How Will America’s “Silver Tsunami” Impact Demand for Nursing Homes?

The U.S. Department of Health and Human Services estimates that a person turning 65 today has a 70 percent chance of requiring long-term care services at some point in their golden years. As the massive Baby Boomer generation ages, demand for nursing facilities will continue to climb.

However, not all states will feel this growing demand equally. Many states will face a much larger nursing home crisis than others. To put into perspective those differences, we analyzed data from the U.S. Census Bureau, the federal Centers for Disease Control and Prevention, and Kaiser Family Foundation.

Here are some key findings:

• More than 3,000 new nursing homes could need to be built to keep up with demand as the older population expands.
• Arizona is projected to see the number of older adult residents rise by 41 percent by 2030, with Florida in a close second at 39 percent. The only place where the older adult population may decline is the District of Columbia.
• Nursing homes in Florida, Arizona, and Nevada may need to add 40 beds each on average to keep pace with rising populations of older adults.

Sunny States May Have Largest Growth in 65+ Populations

Baby Boomers were born into a post-World War II economy on the verge of greatness. Between 1940 and 1960, about 58 million Baby Boomers were born, and the total gross national product of the U.S. more than doubled.

By 2030, the surviving members of the generation, almost 80 million strong at its peak, will all be 65 or older, and the number of Americans in that age bracket will reach 71 million, an increase of about 23 percent compared to today.

Warm-weather states will have the most significant increases in the 65 and older populations. Census data shows that Arizona will have the most significant jump, with its 65+ population increasing by 41 percent. Florida is a close second at 39 percent, and Nevada’s increase of 37 percent is third. And two other temperate states, Texas and Georgia, round out the top five (for more detailed data tables, jump down to the data appendix).

But this increase isn’t unique to warm weather locales. New Hampshire, where the average November temperature is a chilly 36 degrees (compared to a contiguous-U.S. average of 49 degrees for the month), is expected to have the ninth-highest increase. Every state will have an increase in the number of people over 65, except D.C. This is the only place where the senior population may shrink by 2030.

For states like Florida and Arizona, having large populations of older adults is nothing new. In fact, by percentage, Florida has the second-largest share of residents 65 and older, just behind Maine. Arizona’s 65+ population is also above the current national average of about 17 percent, according to data from the U.S. Census Bureau.

But other states’ elder care infrastructure may not yet be in place, based on today’s share of older adult residents. Nevada, for example, which will have the third-biggest increase in the aging adult population, currently ranks 36th regarding the percentage of residents over 65 (17 percent). While California’s share of older residents is even lower (15 percent), the state is expected to see a 25 percent increase in the number of people 65 and up.

3,000 New Nursing Homes May Be Needed to Keep up With Population Growth

According to our estimates, the nation could need as many as 3,000 new nursing facilities to keep pace with the surge in population among older adults. But, again, the impact is not equal across the country.

Since they’re the most populous states, Texas, California, and Florida all top the list regarding increasing their total number of nursing facilities. They account for nearly 30 percent of our projected increased need in nursing homes. Each of these states may need more than 250 nursing homes by 2030 to maintain the current population-to-nursing-home ratios.

D.C. is the only territory that will not require additional nursing care facilities. Some states, like Alaska, Wyoming, Hawaii, and Vermont, may only need a few new facilities to keep up with population increases.

Building new nursing facilities is easier said than done, partly because nursing homes are notoriously challenging to staff. This problem has gotten worse due to the current economic situation. According to a survey by the American Health Care Association and National Center for Assisted Living, 87 percent of nursing homes deal with moderate to high staffing shortages, and 61 percent limit new admissions due to workforce issues.

The staffing issues primarily come down to two factors:

1. High turnover: According to data from the Centers for Medicare & Medicaid Services, the average nursing home has seen 53 percent nursing staff turnover between November 2021 and November 2022. These rates will likely remain high as stress and burnout plague nursing home workers.
2. Low wages: While registered nurses are relatively well-paid, earning an annual median wage of about $72,000 in nursing homes, the same can’t be said for most other nursing care providers in these facilities. Nursing assistants have a national median wage of about $30,000 per year. Home health and personal care aides make even less, earning a median annual wage of just over $29,000.

What About Expanding Existing Nursing Homes?

Instead of (or in addition to) building new nursing facilities, states could focus on adding capacity to existing nursing homes. According to our analysis, the average U.S. nursing home must add about 20 beds to keep up with population growth. Still, that figure is even higher in states where the older adult population will rapidly expand.

For example, the average nursing home in Florida, Arizona, or Nevada would need to add 40 beds to keep up with projected growth. On the other hand, Alaska, Iowa, South Dakota, and West Virginia would need only nine beds per facility to keep pace.

Are federal and state governments preparing for their aging populations?

In most states, the primary focus is quality, not quantity, in nursing homes. However, some policies and potential reforms address both issues. Here’s a look at what the federal and some state governments are doing to prepare for the silver wave in nursing homes. Other states may need to implement these initiatives to strengthen their infrastructures:

• Clarifying minimum staffing requirements: The CMS has been tasked with a study into nursing home staffing that will result in a proposed new federal rule in spring 2023. Federal law is somewhat vague on the types of nurses facilities must hire and how many hours they must be available daily. Many hope that clarifying this matter will reduce staff turnover and improve the quality of care.
• Increasing wages for caregivers: Both labor and patient care advocates say paying nursing home and care workers more will make the jobs more attractive for those already in the jobs and those considering the career. An Oregon-based nursing home chain recently bargained with a service workers union to raise the wages for some workers and give them a path to renegotiate wages every year.
• Investing in home-based care programs: Most older adults want to remain in their own homes as they age, but in-home care costs can be prohibitive. Minnesota has expanded access to in-home care by granting waivers to Medicaid recipients. These waivers permit them to receive care at home, adult daycare centers, or other community-based settings. This reduces the demand for inpatient nursing facilities and can improve patient outcomes. More than 70 percent of those receiving these waivers in Minnesota receive care in their own homes.
• Establishing long-term care benefit programs: Washington’s WA Cares Fund was established in 2019 to provide additional funding for home- and facility-based care, home modifications, caregiver training, and transportation services.

Conclusion

The rapid growth in the older adult population will undoubtedly create many ripple effects across the healthcare industry and the U.S. economy. However, if policymakers and leaders understand those challenges, they can better future-proof the nursing care system.

Our data

For this report, we analyzed population projections created by the U.S. Census Bureau and accessed via the Centers for Disease Control’s WONDER database. These projections are estimates of how many Americans aged 65+ will be living in each state in 2030. We also used Census data to determine the current number of people aged 65 or older.

We also analyzed data from the Kaiser Family Foundation on the current number of certified nursing facilities per state and the number of beds in the average facility per state. We used these numbers to determine the current percentage of the 65+ population in each state that live in nursing facilities and the ratio of people 65+ to the number of facilities and beds per state. We then determined the additional number of facilities and beds that may be needed in 2030 to maintain the current ratios of patients to facilities in each state.