The Decline of Nursing Homes Statewide

 

Older Minnesotans, especially those in small towns and rural areas, are facing a critical shortage of skilled nursing facilities — the nursing homes that serve people who require assistance with daily living tasks like dressing and bathing, or shorter-term needs such as rehabilitation after surgery or a fall.

According to a report issued in November by the Mankato-based Center for Rural Policy and Development, the statistics are grim:

• As of this past February, Minnesota overall had 33 percent fewer nursing-home beds than it did in 2005.
• The demand for skilled nursing beds throughout Minnesota will soar by 45 percent between now and 2045.
• Rural counties will experience that demand “significantly sooner,” between 2035 and 2040. Entirely urban counties — such as Hennepin and Ramsey — will not face peak demand for nursing home beds until 2050.
• The most severe drop in the number of skilled-nursing beds since 2005, at 41.7 percent, has been in “entirely rural” counties — such as Faribault County to the south, Traverse County to the east, and Kittson County in the northeast corner of Minnesota. That compares with a nearly 29 percent drop in urban counties.

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Not every aging adult requires a nursing home. But other types of senior housing or housing assistance — from in-home help that allows seniors to “age in place” to amenity-rich “assisted living” facilities — are becoming harder to find as well, according to Kelly Asche, author of the report. Again, that is especially true in Greater Minnesota.

“We are hearing frequently from rural leaders and residents that access to home care is becoming difficult, assisted living may be too expensive if it even exists in a rural area, and that nursing facilities are either shrinking the number of beds they have available or closing completely,” says Asche, senior researcher at the Center for Rural Policy and Development. 

A webinar hosted in November by the center and the Citizens League focused on the lack of acute-care housing for seniors throughout the state. Panelists representing LeadingAge Minnesota, the Minnesota Department of Human Services (MHS), the Minnesota Home Care Association, and two healthcare providers explained that the reasons can be traced to both demographics and economics — in the form of a growing worker shortage, often due to low wages.

“We are an aging state. We’re getting older faster, especially in rural Minnesota,” said Erin Huppert, vice president of advocacy at LeadingAge Minnesota, a network of organizations that serves older adults. Arguing for elected leaders to “reframe the state’s priorities,” she said LeadingAge Minnesota will continue pressing the 2025 state Legislature, as it has in two previous sessions, to mandate wage increases for home-health workers.

The perception of nursing homes as difficult, depressing places exacerbates the worker shortage in this sector of the senior-housing industry, panelists explained. “Ask a new RN where they want to work. You’ll hear pediatric, emergency, a shinier object,” said Jason Anderson, director of long-term care services at Sanford Canby Medical Center in Canby.

His organization had an RN position open and available in a Canby-area nursing home “for 450 days,” he said.

 

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Demographics and Economics

The sheer size of the Baby Boom, defined as people born between 1946 and 1964, is at the heart of the issue, said Kim Brenne, interim director of nursing facility rates and policy at DHS. 

“We have a math problem,” she explained. “People are living longer than ever. But the workforce we’re relying on for care is shrinking. There are probably enough beds, but they’re not in the right locations.”

The oldest Baby Boomer turned 78 in 2024, and 17 percent of Minnesota’s residents are now over age 65, according to Minnesota Compass. In addition, just over half of the state’s older adults live in small-town or rural Minnesota, where the shortage of nursing-facility beds is most severe.

Other demographic factors — not cited in the center’s report — are relevant to the well-being of Minnesotans and likely of interest to Minnesota Women’s Press readers:

• At 53.6 percent, women make up the majority of older Minnesotans, according to Minnesota Compass; women historically have earned less than men, so retirement can be harder to manage financially.
• More than 9 percent of the state’s older residents live in poverty.
• Some 28 percent of Minnesotans over age 65 have one or more disabilities.

Why Are the Facilities Numbers in Decline?

“Shrinkage versus closure” is how report author Asche described the reasons supply is dwindling despite demand. “A facility can reduce the number of licensed [nursing home] beds,” he said, adding, “There’s more closure in rural areas.”

Non-institutional care — such as home-health aides — can fill that gap, allowing relatively healthy seniors to remain in their homes. But the urban-rural disparity exists for these services as well. Carver County in the west metro, for example, has 37 home-based care organizations providing skilled nursing care. Roseau County in northwestern Minnesota, along the Canadian border, has six providers for home-based care.

The average annual cost of nursing-home care is $133,000 per person, said DHS’ Brenner, who has worked in the field her entire career. Medicare or Medicaid often pays for such care, panelists said, but reimbursements are slow and rarely cover the full cost.

“Those reimbursement rates are set by the government,” said Kathy Messerli, executive director of the Minnesota Home Care Association. A gap between reimbursement rates and actual costs “affects salaries and wages,” she explained.

The 90-minute webinar could not offer much time to talk about potential solutions — and most focused on the essential need to speak up, whether you are an elder yourself or caring for an aging loved one.

For example:

• Ask legislators, who tend to be “teachers, lawyers and insurance brokers,” how they will engage with nonprofit leaders to work on elder-care issues, Huppert said. “Or run for office yourself.”
• “Talk about elder care at your job,” said Anderson.

Messerli, who also urged webinar participants to contact their legislators, offered this reality check for folks 60 and older: “Even if you think you may not need it right away, get your name into a facility for senior care. Wait lists are long.”

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Related Resources

Declining Capacity of Nursing Facility Care in Rural Minnesota

The Future of Nursing Homes and Elder Care Across Minnesota

 

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