Nebraska's long-term care system is shifting in favor of urban areas, paper finds

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Cody Smith, policy writing assistant,, 402.687.2100 ext. 1016; or Rhea Landholm, brand marketing and communications manager,, 402.687.2100 ext 1025

LYONS, NEBRASKA – Over the past decade, almost two dozen long-term care facilities have closed across rural areas of Nebraska. A white paper released today by the Center for Rural Affairs, “Rural Nebraska’s shifting long-term care system” examines factors that impact rural long-term care access, such as health professional shortages and programs like Medicaid and Medicare.

“As access becomes more limited and fewer beds are available, many rural Nebraskans and their families are struggling to make decisions about long-term care,” said Cody Smith, policy writing assistant at the Center for Rural Affairs and author of the analysis. “When a community's long-term care facility closes, elder residents are forced to decide if they should abandon their community or risk staying in their homes without care.”   

Rural areas of Nebraska have higher uninsured rates and a larger elderly population than their urban counterparts. The uninsured rate for rural counties is 12.1 percent. The percentage of residents 65 and older was 18.5 percent, 6.3 percent higher than metropolitan areas. According to the publication, Medicaid covers as many as one-in-two residents of nursing homes, providing coverage for many seniors, but excluding a significant share of the population.

“We know that about 15 percent of the nursing home population is under 65 years old and currently, most are ineligible for Medicaid coverage, even if they’re uninsured,” Smith said. “Expanding Medicaid coverage to those earning less than $17,000 annually would lead to improved population health and would likely leave providers with less financial stress by reducing uncompensated care expenses.”

The paper also found 64 of Nebraska’s counties struggle with primary care health professional shortage areas. These professionals, including doctors and registered nurses, play an important role in managing long-term care programs for residents. Of the 64 counties confronting this issue, 57 of them were rural.

“This problem isn’t going away; the number of elderly Americans is expected to double by 2060,” Smith said. “Nebraskans deserve access to long-term care, no matter where they live.”

For more information and to view “Rural Nebraska’s shifting long-term care system,” visit