Previous studies have found that nursing home closure rates are higher in rural areas, and rural nursing home residents have higher rates of behavioral/mental health care needs. More recently, over 200,000 nursing home residents and staff have died from COVID-19, and residents continue to suffer from other adverse health outcomes related to the COVID-19 pandemic including severe complications, disrupted care, and long-time social isolation that has exacerbated behavioral and mental health conditions.

Using the latest data available, this study will evaluate nursing home staffing, closure, financial performance, and resident health before and during the COVID-19 pandemic. More specifically, researchers will evaluate staffing shortages in rural nursing homes since 2020. Researchers will also compare the changes in resident health status as well as average nursing home staffing levels for registered nurses, licensed practical nurses, and certified nurse aides from 2017 to 2022. Finally, researchers will evaluate nursing home closure and financial performance for rural and urban areas from 2017 to 2022.