A major new study has revealed that the apparent disappearance of US nursing homes often does not mean that facilities have permanently exited the market. Instead, many “closures” are part of a more complicated cycle of ownership transfers, organizational restructuring, and changes in the number of beds operated within the same physical location. The findings, published in JAMA Health Forum, offer the most extensive long-term examination to date of how nursing home facilities enter, leave, and transform across the United States.
Researchers analyzed the operational histories of 33,110 nursing home locations over four decades, from 1985 through 2025. By following individual locations over time rather than counting facilities only at particular moments, the study was able to distinguish between several forms of change that are often combined under the single label of “closure.” This approach is important because a nursing home may stop operating under one owner while continuing to provide care under another, or it may reduce or reorganize its capacity without disappearing entirely.
Nearly half of the facilities followed what the researchers describe as simple entry-exit patterns. These locations opened, operated, and eventually ceased operation without evidence of a more complex transition. Such patterns are consistent with conventional definitions of market entry and exit, in which a new facility begins serving residents and later closes permanently. However, this straightforward pathway represented only part of the broader transformation occurring across the nursing home sector.
Approximately one-fifth of the nursing home locations remained operational even after changing ownership. In these cases, the organizational identity behind the facility changed, but the location continued functioning as a nursing home. A change of ownership can involve the sale of a facility to another company, a transition between nonprofit and for-profit operators, or a restructuring involving corporate subsidiaries and management organizations. For residents, families, workers, and regulators, these changes may be as consequential as a physical closure because they can alter staffing policies, financial priorities, services, and accountability.
The study also identified changes in capacity within facilities as a significant form of operational reconfiguration. A location may continue operating while adding or eliminating beds, changing the scale of its services, or reorganizing how space is used. These adjustments can affect local access to long-term care even when the facility remains visible in official records. A nursing home that reduces its licensed capacity may effectively remove care availability from a community without meeting the formal definition of a closure, while an expansion can increase capacity without creating a new location.
According to the researchers, organizational restructuring became more common over time and was more prevalent than permanent facility closure or true market exit. This trend suggests that the nursing home industry has been adapting through internal and ownership-related changes rather than simply shrinking through the disappearance of facilities. Economic pressures, changing demand, reimbursement conditions, labor costs, regulation, and consolidation may all contribute to these transformations, although the study’s central focus was to document the operational patterns rather than assign a single cause to each transition.
The technical significance of the work lies in its longitudinal cohort design. Instead of treating nursing homes as static entities, the researchers constructed facility histories across 40 years, allowing them to classify operational trajectories. This type of analysis can reveal whether a facility that appears to have closed has actually been replaced, renamed, transferred, or reorganized. It also helps separate a genuine loss of care infrastructure from an administrative change that leaves the physical location active. Such distinctions are essential for measuring the supply of long-term care accurately.
The findings challenge how policymakers and researchers interpret nursing home closures. Traditional monitoring systems may overestimate permanent market exit if they count ownership transitions as closures or fail to link records from the same physical location across time. At the same time, focusing only on whether a building remains open may underestimate the effects of capacity reductions or major organizational changes. A facility can remain operational while offering fewer beds, changing its ownership structure, or altering the services available to residents.
The researchers argue that nursing home policy and oversight should incorporate ownership transitions and capacity changes alongside conventional closure measures. Regulators may need to track not only which facilities are open, but also who controls them, how their licensed capacity changes, and whether residents experience continuity or disruption during transitions. For communities confronting the loss of long-term care access, this distinction could determine whether a local nursing home has truly vanished or has been transformed into something operating under a new name, ownership structure, or capacity level.
By showing that nursing home change is often organizational rather than purely geographic, the study provides a new framework for understanding one of the most closely watched sectors in US health care. The results suggest that the future of nursing home access cannot be assessed by counting closures alone. A more complete picture must follow the full life cycle of each location, including entry, ownership change, capacity reconfiguration, continued operation, and permanent exit.
Subject of Research: Long-term trends in US nursing home closures, ownership transitions, capacity changes, and operational restructuring.
Web References: https://doi.org/10.1001/jamahealthforum.2026.2492
References: Chung J, et al. Cohort study of 33,110 US nursing home locations, 1985–2025. JAMA Health Forum. DOI: 10.1001/jamahealthforum.2026.2492.
Keywords: Nursing homes; United States; health care facilities; facility closures; ownership transitions; organizational restructuring; capacity changes; long-term care; cohort study; health policy.
