Nursing Homes In The United States
U.S. nursing homes housed more than 1.2 million patients in 2024 and incurred spending of $193 billion in 2022, which is equivalent to one-seventh of the national expenditures on the hospital sector and 4 percent of national medical spending. As baby boomers continue to age, spending on nursing home care and the number of nursing home residents are expected to grow sizably.
Nursing home residents include both short-stay patients receiving post-acute rehabilitative therapy and long-stay patients requiring assistance with daily living activities. In the U.S., nursing homes are mostly operated by private entities but largely financed by the government through Medicare and Medicaid: only six percent of nursing homes are government-owned, yet Medicare and Medicaid are the primary payers for three-quarters of nursing home residents. Most short-stay nursing home patients receive coverage from Medicare, while long-stay patients largely rely on Medicaid.
In its paper published in July 2025 entitled “GOVERNMENT MONITORING OF HEALTH CARE QUALITY: EVIDENCE FROM THE NURSING HOME SECTOR,” the NBER concludes: “Using data on nursing homes across the US, we find that nursing homes exhibit strategic responses to the inspection. Nursing homes increase the quantity and quality of labor inputs, reduce admissions, increase temporary discharges, and improve patient care in response to the inspection. However, nearly all responses described above drop immediately once the inspection is completed. While inspection rating is unlikely to reflect nursing homes’ absolute quality given the strategic responses, using a quasi-experimental research design we find that inspection rating predicts nursing homes’ relative quality.”
“[W]e find clear evidence of increased quantities of labor inputs. Nursing homes significantly increase the work hours of nurses and nurse assistants, the main nursing home staff, in response to health inspections. On the day of peak response, the work hours of nurses and nurse assistants rise by 10.2 and 6.6 hours on average, respectively. These effect sizes are 26 percent and 38 percent of the differences in nurse and nurse assistant hours between weekdays and weekends, respectively. We also find similar increases in the work hours of every other leading type of staff observed, including physical therapists, occupational therapists, social workers, activities professionals, administrators, physical therapy assistants, occupational therapy assistants, dietitians, feeding assistants, and speech/language pathologists.”
“The share of nursing staff hours provided by nurses (higher-skilled) as opposed to nurse assistants (lower-skilled) and the share of nurse hours provided by registered nurses (RNs, higher credential) as opposed to licensed practical nurses (LPNs, lower credential) both increase in response to the inspection.”
“[W]e find that nursing homes exhibit declined admissions in response to health inspections. On the peak day, admissions decline by 10 percent.”
“[W]e find a significant increase in temporary discharges, i.e., the number of patients who are discharged but return to a nursing home within two weeks, in response to health inspections. On the peak day, temporary discharges increase by four percent. Decomposition shows that the increased temporary discharges are nearly all driven by patients returning to their original nursing homes (rather than to other facilities) and that the original nursing homes largely hold these patients in hospitals before readmitting them. Both declined admissions and increased temporary discharges can raise staff-to-patient ratios.”
“[W]e find suggestive evidence that nursing homes improve the quality of resident care in response to health inspections as measured by residents’ influenza and pneumococca vaccination rates. We also find slight declines in the use of chemical restraints (antipsychotics), though the estimates are less precise.”
“However, nearly all responses described above drop immediately once the inspection is completed … The strategic responses suggest that the quality rating from health inspections is unlikely to reflect nursing homes’ absolute quality compared to their typical levels, a finding highly relevant to a range of important nursing home regulations that rely on facilities’ absolute quality assessments, including enforcing compliance with quality standards and certification that regulates nursing homes’ eligibility to admit Medicare and Medicaid patients.”
If you or a loved one may have been injured (or worse) as a result of malpractice in a nursing home in the United States due to nursing home staff shortage, nursing home understaffing, nursing home pressure ulcer (nursing home bedsore) negligence, a nursing home infection, nursing home fall, nursing home aspiration, nursing home neglect, nursing home negligence, nursing home abuse, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home malpractice lawyer who may investigate your nursing home malpractice claim for you and represent you or your loved one in a nursing home malpractice case, if appropriate.
Click here to visit our website or call us toll-free in the United States at 800-295-3959 to find nursing home malpractice attorneys in your state who may assist you with your nursing home claim.
Turn to us when you don’t know where to turn.
