Sergio Esteves, right, licensed practical nurse, sits in an office at Jewish Senior Services. The nursing home follows a household model, where each resident has their own room and bathroom and shares common areas, including kitchen. Yehyun Kim /

Original reporting by Jenna Carlesso and Dave Altimari. Compiled by Gabby DeBenedictis.

Editor’s Note: This article is part of CT Mirror’s Spanish-language news coverage developed in partnership with Identidad Latina Multimedia.

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Connecticut’s nursing homes, where about 20,000 people reside, are facing an identity crisis.

Occupancy, which plunged steeply during the pandemic, has yet to fully recover. Complaints about the quality of care in some homes are escalating, and Connecticut policymakers no longer envision nursing homes as the primary option for elder care but as a recourse only for those with medical needs that can’t be managed at home.

As the state’s population of older adults continues to grow and shows increased interest in home-based care, changes in the nursing home industry appear inevitable.

Here’s what to know about the current state of the industry in Connecticut — and its future.

Complaints about care in nursing homes are on the rise.

In 2017, the Office of the State’s Long-Term Care Ombudsman logged 3,090 grievances from nursing home residents and their loved ones. Last year, it received 4,278.

Complaints range from lack of access to care to meals arriving late and cold, problems with heating and air conditioning, trash piling up and residents missing daily activities.

In some homes, residents say they’ve seen a single nursing aide assigned to 20 people. A typical ratio to ensure good care is one worker to every eight or 10 people, the state’s long-term care ombudsman has said.

During the last quarter of 2022, the health department issued four “immediate jeopardy” findings in Connecticut. The findings indicate that violations in a nursing home caused or were likely to cause serious harm or death to a resident.

More recently, the Newtown Rehabilitation and Health Care Center, which is owned by Athena Health Care Systems, was placed under “immediate jeopardy” as well.

Residents at nursing homes owned by Athena have complained of being stranded in bed for long stretches of time, missing meals or medications and being unable to attend daily activities. Family members described their loved ones as unkempt during visits. Residents have reported regularly missing showers and haircuts.

Nursing homes are facing staffing shortages.

Nursing home owners say they are having extraordinary difficulty recruiting and retaining workers. Many facilities are understaffed — they saw a drop in staff when the pandemic began and haven’t recovered since.

From February 2020 to December 2022, the nursing home industry lost 210,000 jobs nationally, and staffing tumbled to levels not seen since 1994, officials with the American Health Care Association and National Center for Assisted Living said.

Finding staff is a major challenge — not only for nursing homes but for anyone in the health care sector, including home health care agencies or home companion agencies, where turnover can be as high as 50% annually.

Nursing homes occupancy is falling.

Nursing home occupancy fell steeply during the early months of the pandemic. Hovering around 88% statewide before the first reported case of COVID, it plunged to 71% by July 2020.

As of February 2023, it had climbed to 83% but still hadn’t reached pre-pandemic levels.

Even as the total number of beds in nursing homes decreased because some facilities closed during the pandemic, the number of available beds has increased. In February 2020, there were 3,112 open beds in the state’s then-210 nursing homes. Roughly two years later, in March 2022, that number reached 5,017 open beds in 205 nursing homes.

As of late February, there were about 3,800 open beds in about 200 nursing homes, according to state data.

State officials believe many nursing home beds aren’t filled because family members who worked from home during the pandemic were able to keep their parents or relatives at home, while others turned to private caregivers or home companion agencies when possible.

The state is pushing for programs that aim to keep residents in their homes and communities.

Connecticut policymakers no longer envision nursing homes as the primary option for elder care but as a recourse only for those with medical needs that can’t be managed at home.

In 2018, for the first time ever, the state spent more Medicaid funds on home and community-based services than on institutional care, 53% to 47%, state data show. By 2022, it had spent 58% of its Medicaid long-term care money on home services, versus 42% for nursing homes and other facilities.

Although the spread of COVID accelerated that swing, a migration from institutionalized care to home services had been underway for years. In 2009, 65% of the state’s long-term care Medicaid expenditures went to nursing homes. By 2017, that number had dropped to 50%.

Connecticut launched a vast network of programs in recent decades designed to prevent unneeded nursing home admissions and increase the flow of people from facilities back to the community.

State officials are also trying to “right size” the nursing home industry by scaling back the number of beds — and, eventually, facilities — to align with current demand. Lawmakers introduced a measure that would slash funding for buildings whose occupancy drops below 90% over a 12-month period.

Finding answers to big questions in Connecticut. CT Mirror Explains is an ongoing effort to distill our wide-ranging reporting on Connecticut topics into a "what you need to know" format.