Assessing the Future of County Nursing Homes

Scenario: In an era marked by pressing fiscal challenges for public nursing homes and an increasing shift of nursing home beds from the public to the private sector, the New York State Health Foundation funds a comprehensive evaluation to assess the future of public homes and recommend next steps for state and county policymakers.


  1. Financial stability of taxpayer-funded nursing homes has eroded substantially in recent years; 92% of homes in NY outside New York City lost money in 2010
  2. Publicly-funded homes in the state are rapidly losing market share to non-public homes and for-profit providers
  3. Number of NY counties operating public nursing homes is steadily declining
  4. For counties opting to stay in nursing home business, the current financial model is unsustainable

What CGR Delivered

Expert data collection and analytical support, encompassing:          

  • Detailed review of environmental factors impacting public nursing homes in NY
  • Assessment of staffing and costs for public and private sector nursing homes
  • Impact analysis of recent ownership transitions (e.g., public to private)
  • Development of recommendations for county decision-makers and state policymakers

Result and Impact

  • CGR’s analysis drove a statewide dialogue on the precarious situation county-funded homes are in operationally and financially
  • CGR’s online final documents:
    • provide guidelines for counties exploring options for their nursing homes
    • continue to impact the decision-making process related to future ownership of public nursing homes across the state
  • Online website is valuable resource for leaders outside New York confronting similar challenges

Note: CGR was awarded the 2014 “Most Distinguished Research” Award from the national Governmental Research Association for this study