment models could encourage facilities to invest more in staffing and resident care.
3. Support Rural Nursing Homes
When rural nursing homes close, families may have to travel long distances to visit loved ones, and hospitals can struggle to discharge patients who need long-term placement. Stabilizing these facilities is essential for maintaining access to care in underserved communities.
4. Strengthen Hospital–Nursing Home Partnerships
Cross-training staff, sharing workforce resources, and improving communication between hospitals and long-term care facilities can help create smoother transitions for patients while improving staffing flexibility.
5. Expand Access for People Living With Dementia
Policies that improve funding and coordination for dementia care can help ensure patients receive appropriate services earlier and reduce unnecessary hospitalizations.
What This Means for Nurses
Nurses are central to the future of long-term care.
Whether you work in acute care, rehabilitation, home health, or skilled nursing, you'll likely care for more older adults with increasingly complex needs throughout your career.
Beyond bedside care, nurses can help drive change by:
- Advocating for policies that strengthen the long-term care workforce
- Mentoring new nurses interested in geriatric care
- Supporting quality improvement initiatives
- Participating in interdisciplinary care planning
- Educating families about long-term care options
As demand continues to grow, nursing expertise will be critical in shaping a healthcare system that can provide safe, compassionate, and sustainable care for older adults.
Looking Ahead
America's nursing home challenges cannot be solved overnight. However, addressing workforce shortages, improving reimbursement models, strengthening partnerships, and investing in caregivers can help prepare the healthcare system for the future.
For nurses, this issue extends far beyond nursing homes. It affects hospital capacity, care transitions, patient outcomes, family caregivers, and the overall health of our aging population.
The decisions made today will influence how millions of older adults receive care for decades to come, and nurses will play an essential role every step of the way.