Trends and Factors in Nursing Home Closures.

Importance: US nursing home closures, whether planned or unexpected, can disrupt continuity of care, place additional burdens on remaining facilities, and disproportionately affect vulnerable populations. It is important to understand the trends and factors associated with these closures, as such knowledge can inform policy decisions, guide resource allocation, and help develop strategies to mitigate negative effects on both residents and the broader health care system. Objective: To examine nursing home operational dynamics in the US and to identify how facilities transition through openings, closures, and changes of ownership (CHOW). Design, Setting, and Participants: A longitudinal cohort study used 40 years of data from the Centers for Medicare & Medicaid Services Provider of Services File, covering the period from 1985 through June 2025. Facility trajectories were examined using physical location identifiers rather than facility names or provider identifiers. Main Outcomes and Measures: Facility lifecycle status (active, closed, or reopened), CHOW events, net changes in certified bed capacity, facility size, availability of specialized beds for patients with dementia, Medicare and Medicaid participation, and staffing intensity were assessed. Descriptive statistics and multivariate logistic regression were used to analyze trends and differences between closed and active facilities. Results: A total of 39 449 records were analyzed, representing 33 110 unique physical locations and 80 257 event records. Nearly half of all entities followed an entry-exit trajectory without any CHOW, accounting for 46.29% (n = 15 328). A substantial proportion of entities remained active while experiencing at least 1 CHOW (20.48% [n = 6780]). CHOW events accounted for 13 053 occurrences (16.26%) of lifecycle activity, and capacity changes were increasingly concentrated in recent years in select states. Overall, organizational restructuring and within-facility capacity adjustment became more prominent over time than entry or exit. Conclusions and Relevance: This study found that nursing home markets were characterized by continuous organizational change, with ownership transitions and capacity reconfiguration increasingly substituting for entry and exit. Examining the location-based life cycle of the facility shows that closure often reflects restructuring within evolving ownership structures rather than a single terminal event. These findings suggest that nursing home policy and oversight should attend to ownership transitions and capacity reconfiguration, alongside measures of facility entry and exit.