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Survey: Just 1 in 4 Nursing Homes Confident They Can Survive Another Year

Pandemic Devastates An Already Struggling Industry

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Above image credit: An unidentified family member visits through the window with their loved one at Cross Creek. (Contributed)

Early in March 2020, Cross Creek assisted living and memory care center in Lee’s Summit closed its doors to the public. 

Executive Director Laura Benefiel’s goal was to protect her residents. The decision was made one week before the Kansas City leaders issued a citywide stay-at-home order.

Laura Benefiel is the executive director at Cross Creek assisted living and memory care center in Lee’s Summit. (Contributed)
Laura Benefiel is the executive director at Cross Creek assisted living and memory care center in Lee’s Summit. (Contributed)

Key cards to enter facilities were voided and FaceTime calls replaced in-person family visits. Inside the center’s glass-paned doors were older residents who were among the most vulnerable for complications from COVID-19 disease.  

“Honestly, we were pretty full, pretty much at max capacity before the pandemic,” Benefiel said. “We felt like we had no choice but to close down when we did and how long we did.”

Luckily, Cross Creek had zero cases of COVID among residents and the employees who did have it were quarantined immediately. But she knows of other Kansas City-area centers that had outbreaks. 

More recently, cases of COVID among nursing home residents and staff have been on the rise in Kansas and Missouri as the Delta variant has spread. The data are worrying, showing that in the last week of July cases of the virus more than doubled since this spring. For that reason, the AARP called for a vaccine mandate at nursing homes, according to the Kansas Reflector.

This has contributed to a sense of wariness among community members to visit or even bring their loved ones to live in a congregate setting these centers typically are. 

“Of those in the industry who were hit so hard … that’s just hard to come back from,” Benefiel said. 

Her anecdote aligns with a shocking statistic. Just 25% of assisted living communities and nursing home providers are confident they’ll remain open in a year, according to a recent American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) survey

Among the survey’s findings: 

  • About half of all nursing homes and assisted living centers are operating at a loss.
  • 49% of nursing homes and assisted living centers made cuts because they had increased costs and lost revenue. 
  • The top three costs facilities incurred were “additional pay for staff, hiring additional staff, and personal protective equipment (PPE).” 
  • 92% percent of nursing homes and 62% of assisted living facilities said the Provider Relief Fund has been helpful during COVID.
  • Medicaid fee-for-service has posed problems in covering the actual cost for more than half of nursing homes and more than one-third of assisted living communities.


Another analysis estimates that the nursing home industry will lose roughly $94 billion over the course of the pandemic, and more than 1,800 facilities could close their doors. Many facilities were operating under, what AHCA CEO Mark Parkinson called, “shoestring budgets.”  

Long-term care centers were already facing difficulty but the pandemic’s economic impact made things worse, according to the AHCA and NCAL.

As a director who oversees the ins and outs of operations, Benefiel said she certainly felt the weight of the financial and emotional burden these past 18 months. 

Cross Creek saw a loss in revenue, but, “because we’re assisted living, we’re in a different boat than nursing homes.” Plus, the federal CARES Act Provider Relief Fund kept its head above water. 

Assisted living centers are funded differently from nursing homes. 

Centers like Cross Creek accept private pay and earn revenue from federal programs, whereas nursing homes, which offer more intensive care, accept and rely on Medicaid to care for their lower-income seniors. 

According to a statement by the AHCA and NCAL: “Medicaid, which is the primary reimbursement source for residents in nursing homes, only covers about 70 to 80 percent of the actual cost of care. Meanwhile, nursing homes spent $30 billion on staffing and PPE in 2020 alone, and these COVID costs are expected to continue.” 

Assisted living centers, however, rely on a census count of how many folks live in a congregate setting to get appropriate funding. Once the numbers in the Census go down, the money goes down with it. 

“The main thing is we watch our expenses, so we will be fine,” Benefiel added.



Even though she has been in health care for more than 20 years – having worked in nursing homes for most of that time – the pandemic was nothing she or her staff had ever experienced. The toll it took is still felt to this day. 

They were the only ones the residents saw every day, which impacted both staff and the residents. 

This made it difficult for staff to maintain some protocol, she added. 

“Of course you wanted to remain socially distanced,” she said. “But we were all (the residents) had – trying to be that family for them when their family couldn’t be there.”

Many of the residents there need help managing their day-to-day lives, and some require even more support for degenerative diseases such as Alzheimer’s or dementia. 

The pandemic illuminated another gaping issue: staffing in health care. 

