Decline in U.S. nursing home capacity since COVID-19: Rural areas hit hardest

University of Rochester Medical Center

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Though the U.S. population is aging, nursing home capacity has declined nationwide since the COVID-19 pandemic began. According to a study published in JAMA Internal Medicine this week, one quarter of U.S. counties experienced declines of 15 percent or more, with the greatest declines reported in rural areas.

Analyzing licensed beds, staffing, and patient census data from nearly 16,000 skilled nursing facilities, researchers found that national nursing home operating capacity fell by five percent between 2019 and 2024. That translates to nearly 4,000 fewer beds available for new patients each day.

But this decline was not felt by all communities equally. It varied widely across geographic regions, with rural counties more likely to face declines of 25 percent or more. That tracks with broader trends in the rural health care system, where physicians are in short supply and hospitals are closing or curtailing vital services, making it ever more difficult for rural residents to access health care.

Consequences for Patients and Families

In addition to providing long-term care for older adults, nursing homes provide crucial skilled nursing care for patients after hospitalization. According to the study, the reduction in nursing home capacity was linked to longer hospital stays, especially extended stays of 28 days or more.

“In rare cases, patients can get stuck in the hospital for several months or indefinitely,” said study author Brian McGarry, PhD, assistant professor of Geriatrics & Aging at the University of Rochester Medical Center. “If you’ve ever spent time in a hospital, you know they’re not designed for long-term care. It’s not a comfortable place to live."

The study also suggests that, once discharged, patients had to settle for skilled nursing facilities farther from home. Patients tend to choose nursing homes that are close to home, making it easier for family to visit and provide vital support, but declining nursing home capacity was linked to increasing distance between a patient’s home and the nursing home they were able to get into.

Drivers of the Decline

Capacity issues in nursing homes have been studied for years, but most research focused solely on the number of licensed beds at facilities. This study estimated nursing homes’ operating capacity by taking other resource constraints into account.

“Licensed beds are hard to get and free to keep,” said McGarry. “The beds may physically exist, but the facility may not have the staff or other resources to fill every bed.”

While more research is needed to understand what caused the decline, the study found an association between declining nursing home operating capacity and staff shortages. According to McGarry, operating capacity hit a low in 2021 and has been slowly recovering since then, likely due to rebounding labor markets as the chaos of the pandemic subsided.

“But the upcoming cuts to the Medicaid budget could have trickledown effects to stunt or reverse that recovery,” McGarry said. “We need to invest more in nursing homes and staff. It's hard to do that when the primary payer for nursing home services—Medicaid—is having its budget slashed.”

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Journal

JAMA Internal Medicine

DOI

10.1001/jamainternmed.2025.7197 

Method of Research

Data/statistical analysis

Article Title

Changes in US Skilled Nursing Facility Capacity Following the COVID-19 Pandemic

Article Publication Date

12-Jan-2026

COI Statement

Dr McGarry reported personal fees from the Foundation for Post-Acute and Long-Term Care Medicine outside the submitted work. Dr Wilcock reported grants from the National Institute on Aging (NIA) during the conduct of the study. Dr Gandhi reported grants from the NIA during the conduct of the study and grants from Arnold Ventures outside the submitted work. Dr Grabowski reported grants from the NIA during the conduct of the study and personal fees from Analysis Group, Entity Risk, GRAIL, LLC, and the University of Southern California outside the submitted work. No other disclosures were reported.

 

Nuclear power projected to reach 22% in China by 2060, catalyzed by coal-to-nuclear conversion

Higher Education Press

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image: 

Electricity generation mix evolution of three scenarios. 

view more 

Credit: Daiwei Li, Hongyu Zhang, et al.

Amid efforts to mitigate climate change, decarbonizing the power system has become a top priority. While the transition to non-fossil energy sources is accelerating in China, key challenges persist regarding the premature retirement of coal-fired power plants: the risks of asset stranding, the ongoing need for dispatchable firm power sources to ensure grid stability, and the need for a just transition in local employment and economic development. A recent study published in Engineering by Daiwei Li, Xiliang Zhang, and their colleagues from Tsinghua University offers a systematic evaluation of a promising solution: coal-to-nuclear (C2N) conversion, i.e. repowering the to-be-retired coal-fired power plants with nuclear power, particularly small modular reactors (SMRs).

