More Than 2 Dozen States Link Staffing Woes to Assisted Living Community Closures

Challenges hiring workers helped prompt permanent closures of assisted living communities in 27 states across the U.S. in the last year, according to new survey data from nonprofit KFF.

The data showed that assisted living was among the Medicaid care settings most likely to have permanently closed in response to workforce challenges. The care setting ranked behind group homes, for which 29 states reported permanent closures and adult day health programs, for which 32 states reported permanent closures.

Another 27 reported permanent closures for “other home- and community-based” settings. Just 11 states reported such permanent closures for home health agencies.


Most states — 43 out of 50 — reported permanent closures of home and community-based providers within the last year.

The report states closures occurred for a variety of reasons, including provider shortages and the struggles of trying to recover post-Covid. Minnesota in particular reported downsizing to “coordinate locations” due to staffing shortages.

All states but Nebraska reported staff shortages for more than one type of provider, and 48 states reported shortages in five or more types of provider. Direct support professionals were reported to be the most common shortage found in all 50 states, followed by personal care attendants and nursing staff in 49 states.


The report states the shortages could be caused by ongoing effects of the pandemic, low compensation and increasing requirements by providers.

To attempt to address the staffing shortages, all states responded to taking some form of action, with 48 increasing pay rates, 42 expanding or developing staff training and 41 offering payment incentives to recruit or retain staff.

Other incentives included establishing or raising the state minimum wage requirement for HCBS workers in 20 states and offering paid sick leave for workers in 18 states.

The report goes on to state that while some states have permanent payment rate increases, 13 states reported the increase is only temporary. Additionally, 14 states have cost of living increase formulas automatically applied, but the increase doesn’t apply to all workers.

Proposed changes from the Biden administration would set mandates in nursing facility staffing levels, but the report indicates that less than one in five facilities would meet the proposed staffing levels.

The report concludes that staffing challenges will only continue to increase as the population ages–Arizona alone responded to the survey estimating that it needs over 35,000 workers to meet the demands of its aging population.

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