Nursing home bed availability is declining sharply across New York and the United States, raising concerns about capacity to meet the needs of an aging population. In New York City’s South Bronx, the San Vicente de Paul Nursing Home, operated by the nonprofit ArchCare, has not admitted a new patient since December 2024. ArchCare has already reduced the home’s capacity from 120 to 53 beds with plans for further cuts. Similar reductions have occurred at its Staten Island facility, which closed an entire floor, and at Ferncliff Nursing Home in Dutchess County, which shrank from 309 to 196 beds. Overall, ArchCare’s eight nursing homes have 269 fewer usable beds than 18 months ago, representing nearly a 12 percent decrease.
The trend reflects a broader statewide and national pattern. Since 2020, 24 nursing homes have closed in New York State, removing more than 3,000 licensed beds, according to LeadingAge New York, a nonprofit that represents senior living organizations. Nationally, the number of certified nursing facilities declined by over 900 between 2015 and 2025, from 16,648 to approximately 15,700.
The timing is significant as the nation’s oldest baby boomers reach age 80, a milestone associated with increased need for long-term care. Experts warn that the shrinking supply of nursing home beds could worsen as demand rises. David Grabowski, a health policy researcher at Harvard Medical School, highlighted the problem in a recent study showing a 5 percent drop in nursing home capacity nationwide from 2019 to 2024, cautioning that the trend “is only going to get worse,” particularly in light of recent immigration policy changes and Medicaid financing challenges.
Industry representatives attribute the decline largely to chronic underfunding from Medicaid, which covers most nursing home care but often reimburses below the actual cost of services. ArchCare’s Chief Operating Officer, Jason Hutchens, described recent financial losses as unsustainable, forcing difficult decisions to curtail bed availability. Nursing homes have increasingly focused on attracting short-term patients covered by Medicare, which offers higher reimbursement rates, but filling beds remains challenging unless operators are highly efficient or willing to take significant financial risks.
Staffing shortages compound these financial pressures. Nursing aides endure demanding work conditions paired with comparatively low wages—around $20.67 per hour last year—and high turnover rates. Nearly 40 percent rely on public assistance. While the workforce has begun to recover since the COVID-19 pandemic, employment levels remain below 2015 figures. Staffing difficulties are particularly acute in rural areas, where smaller labor pools and longer commutes exacerbate recruitment and retention.
Although overall nursing home occupancy has rebounded to approximately 80 percent, this figure can mask restricted access. Licensed beds differ from operating beds—the latter reflecting actual capacity constrained by staffing and other issues. In 2024, nearly half of nursing homes nationwide limited new admissions, and 57 percent reported waiting lists. The resulting bottlenecks extend to hospitals, where patients may face longer stays post-discharge due to inadequate availability of nursing home placements.
Quality concerns also influence patient and family decisions. According to a 2023 analysis, 27 percent of nursing homes received at least one serious violation related to resident harm or risk. Many older adults and families prefer alternatives such as assisted living or home- and community-based services (HCBS), which have expanded significantly over recent decades. Medicaid’s spending on HCBS increased from 10 percent in 1988 to over 60 percent by 2020, reflecting a broader policy shift toward “rebalancing” away from institutional care.
Looking ahead, the impact of federal policies remains uncertain. Revocation of legal status for certain immigrant groups has heightened staffing shortages in some areas, including Florida, New York, and Massachusetts, although nationwide effects have not yet been pronounced. Proposed Medicaid funding cuts totaling more than $900 billion over the next decade may further strain long-term care systems. While home-based services are expected to bear the initial reductions, advocates warn this could drive more patients into nursing homes, increasing pressure on already reduced capacity.
Researchers, industry leaders, and advocates are calling for improved data systems, targeted financial support, and immigration policies that facilitate hiring of essential caregivers. However, many factors remain uncertain, and stakeholders await clarity on regulatory and market responses as they confront the complex challenges of meeting the needs of a rapidly aging population.