Demand on staff increased, as residents required more one-on-one care to make sure the virus didn’t spread. But applications were slim to none as folks were forced to navigate their own lives and prioritize their own safety while considering the health of the vulnerable residents.

The AHCA stated: “With staff members getting sick, having to isolate, or having a lack of childcare options, this exacerbated the workforce challenges providers were already facing.”

Benefiel saw it firsthand. 

“It’s been hard to find people who want to work,” she said. “We have definitely noticed an increase of no applicants at all … (and) we need good staff to take care of our folks.” 

Some days Cross Creek saw a trickle of applications and other days some candidates were no-shows for the interview. 

This is one of many fractures in the long-term care system that leaders at AHCA and NCAL tried to point to in their survey. The trends in the data show that senior care has never been properly supported. This was the case even before the pandemic.

“This isn’t about facilities buckling — it’s about public health officials and policymakers failing to properly prioritize and support long term care during this unprecedented crisis,” according to the AHCA/NCAL. 

“Without immediate aid, this could lead to thousands of long-term care facilities closing their doors, which would displace tens of thousands of vulnerable residents and limit access to critical services for our nation’s seniors.” 

On Aug. 11, Missouri Gov. Mike Parson announced a $30 million boost of funding to care for health care professionals and the system. Of that, $15 million would go toward acute care centers like the long-term care facilities that expect to close their doors within the next year. 

According to the announcement, “funding will be provided on a firm, fixed staffing rate and will not exceed the cap designated to each tier.

  • Tier 1: 0-25 licensed or CMS-certified beds – $50,000 cap;
  • Tier 2: 26-75 licensed or CMS-certified beds – $75,000 cap;
  • Tier 3: 76-200 licensed or CMS-certified beds – $100,000 cap;
  • Tier 4: 201-400 licensed or CMS-certified beds – $150,000 cap;
  • Tier 5: 401+ licensed or CMS-certified beds – $200,000 cap.”

Many nursing homes and other long-term facilities that take residents on Medicaid, an assistance program for low-income people, were hit the hardest. An added complicating factor is that Medicaid, according to the AHCA, has been historically underfunded. 

Poor funding impedes decent pay for those workers and hurts the families’ abilities to get the care necessary to care for their aging loved ones. 

Cross Creek did their best to keep their residents occupied during the pandemic with activities such as gardening. (Contributed)
Cross Creek officials did their best to keep their residents occupied during the pandemic with activities such as gardening. (Contributed)

Some advocates say this is why rather than go to nursing homes and assisted living centers, community-based programs can help. 

“The story of America and aging is that the default is a nursing home,” said James Stowe, director of the Mid-America Regional Council’s Aging and Adult Services. “We propose that the alternative narrative is – there are supports in the community where people want to live and remain.” 

Stowe added: “Nursing care and assisted care should only be institutionalized in the necessary cases.” 

However, in-home health options are at times difficult to access and pay for, which prompted the Center for Medicaid and Medicare Services (CMS) to push for more flexible payment options in September last year. The idea behind these ​​federal monies was to help folks transition from nursing centers and into community-based programs.

Ideally, folks should be at home where they are comfortable. This funding would help 33 states – including Missouri – take the steps necessary to make that a priority.

“Residential care will always be an essential part of the care continuum, but our goal must always be to give residents options that help keep our loved ones in their own homes and communities for as long as possible,” said Seema Verma, in a CMS news release last September, announcing federal monies for community-based programs. 

Stowe agrees. 

“In general we have observed that they … were in dire straits well before the pandemic and that has not become easier or better after the pandemic,” Stowe said. 

As an example, a facility that was previously a nursing home close to Cross Creek converted into a rehab facility. Their census numbers had plummeted and they tried to survive, somehow. 

Benefiel is now focused on safety and the mental well-being of her residents. After a year of no visits for her residents, reuniting families has been top of mind. 

“It behooved us to have our families here, inside our facilities,” she said, adding that her staff still minds protocol because of the Delta variant. 

One resident’s story gripped her in particular. A husband would visit his wife of 50-plus years at Cross Creek every day, have lunch and spend the afternoon with her. Then that all came to a halt. 

One year and a month had passed since they’d seen each other face-to-face. 

“She would get upset and mad and she’s like, ‘Where’s he at? I haven’t seen him’,” Benefiel recalled. 

“The first day he walked in, he was tearful. We all teared up, you know? It was a great moment.”

Vicky Diaz-Camacho covers community affairs for Kansas City PBS.

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