 

To conduct the analysis, the research team improved a power system capacity expansion and operation model of China with provincial-level spatial resolution. By expanding its nuclear technology classification and incorporating specific constraints of C2N conversion, the team comprehensively assesses the technical and economic viability of this technology pathway in advancing China’s power system decarbonization goals.

 

The study suggests that, under China’s carbon peaking and neutrality goals, with the opening up of inland nuclear development, it could see substantial increase in the development of nuclear power—reaching 422 GW in installed capacity and accounting for 18% of China’s total electricity supply by 2060. The team further designed three scenarios to quantify how C2N development would impact nuclear  installed capacity, their regional distribution, and total power system costs.

 

Scenario analysis results demonstrate that C2N conversion will unlock additional nuclear growth in China: repowering eligible retired coal power plants will expand nuclear sites and increase nuclear power capacity by 13%–23%, raising its share in China’s total electricity supply by 2–4 percentage points in 2060, reaching as high as 22%. This expansion is achieved without compromising China’s power system stability—maintaining a well-rounded mix dominated by non-fossil sources while renewable power curtailment rates kept below 7%. Notably, C2N conversion is particularly effective in facilitating SMR deployment in northwestern provinces with large coal power legacies. While supplemental to conventional greenfield nuclear sites, C2N enables nuclear power to be deployed across 28 provincial regions by 2060.

 

From an economic perspective, C2N conversion proves to be cost-effective. Between 2030 and 2060, the two C2N development scenarios will deliver cumulative cost savings of 0.22%–0.69% (0.44–1.39 trillion CNY) for the entire power system compared to the scenario without C2N. These savings stem from multiple factors: reduced investment in new nuclear development by leveraging existing coal plant sites and facilities, and optimized system operation where flexible SMRs installed via C2N displace unnecessary fossil-fuel-based generation, lowering overall operational costs.

 

Beyond the technical and economic insights, the study offers a few policy recommendations to support C2N development: prioritizing the protection of greenfield nuclear sites; promoting C2N pilot projects with supportive policies; expanding manufacturing capacity for key nuclear components; and supporting advanced nuclear technology R&D to lower costs and enhance operational flexibility. The implementation of these measures will well facilitate China’s power system transition.

 

This systematic analysis provides valuable guidance for policymakers and industry stakeholders committed to advancing power system decarbonization. By allowing for C2N conversion with diverse nuclear technologies, China and other countries facing similar coal transition challenges can mitigate asset stranding risks associated with traditional fossil fuel infrastructure while building a more cost-effective and low-carbon energy system.

 

The paper “Role of Coal-to-Nuclear Conversion in China’s Electricity System Decarbonization” is authored by Daiwei Li, Hongyu Zhang, Ying Zhou, Sheng Zhou, Siyue Guo, Junling Huang, and Xiliang Zhang, receiving supports by the National Natural Science Foundation of China (72140005 and 72374122) and the China Carbon Neutrality Initiative of Tsinghua University. Full text of the open access paper: https://doi.org/10.1016/j.eng.2025.11.025. For more information about Engineering, visit the website at https://www.sciencedirect.com/journal/engineering.

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Journal

Engineering

DOI

10.1016/j.eng.2025.11.025 

Article Title

Role of Coal-to-Nuclear Conversion in China’s Electricity System Decarbonization

 

Historic ocean treaty underpinned by Oregon State University science takes effect Jan. 17

Oregon State University

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CORVALLIS, Ore. – Oregon State University research into marine protected areas plays a crucial role in the historic “High Seas Treaty” that goes into effect Jan. 17.

Less than two years after OSU scientists led the publication of a landmark marine protected area guide in Science, the United Nations in June 2023 adopted the text of the treaty. The treaty’s aim is to safeguard and sustainably use the high seas, the two-thirds of the ocean not under individual nations’ control.

Known officially as the Biodiversity Beyond National Jurisdiction Agreement, the treaty was under discussion for more than two decades. Once the agreement was opened for signatures, it took just three days for an economically and geographically diverse collection of 81 U.N. member states, including the U.S., to sign it, giving a non-binding signal of their intent to comply.

The first nation to ratify the High Seas Treaty – providing formal consent to being legally bound by it – was Palau in January 2024. The terms of the treaty call for it to go into effect 120 days after 60 nations have ratified it, and Morocco became the 60th on Sept. 19, 2025.

“It’s time to celebrate,” said Oregon State University Distinguished Professor Jane Lubchenco, senior author of “The MPA Guide: A framework to achieve global goals for the ocean,” published in Science in September 2021.

