Workforce gains offer hope, but declining bed capacity and rising demand signal a looming access crisis for skilled nursing and residential care.
By Jenna Hughes
Nursing facilities faced unprecedented financial challenges during the pandemic. The impacts of COVID-19 resulted in lower occupancy rates and revenue in nursing homes, higher operating costs and exacerbation of existing staffing shortages, according to the U.S. Department of Health and Human Services (HHS).
After historic job losses in recent years, the nursing workforce is now slowly recovering and stabilizing, according to the American Health Care Association/National Center for Assisted Living’s (AHCA/NCAL) 2026 Nursing Home Workforce Report. Ongoing access to long-term care, however, remains a growing concern as the nation’s aging population continues to grow.
“The aging population is growing rapidly, and demand for long-term care is expected to rise significantly in the coming years,” according to the AHCA/NCAL. “We need to support the entire continuum of care because each long-term care setting has a valuable role to play. The most cost-effective and life-affirming setting for a senior is the one best suited to their needs.”
Workforce shortages
Skilled nursing facilities (SNFs) are the primary provider of institutional post-acute care in the U.S., according to the JAMA study “Changes in US Skilled Nursing Facility Capacity Following the COVID-19 Pandemic.” SNFs provide transitional care, such as ongoing patient care after recovery from an illness, injury or surgery. SNFs often also include rehabilitative services for patients.
On the other hand, nursing home care, also known as long-term residential care, focuses on managing patient’s chronic conditions and providing ongoing daily living assistance such as with tasks like dressing, bathing or eating.
SNFs especially experienced historic workforce losses due to the COVID-19 pandemic and continue to struggle today with finding adequate numbers of qualified caregivers. Many facilities made the difficult decision to reduce the number of beds available during the pandemic in order to safely operate.
The number of licensed skilled nursing beds in the U.S. has, in fact, dropped since 2019, with estimated operating capacity based on maximum census counts having declined 5% by 2024, and many counties experiencing declines of 15% or more, per the JAMA study. The largest declines were more common among rural counties, and capacity declines were larger in counties with more frequent reports of SNF staffing shortages.
By 2028, the U.S. is projected to face a deficit of 100,000 health care workers, with the greatest gap among nursing assistants – caregivers who are often considered the backbone of long-term care.
When SNFs are forced to close or limit admissions due to caregiver shortages, the impacts are immeasurable on residents and their families – hospitals that experienced larger declines in nearby SNF capacity experienced greater increases in mean length of stay, percentage of stays lasting 28 or more days, and median distance traveled to admitting SNFs.
Areas with more significant declines in SNF capacity were also associated with longer hospital stays and increased travel distances to SNFs – which, according to the JAMA study, suggests that declines in operating capacity may be impairing patients’ access to care.
Moreover, Medicaid-only nursing facilities had higher closure rates than Medicare-only skilled-nursing facilities and dually certified nursing homes, per a National Institutes of Health (NIH) report.
“With residents primarily relying on Medicaid or Medicare for this care, this means those programs must be protected and fully funded,” said AHCA/NCAL. “Meanwhile, creating a more effective oversight system that promotes quality care and innovation while maintaining safety, accountability and transparency will ultimately improve care.” According to AHCA/NCAL, addressing the growing caregiver shortage is crucial to ensure seniors and those with disabilities are able to access long-term care.
Steady decline in turnover
During the pandemic, nursing homes offered the highest wage rate increase across all of health care to incentivize new and retain current employees.
Amid ongoing struggles, the nursing home workforce has continued to increase post-pandemic. According to the AHCA/NCAL report, the nursing home workforce gained more than 40,700 total workers in 2025.
Approximately 62% of providers, per the Nursing Home Workforce Report, say their overall workforce situation has gotten better in the past year, and nursing turnover rates have steadily declined since mid-2022, with nursing homes reducing total nursing and RN turnover by nearly 11%.
To recruit new employees and retain existing ones, nursing homes have implemented strategies including increased compensation, updated staff benefits packages, providing education and training opportunities, prioritizing employee well-being and enhancing staff’s work-life balance.
Moving forward
While nursing homes are indeed slowly recovering from the pandemic, a growing elderly population means access to care remains very much a concern.
While all other healthcare sectors have already gained additional jobs post-COVID, nursing homes are still largely rebounding from the pandemic. According to AHCA/NCAL, nursing homes still need 26,500 workers to return to pre-pandemic levels.
Intense competition from other care settings and private industries, many of which have more resources, continue to make recruitment to the nursing home profession challenging.
Nursing homes and skilled nursing facilities need prompt solutions, as according to AHCA/NCAL, in the next decade, the population of adults 80 and older is expected to increase by 8 million. The average age as of now is 79.
“Providers across the long-term care continuum have made considerable progress to enhance their workforce,” said the AHCA/NCAL. “But population projections suggest a real challenge with having enough caregivers throughout health care in the coming years. To meet this demand, long-term care providers require the support of lawmakers to ensure we have the people, policies, and payment needed to deliver the highest quality care.”
AHCA/NCAL has responded to this escalating challenge by launching policy solutions as an approach to the rising elderly population and declining caregiver numbers – aimed at caregiver recruitment and retention, training and career growth, technology and innovation and building the pipeline (investing in nursing schools and nursing facilities) and streamlining legal pathways for international caregivers.
“Our ‘Caregivers for Tomorrow’ policy roadmap calls on federal and state policymakers to invest in the caregiver pipeline, recruitment efforts and career development to support strengthening the strong long term care workforce and access to care for residents,” said AHCA/NCAL.
AHCA/NCAL also promotes ‘The Better Way,’ a policy roadmap to help transform care for older adults and individuals with disabilities, prioritizing the strengthening of the long-term care workforce, protecting Medicaid, reaffirming the promise of Medicare Advantage and rationalizing the regulatory environment.
“With the significant growth of the senior population, providers are committed to meet the demand for care while providing healthcare solutions that improve outcomes for seniors and individuals with disabilities,” said the AHCA/NCAL. “We look forward to working with policymakers to meet this critical moment.”
Key Takeaways
- Skilled nursing facilities continue to struggle with staffing shortages and reduced capacity following the pandemic, limiting access to long-term and post-acute care in many communities.
- The nursing home workforce is gradually recovering, with facilities adding workers and lowering turnover rates through higher pay, better benefits and employee support initiatives.
- As the U.S. senior population rapidly grows, industry leaders are calling for increased policy and funding support to strengthen the long-term care workforce and protect access to care.