1,440 Nursing Homes Closed. In 29% of Cases, No Bed Nearby

The notice gives a family a few weeks. Somewhere in it is a line about transfer assistance, and then the real work starts: calling every facility within driving distance to learn which has a bed, which takes Medicaid, which has a locked memory-care wing, and which will say yes to a resident who gets up and wanders at two in the morning. For most families that search ends inside the same county. For a substantial minority, it does not end anywhere close — KFF Health News, reporting on rural closures in 2023, described residents relocated twice, waiting more than a month in hospital beds for placement, or moved as far as 60 miles from the town they had lived in.

A research letter published online in JAMA on June 17, 2026, by the health economist Andrew R. Olenski and the physician-researcher Rachel M. Werner attaches a national number to that minority. Working from two federal administrative files — the CMS Provider of Services file and Nursing Home Compare — the authors identified every US nursing home that stopped operating between 2016 and 2025. Then they asked the question a closure count never answers on its own: once the doors shut, was there anywhere left within 10 miles that could actually take the people inside?

Over the decade, 1,440 nursing homes closed. Another 849 opened, offsetting roughly half the losses and leaving a net decline of 591 facilities. The annual closure rate averaged about 0.9% of facilities before the pandemic and 1.1% from 2020 through 2025 — which is, on its own, a quietly surprising result. The pandemic did not produce a wave of closures so much as a slightly steeper version of the trend already running.

The access findings are where the letter earns its title. In 14.5% of closures, no nursing home at all remained within 10 miles. In a further 14.4%, facilities remained but lacked the room to absorb them: the authors summed excess beds — certified beds minus mean daily residents — across every facility inside the 10-mile radius and found the total insufficient to absorb the closing home's residents. Combined, about 29% of closures produced an access shortage by that definition. The burden fell unevenly. In rural communities across the Midwest and Great Plains, roughly 37% of closures created a shortage, against 22% everywhere else.

Closures also tilted toward the lowest-rated homes. One-star facilities accounted for 24.2% of closures while making up 17.1% of nursing homes nationally, and their share of closures grew over the period.

The letter opens on a policy fact: roughly $20 billion in federal relief flowed to nursing homes during the COVID-19 public health emergency between 2020 and 2023. It then reports the comparison that coverage of the study has leaned on hardest. Facilities that received an average of about $1 million in 2020 relief funding closed at a rate of 3.2% from 2021 through 2025. Facilities receiving below-median funding — around $113,000 — closed at 5.4%.

Read quickly, that looks like evidence that relief dollars kept homes open. Read carefully, it is close to unfalsifiable by design. Pandemic relief was allocated largely on facility revenue and bed counts, which means the $1 million group is, almost by construction, the larger, higher-revenue facilities — precisely the ones least likely to close in any five-year window, funded or not. The comparison is between big homes and small homes at least as much as between well-funded and thinly funded ones. Nothing in a descriptive letter can separate the two, and the authors, working in a format that runs about three journal pages, do not claim to.

The star-rating result invites a similar overreach. A 24.2% share of closures against a 17.1% base rate is a genuine skew, and it is worth knowing that the market is not pruning at random. But it also means roughly three-quarters of the homes that closed were not one-star facilities. The comforting story — that closures are the system shedding its worst performers — accounts for a minority of the losses.

The authors flag the sharpest limitation themselves: because licensed beds can exceed the beds a facility can practically staff, the findings may understate access shortages. A home certified for 90 beds that can safely staff 60 counts, in this analysis, as having 30 beds of slack it does not have. The industry's own trade association has pointed in the same direction, citing a separate JAMA Internal Medicine analysis finding that operating capacity fell about twice as fast as licensed beds between 2019 and 2024. Both suggest the 29% figure is a floor.

The 10-mile radius cuts in the other direction too. It is a straight line on an administrative map, not a travel time. In the Great Plains, 10 miles is a rounding error on a daily visit; in a dense metro, a facility nine miles away can be an hour each way for a spouse who no longer drives. And the offsetting 849 openings are a national count, not a local one. Nothing in the reported figures ties a new facility to a community that lost one.

What the study cannot do at all is explain why any of this happened. Closures get attributed, routinely and confidently, to staffing rules, thin occupancy, and Medicaid rates. This design tests none of those. It is worth noting that both authors also published in Health Affairs in March 2026, examining nearly 6,900 facilities across 22 states from 2010 to 2023, and found that state minimum-staffing mandates raised care hours without causing closures — added labor costs of about $273,000 per facility per year against roughly $546,000 in additional net revenue. The most popular causal story about closures is, in its policy form, the one their other paper does not support. What this letter contributes is narrower and harder to argue with: a decade-long map of where the beds went, and how often nothing took their place.

A study that counts things well, and a set of numbers that invite causal readings the design never tested. The durable finding here is the geography: about 29% of a decade's nursing home closures left no reachable bed behind, and in the rural Midwest and Great Plains that figure approached 37% — a distribution that a national net-loss number of 591 facilities completely hides. The relief-funding contrast, which trade coverage led with, is the weakest number in the letter and is easily misread as evidence the $20 billion worked; it should be read as a comparison of large facilities to small ones until someone tests it properly. And the closures-are-culling-bad-homes framing survives only if one ignores that three in four closed facilities were not one-star. For a family whose facility is on a watch list, the useful takeaway is not a cause but a probability: in most of the country the next nearest bed exists, and in rural stretches of the middle of the country there is roughly a one-in-three chance it does not.