“We have an unprecedented opportunity to protect and sustainably use the biodiversity in an area covering nearly half the planet,” said Lubchenco, who writes about the treaty in an article published today in Nature Reviews Biodiversity. “That area houses phenomenal biodiversity, but it’s declining and at risk. This new treaty is a very big deal and very good news – science is informing pioneering global policy, and needs to continue doing so.”

OSU’s Kirsten Grorud-Colvert and Jenna Sullivan-Stack were the lead authors of the MPA Guide, coordinating the contributions of more than three dozen scientists from around the globe to produce a road map for helping nations better plan, evaluate and monitor marine protected areas. MPAs are parts of the ocean set aside to protect ecosystems from extractive activities such as fishing, mining and drilling.

The World Data Base on Protected Areas, a United Nations affiliate, has adopted the MPA Guide and hosts its documents on its Protected Planet website, and the MPAtlas, an independent, non-governmental authority on ocean protection, bases its determinations on the MPA Guide. MPAs are categorized based on their level of protection.

“The guide was the culmination of decades of work by hundreds of scientists and stakeholders and established a structure for an evidence-based understanding of where we stand on ocean protection,” said Grorud-Colvert, associate professor of integrative biology in the College of Science. “We obviously still have a lot of work to do, but the High Seas Treaty represents another huge milestone and I’m really proud of the part OSU plays in providing the science for establishing MPAs on the high seas.”

Grorud-Colvert and Sullivan-Stack reflect further on the treaty in an editorial published today in Science.

Lubchenco says marine protected areas can deliver tangible ecological, conservation and social outcomes and are effective at protecting biodiversity from abatable threats if properly designed and supported.

In addition to Lubchenco, Grorud-Colvert and Sullivan-Stack, Oregon State’s Vanessa Constant and Ana Spalding also contributed to the MPA Guide project. Constant was an integrative biology doctoral student at the time, and Spalding is a courtesy professor of marine and coastal policy in the colleges of Liberal Arts and Earth, Ocean, and Atmospheric Sciences.

“We need the social sciences if the High Seas Treaty is to reach its potential,” said Lubchenco, who has served in numerous federal leadership roles including head of the National Oceanic and Atmospheric Administration. “Social sciences emphasize the importance of inclusivity of geographies and cultures for effective treaty implementation.”

To date, 145 of the United Nations’ 193 member states have signed the treaty, and 81 have ratified it. The U.S. signed the treaty in 2023 but is not among the ratifying nations.

“Ratification is in every country’s interest,” Lubchenco said. “It means having a voice and vote in decisions, such as about creating marine protected areas or allowing activities like geoengineering or deep-ocean aquaculture that might impact their domestic fisheries or coastal waters. Not ratifying means you’re ceding power to other nations for decisions that affect everyone.”

Lubchenco’s article in Nature Reviews Biodiversity includes a link to a map, known as a Spilhaus projection, that shows both the one-third of the ocean under countries’ national jurisdiction – known as Exclusive Economic Zones – and the two-thirds that make up the high seas. The new map was created through a partnership among Lubchenco, Cory Langhoff of the College of Earth, Ocean, and Atmospheric Sciences, and Dawn Wright of Esri, a company that develops geographic information systems software.

Wright, chief scientist at Esri, also holds a courtesy appointment in CEOAS.

“The map is a different view from what folks are used to seeing,” Lubchenco said. “I like it because it emphasizes that although there are multiple ocean basins – the Pacific, Atlantic, Arctic, Indian, etc. – there is really only one ocean; it’s all connected. Other Spilhaus projections have been created, but none that any of us could find that showed EEZs and the high seas, so we created one.”

In addition to being NOAA’s administrator from 2009 to 2013, Lubchenco led the Climate and Environment team at the White House Office of Science and Technology Policy from 2021 to 2025 and was the State Department’s Science Envoy for the Ocean from 2014 to 2016. At Oregon State she is the Wayne and Gladys Valley Professor of Marine Biology and Distinguished Professor of Integrative Biology.

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Journal

Science

DOI

10.1126/science.aef3177 

Method of Research

Data/statistical analysis

Subject of Research

Not applicable

Article Title

The High Seas Treaty, at last

Article Publication Date

15-Jan-2026

 

Parenthood ‘inoculates’ adults against disgust, new study reveals

From nappy changes to nursing care, exposure to unpleasant substances is a daily reality for millions of people but how does the brain adapt?

