Rural long-term care facilities are generating more than $1.8 billion in economic activity across Oklahoma, according to a new study covering their impact.
The report was prepared by economist Dr. Russell Evans for Care Providers Oklahoma, which represents a portion of the state's nearly 300 nursing homes. CEO and President Steve Buck said during facility visits, administrators often tell him they are the largest non-governmental operator in the community.
"I immediately jumped to the question of, 'How big is this phenomena?'" Buck said.
Directly, it is equal to 10,301 mostly rural jobs, according to the study, which utilized data from the Centers for Medicare and Medicaid Services, Bureau of Labor Statistics, and American Health Care Association and the National Center for Assisted Living. Most are concentrated in health care services and administration occupations.
The direct household labor income for those jobs equates to $510,368,872, representing a direct contribution to rural Oklahoma of $49,546 per job.
"Employment in your local nursing facility, provided the nursing facility is reimbursed at a cost that allows it to be successful, [is] one of the most consistent and well-paying jobs that you might find in that local community," Buck said.
Long-term care facilities deliver $939,842,660 in health care services to rural Oklahomans, according to the study. They also address supply and demand for health care professionals, with many offering programs, reimbursement and job placements to encourage existing employees to upskill through education.
The operations of these facilities further interact with their local economies by purchasing goods and services, like medical devices, office supplies and food services, and employing workers who spend their paychecks in their local consumer markets.
That's where their economic impact grows to nearly $2 billion.
"Rural nursing homes are a hidden economic engine that exists in rural Oklahoma," Buck said.
Buck said that engine is all the more necessary in rural communities where economic activity and people are moving to urban areas. In 1969, the share of the state's population between rural and metro areas was nearly even. But, as of 2023, 62.2% of Oklahoma's population resides in metro areas, while 37.8% is rural.
Oklahomans who are 65 and older are overrepresented in rural areas compared to statewide demographics, according to the study. And, as medicine advances, that population is living longer and is projected to outnumber children for the first time by 2034.
That concentration and longevity require more caregiving to maintain quality of life, Buck said.
"A lot of middle-aged career earners have left the rural communities, leaving an aging population that still wants to live there, that wants to be cared for there, that wants to live their lifespan there," Buck said. "And so for those who make that choice, it's important that there be this vibrant network of long-term care facilities available."
Facilities in rural counties currently cover larger geographic areas, with urban areas averaging eight nursing facilities per county, while rural ones average approximately two. Those rural nursing homes face unique challenges, including aging infrastructure, building staffing pipelines and transportation costs when seniors need higher-level care in urban areas.
The study also notes that, if post-acute or rehabilitative care is needed once they reach urban areas, the specialty care provider will often decide to keep the patient there.
"While this practice does allow the specialty care provider to be adjacent to the resident, it effectively withholds demand for rural skilled care and the higher reimbursement rate for skilled care from the rural facility even when skilled care is available in the resident's home rural facility," the study reads.
"If the period of post-acute or rehabilitative care extends for a long period of time, it removes the patient from their home community and can leave them isolated from their family, friends, and home congregation," the study adds.
Buck said he hopes this report will inform the Rural Health Transformation Program. The five-year, $50 billion federal investment in rural health care was signed into law last year alongside an estimated $911 billion in reductions to federal Medicaid spending over a decade. Oklahoma's application received one of the highest awards nationally.
He also said he thinks it's important to underscore the value of long-term care facilities as Oklahoma prepares for the implications of federal Medicaid cuts.
"Nursing homes are a critically important part of the rural fabric," Buck said. "Policymakers need to understand that so that as they make decisions, those decisions do not undermine what is already … the fabric of the community."
