When care options disappear in rural Nebraska
When a nursing home or assisted-living facility closes in a rural Nebraska community, the need for care doesn't close with it.
The people who needed help yesterday still need it today. Their families still have jobs, children and responsibilities of their own. The difference is that the next available option may now be another town, another county or much farther from home.
And across rural Nebraska, that is becoming a very real concern.
Fewer options, farther from home
Nebraska has lost nearly 39 nursing homes and 32 assisted-living facilities since 2017. At the beginning of 2025, testimony before the Nebraska Legislature reported that 22 Nebraska counties had no nursing home within their county lines and 17 of those counties also lacked assisted living.
The reasons behind those closures are complicated. The same legislative testimony cited low reimbursement rates, rising costs of care, shortages of qualified employees and declining facility populations as contributing factors.
Those numbers matter differently in rural Nebraska than they might in a metropolitan area.
When the only facility in or near a small community closes, the next option isn't necessarily a few miles down the road.
After the nursing home in Mullen closed in 2022, Nebraska Examiner reported that some area residents were traveling 90 miles or more for care. One Sandhills resident who required skilled nursing care described having to stay in Broken Bow, far from her family and community.
For the person receiving care, moving farther away can also mean moving farther away from family, friends, church, neighbors and the community they've called home.
This isn't a problem that's going away
Nebraska's need for long-term care isn't disappearing simply because facilities are.
The issue has become significant enough that in 2025, the Nebraska Legislature launched an interim study examining the current and future availability and sustainability of nursing facility care in Nebraska.
The resulting legislative report identified 17 Nebraska nursing homes that had closed over the previous four years, including facilities in communities such as Valentine, Mullen, Grant, Trenton, Butte, Laurel and Pawnee City. The report also specifically noted that when a nursing home closes, family and friends may have to travel greater distances to visit the person receiving care.
But a statewide number doesn't tell the entire story.
For a family in rural Nebraska, what matters is whether appropriate care is available where they live.
When staying home becomes part of the answer
Not everyone who needs help needs to live in a nursing facility.
And in-home care isn't a replacement for skilled nursing care when someone requires that level of medical support. Nursing facilities remain an important part of Nebraska's care system.
But there is a lot of space between living completely independently and needing around-the-clock skilled nursing care.
Someone may need help bathing or getting dressed. They may need meals prepared, help around the house, assistance with mobility, safety supervision or simply another person there regularly. A family caregiver may be able to provide some of that support but need help carrying the load.
For some people, the right combination of family support, in-home care and other community-based services can make it possible to remain safely at home longer.
That's not just an idea being discussed by home care agencies. Nebraska's Home and Community-Based Services programs allow eligible people to receive services at home or in their communities rather than in isolated settings. Nebraska's Aged and Disabled Waiver specifically offers services to support eligible people in their homes.
Eligibility requirements apply, and the services available depend on the individual and the program.
Local care matters
In rural Nebraska, "local" has always meant something a little different.
We understand that 30 miles may be considered nearby. We understand that a caregiver might travel between towns. We also understand why families want the people caring for someone they love to know the communities they serve.
That's one reason Safe at Home has continued to build a presence across Nebraska.
Our offices in Sidney, Ogallala, Gordon, Norfolk and Nebraska City serve communities well beyond their city limits. Our caregivers provide non-medical support in homes throughout those regions, helping with personal care, companionship, meal preparation, housekeeping, mobility assistance, safety supervision, respite and other everyday needs.
Sometimes that support helps someone remain at home.
Sometimes it gives a family caregiver enough help to keep going.
And sometimes it becomes part of the plan when the care options a family expected to have nearby simply aren't there anymore.
There isn't one answer to rural Nebraska's care gap
Keeping care available in rural communities will take more than any one program, provider or type of service.
Nebraska still needs nursing facilities. It needs assisted living. It needs healthcare professionals, home and community-based services, family caregivers and a workforce willing and able to provide care in places where the distance between neighbors can be measured in miles.
In-home care is one piece of that larger picture.
For families, the important thing is knowing that needing help doesn't automatically mean someone has to leave home. Depending on the person's needs, health and circumstances, there may be options worth exploring before making that decision.
Because when care options disappear from a community, families shouldn't have to assume that their only option is to leave the community too.
Learn more
Learn about Nebraska programs that allow eligible people to receive services in their homes and communities.
Learn about services available through Nebraska's Aged and Disabled Waiver, eligibility requirements and provider options.
View Nebraska's current roster of licensed nursing facilities.
