Survey: Only one quarter of nursing homes confident surviving one year

Majority of nursing homes, nearly half of assisted living communities operating at a loss

WASHINGTON – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes, assisted living communities, and other long term care facilities across the country, announced the release of a recent survey of providers across the U.S. Results from the survey showcase the urgent need to address the economic crisis facing the profession. 

Key findings include:

  • Only a quarter of nursing homes and assisted living communities are confident they can last a year or more. 
  • More than half of nursing homes and nearly half of assisted living communities say their organization is operating at a loss. 
  • Nearly half of nursing homes and assisted living communities have had to make cuts in 2021 due to increased expenses or lost revenue. 
  • The top three costs facilities have incurred due to COVID-19, regardless of whether they have had cases or not, are additional pay for staff, hiring additional staff and personal protective equipment (PPE). 
  • In 2021, 84% of nursing homes said they are losing revenue due to fewer post-acute patients coming from the hospital. 
  • Ninety-two percent of nursing homes and 62% of assisted living facilities said the Provider Relief Fund has been helpful during COVID. 
  • More than half of nursing homes and more than one-third of assisted living communities say that Medicaid fee-for-service is problematic in covering the actual cost to provide care to residents. Of those, more than one-quarter of both providers qualify it is a serious problem. 

“Even though COVID cases in long term care are at historic lows, providers are struggling to recover from the economic crisis the pandemic has induced. Too many facilities are operating under shoestring budgets simply because policymakers have failed to dedicate the proper resources, and this can have devastating consequences,” said Mark Parkinson, president and CEO of AHCA/NCAL. 

An analysis by AHCA/NCAL earlier this year estimated that the nursing home industry is expected to lose $94 billion over the course of the pandemic, and more than 1,800 facilities could close their doors. Closures are hard on vulnerable residents who are forced to move, their family members who must often travel farther to see their loved ones, and dedicated caregivers who are out of a job. 

“Lawmakers and public officials across the country must prioritize the residents and caregivers in our nursing homes and assisted living communities,” continued Parkinson. “This starts by sending immediate resources through what remains of the Provider Relief Fund, and it continues by finally addressing the chronic underfunding of Medicaid, which only covers 70 to 80% of nursing home care. We have laid out key proposals in our Care For Our Seniors Act to transform America’s nursing homes, but without the help from Congress and state legislators, these necessary reforms will not be possible.”

“We look forward to working with federal and state governments to ensure the stability of our care economy, so that every provider has the ability to deliver the highest quality of care. From being able to have an adequate supply of PPE to compensating caregivers for their heroic work, long term care facilities need financial assistance from lawmakers to keep serving our vulnerable residents,” concluded Parkinson.

Link to a pdf version of a one page executive summary of the results can be found HERE.


The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit or

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