The U.S. faces a growing nursing-home capacity gap: the population aged 80 and older is projected to rise 45% over the next decade, while staffing shortages have led about half of nursing homes to limit new admissions, Weill Cornell's Mark Aaron Unruh says.
Unruh said the U.S. has about 14,500 nursing homes, roughly 900 fewer than a decade ago. Certified bed counts can overstate usable capacity: a home certified for 150 beds may be able to staff only 100. He estimated average certified nursing assistant pay at around $20 an hour and said turnover in those jobs can reach 100% a year or more at some facilities.
Unruh said Medicaid pays most long-term nursing-home care—about two-thirds of those care days—and its payments average only 80% to 85% of costs. He cited a projection that the Big Beautiful Bill Act would reduce Medicaid funding by about $1 trillion over the next decade. A shortage can shift care to families and keep patients in hospitals longer when no post-acute or long-term bed is available. Unruh identified visa pathways, training and employer accountability as possible ways to help address staffing shortages.
