Nursing Homes at a Glance
Factor | Details |
|---|---|
Statistics | |
Number of certified nursing homes | About 15,300 in 2020* |
Number of beds | About 1.6 million in 2020* |
Number of residents | About 1.3 million in 2020* |
Residents (Patients) | |
Requirements for Medicare coverage | Must need daily skilled nursing care or daily rehabilitation therapy Must be admitted to the nursing home or rehabilitation service within 30 days after a minimum 3-day hospital stay (waiver of 3-day hospital stay available in some cases, including with some Medicare Advantage plans) |
Risk factors for nursing home placement | Older age Living alone Inability to care for self Immobility Impaired mental status (eg, dementia) Incontinence Lack of social or informal support Poverty Female sex |
Potential benefits for residents | Increased structure Opportunities for socialization Nutritional encouragement Exercise and activities Access to nursing care Help with adherence to the drug regimen |
Potential problems for residents | Inability to leave the facility Infrequent visitors Complaints that may not be believed or taken seriously because residents are ill or old Abuse, which may be subtle (eg, using medications and physical restraints inappropriately to manage disruptive behavior) or not subtle (eg, pinching, slapping, yanking) Decline in functional ability‡ Undernutrition and weight loss‡ Pressure injuries† Incontinence‡ Constipation‡ Infections‡ Depression‡ Polypharmacy‡ |
Facility | |
Requirements for Medicare reimbursement | A registered nurse on site 8 hours/day, 7 days/week Either a registered nurse or licensed vocational nurse/licensed practical nurse 24 hours/day, 7 days/week Certified nursing assistants sufficient to provide care for residents 24 hours/day, 7 days/week A full-time social worker if the facility has > 120 beds A medical director and licensed nursing home administrator A qualified recreational therapist to provide recreational programs A rehabilitative therapist A dietitian Physicians, pharmacists, dentists, and pastoral services to be available as needed, but not required on site NOTE: In 2024, the Centers for Medicare & Medicaid Services (CMS) published the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule to implement a minimum staffing requirement for nursing homes in the United States. The timeline for implementation of these requirements tracks from the Final Rule publication date (May 10, 2024) and will be staggered over a 3-year period for all non-rural facilities. |
Possible additional services | Medical specialty services (eg, ophthalmologic, otolaryngologic, neurologic, psychiatric, psychologic), which may require transport of patients to other facilities IV therapy Enteral nutrition through feeding tubes Long-term oxygen treatment or ventilator support Special care units (eg, for patients with Alzheimer disease or cancer)§ Scheduled recreational events for groups Choices of leisure-time activities for patients, especially those who are cognitively impaired or bedbound Personal services (eg, hairdressing, makeup), usually paid for by the patient's personal funds |
* Centers for Disease Control and Prevention (CDC): FastStats: Nursing Home Care. Accessed May 2024. | |
† LongTermCare.gov: Costs of Care. Accessed June 2024. | |
‡ These problems, which commonly develop or worsen among nursing home residents, can sometimes be prevented with attentive care. | |
§ Special care units must specify programs and admissions criteria, train staff specifically for the unit, meet regulations and reimbursement requirements, and have an identifiable area or discrete physical space. | |