Rural America Is Losing Nursing Homes, and Small Towns Are Reeling

Urben Gratz first heard it at the post office. The Good Samaritan nursing home where his wife lived was closing. In Mott, a community of almost 700 in southwestern North Dakota, there were no other options. Gratz eventually found a place for Irene at a home in Dickinson, 60 miles away. She moved in on June 1, 2022, their 69th wedding anniversary, and died there three months later at age 90. Some families had to take their loved ones as far as Fargo, 300 miles east. “It was a big blow to the town,” Gratz says. “Everybody was not prepared for that.”

What happened in Mott is familiar to a growing number of communities across the US—and with financial pressures on the elder-care sector showing no signs of easing, more Americans will soon face a similar crisis. Across the country, almost 690 nursing homes have shut their doors since 2020, according to the Centers for Medicare & Medicaid Services (CMS). The American Health Care Association, an industry trade group, expects the number to keep ticking up in the coming years, because of a combination of rising labor costs, falling enrollments and government reimbursements that fall far short of paying the bills.