University of Bristol

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From nappy changes to nursing care, exposure to unpleasant substances is a daily reality for millions of people but how does the brain adapt? New research from neuroscientists at the University of Bristol reveals that repeated, long-term exposure to bodily waste significantly reduces parents’ disgust responses, with effects that persist over time.

The findings, published in the Scandinavian Journal of Psychology, offer fresh insight into how caregiving reshapes the brain and could help inform strategies to support workers in professions where managing disgust is part of the job.

Many professions require regular contact with unpleasant substances, including bodily waste, making some roles difficult to recruit and retain staff. Researchers from the University of Bristol sought to better understand how disgust functions, with the aim of identifying ways to help people cope with it more effectively.

A natural test case for studying disgust is parenthood. Dr Edwin Dalmaijer, a cognitive neuroscientist in Bristol's School of Psychological Science and one of the study’s lead authors explained: “Disgust is a basic human emotion that helps protect us from harm. Most people recognise it as the strong ‘yuck’ feeling we get when we smell gone-off food, see something dirty, or think about bodily fluids. This reaction is not just about being picky, it evolved to keep us away from things that might make us sick.

“When we feel disgust, our bodies often respond automatically, for example by feeling nauseous, or wanting to move away quickly. While this reaction is powerful in the short term, it has long been debated whether repeated exposure over months or years can truly reduce disgust.

“Parenthood dramatically increases exposure to these substances, and people do not choose to become, or stop being, parents based on disgust. This makes it an ideal ‘natural experiment’ for studying how disgust changes over time.”

To test this, researchers analysed questionnaire responses and the actions, such as how much people looked away, from 99 parents and 50 non-parents. To ensure relevance, the study included parent-specific questions and child-related stimuli, such as images of soiled nappies. 

As expected, non-parents showed strong avoidance of images depicting bodily waste. Parents, however, displayed a strikingly different pattern but only once their children had begun eating solid food.

Parents of weaning or weaned children showed little to no behavioural avoidance of soiled nappies or even general bodily effluvia. Their disgust response appeared noticeably reduced, suggesting that prolonged, unavoidable exposure had led to desensitisation. Importantly, this reduced disgust was not limited to child-related stimuli but generalised to other forms of bodily waste.

In contrast, parents whose youngest children were still exclusively milk-fed showed levels of disgust avoidance similar to those of non-parents, even if they had older children. This unexpected finding suggests that disgust may remain heightened during the earliest stage of infancy, when babies are particularly vulnerable to illness.

The researchers believe this pattern may reflect an evolutionary adaptive response. Heightened disgust during the milk-feeding stage could help reduce disease risk for young infants, while later desensitisation allows parents to care for their children when they are ill.

Dr Dalmaijer added: “Parents of young children are bombarded with grossness from day one, from dirty nappies to sick and snotty noses. Our findings provide strong evidence that long-term desensitisation to disgust does occur. After the sensitive early months of infancy, continuous exposure to children’s bodily effluvia appears to ‘inoculate’ parents against disgust, reshaping a deeply ingrained emotional response that is otherwise difficult to change.

“Parenthood doesn’t just change daily routines, it can fundamentally alter how humans experience disgust, with lasting effects that extend beyond childcare itself.”

The study was funded by the University of Bristol’s School of Psychological Science.

Paper

‘Parents develop long-term disgust habituation, but only after beginning to wean their children’ by Yifan Huang, Edwin S. Dalmaijer et al. in Scandinavian Journal of Psychology [open access].

. . . ENDS

Notes to editors

The link for the paper: doi/10.1111/sjop.70069

An image is available on request.

For further information or to arrange an interview with Dr Edwin Dalmaijer please contact Joanne Fryer [Mon to Weds], email joanne.fryer@bristol.ac.uk, mobile: +44 (0)7747 768805 or Caroline Clancy-Cottle [Weds to Fri], email caroline.clancy@bristol.ac.uk, mobile: +44 (0)7776 170238 in the University of Bristol News and Content Team.

Issued by the Research News and Content team at the University of Bristol

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Journal

Scandinavian Journal of Psychology

DOI

10.1111/sjop.70069 

Method of Research

Survey

Subject of Research

People

Article Title

Parents develop long-term disgust habituation, but only after beginning to wean their children’

Article Publication Date

6-Jan-2026