The Alleged Death Spiral Continues
Since 2020:
774 nursing homes closed
62,567 beds gone
46% of facilities limiting admissions
57% have waiting lists (This seems odd, how many facilities do you personally know so stacked with census they literally have a waiting list?)
Only 7 new facilities opened in 2024 in the entire country (?!)
The solution? ACHA recommends more nursing homes. Shocker. Look, this is a bit like chicken farmers telling you how much the world needs chickens. Of course the industry association says we need more nursing homes and less oversight. That's literally their job.
But Here's the Thing: The numbers don't lie. When 36% of closures were 4-5 star facilities and 31% were nonprofits, it's not just about "bad operators." Even good facilities with -19% margins can't survive on government goodwill and Medicare math.
The Real Story: While AHCA cries crisis, some of you are still making money hand over fist. The difference? You figured out the economics work in certain markets with the right operational focus. The weak players are getting eliminated, which honestly maybe isn't the worst thing though I do feel for them. Eating millions in losses is painful indeed.
Bottom Line: Yes, access is shrinking. Yes, that's bad for families needing care. But maybe the solution isn't propping up failing business models - maybe it's letting the operators who actually understand the business expand into those markets or having some federal oversight ensuring states are toeing a somewhat reasonable line in reimbursing facilities. Otherwise healthcare for the elderly collapses.
MILESTONE CELEBRATION
I just want to take a moment to thank all of you. The reception has been tremendous—we've hit 1,000 subscribers! That means a thousand of you have received a PDF from a friend, found my email at the bottom of a page somewhere, or personally reached out asking to be added to the list.
Thank you!
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