Vermont Gets $11.7 Million for Rural Nursing Homes as U.S. Faces Growing Long-Term Care Challenge

The Centers for Medicare & Medicaid Services announced the funding through the federal Rural Health Transformation Program. Vermont will use $9 million for tuition benefits for healthcare professionals in underserved or difficult-to-fill positions. Participants must commit to working in rural Vermont for at least five years after graduation.

The remaining $2.7 million will support three rural nursing homes and four community partners. The money will help facilities care for people with more complicated medical needs and expand training for Licensed Nursing Assistants, or LNAs.

The announcement comes as Vermont faces a particularly difficult nursing-home workforce problem. AARP's second-quarter 2026 Nursing Home Quality and Safety Dashboard reported annual nursing-staff turnover of 57 percent in Vermont, compared with 46 percent nationally. Vermont had the highest reported rate among the states and Washington, D.C., in that edition of the dashboard.

Most longterm care is provided at home, but some people do require nursing home care. For those who meet medical criteria and have limited financial resources, Medicaid often becomes the primary payer and typically uses nursing homes to deliver longterm custodial care.

As a small state, our workforce shortage makes it difficult to expand healthcare services in rural communities." — Vermont Gov. Phil Scott.

Scott said the investment should help expand nursing-home capacity for people with greater needs while giving more Vermonters opportunities to become Licensed Nursing Assistants (LNAs). In Vermont, the state uses LNArather than the more commonly used CNA (Certified Nursing Assistant) terminology found in most other states.

Vermont's Nursing Homes Are Under Pressure

Vermont has 33 Medicaid-enrolled nursing facilities with 2,847 licensed beds, according to a state report. The state says nursing-home utilization has risen above pre-pandemic levels while operating expenses have increased because of workforce shortages, higher wages and greater use of contract staff.

State officials have described the result as increasing "fragility of the nursing home system in Vermont."

"It is critical that Vermont strengthen the long-term care system, from home- and community-based options to skilled nursing facilities, to meet the changing needs of Vermont's aging population," the Department of Vermont Health Access said in a report to lawmakers.

The report said access to care and the ability to serve people with complex needs depend on a strong workforce and financially stable providers. Vermont was already investing in LNA recruitment before the latest federal announcement. State lawmakers appropriated $500,000 in both fiscal years 2025 and 2026 for recruitment and retention grants at skilled nursing facilities.

Those grants can support training, paid internships, student assistance, and recruitment and retention bonuses. State officials reported that approximately 200 LNAs were directly affected by the first year of the program. The new federal funding expands that workforce effort.

Staffing Remains a National Long-Term Care Problem

Vermont's challenges are particularly acute, but nursing homes nationwide continue to struggle with recruitment and retention. More than 1 million Americans live in nursing homes. AARP's second-quarter 2026 dashboard reported nursing-staff turnover averaging 46 percent nationally. Turnover among registered nurses averaged 43 percent.

The U.S. Department of Health and Human Services has also found that staffing shortages that intensified during the COVID-19 pandemic have persisted. Nursing homes have used contract registered nurses, licensed practical nurses, and nursing assistants to fill gaps when permanent workers are unavailable.

Contract workers can help facilities maintain care, but they come at a cost. HHS has described contract staffing as an important but expensive response to persistent workforce shortages.

Vermont specifically cited reliance on expensive traveler and agency staffing as one reason for investing in recruitment and retention.

The problem extends well beyond nursing homes. Home care agencies, assisted living communities, memory care facilities and other long-term care providers compete for many of the same workers. Families trying to keep an older parent at home can face the same problem when not enough paid caregivers are available.

HHS says nursing assistants, home health aides and personal care assistants support the health and well-being of more than 20 million Americans. Yet wages for these workers often are not competitive with entry-level jobs in other industries with similar requirements.

More Medical Care Inside Rural Nursing Homes

Vermont is also using the funding to expand the kinds of residents some rural nursing homes can accept. Part of the investment will purchase ventilators to increase nursing homes' ability to care for residents who need ventilator support. Another project will establish a "dialysis den" in a nursing home, allowing residents and people in the surrounding community to receive dialysis closer to home.

Vermont had already sought proposals to expand dialysis and ventilator services for nursing-facility residents with high-acuity needs. That can have a practical impact for older adults and their families. Someone who is medically ready to leave a hospital may still need substantial nursing care. Finding a facility becomes harder when the person also requires dialysis, ventilator support, or other specialized services.

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In rural areas, the nearest facility equipped and staffed to meet those needs could be far from the person's home and family. Bringing more medical services into nursing homes could let some residents stay closer to their communities while reducing repeated trips for outside treatment.

Rural Communities Have Fewer Options

Workforce shortages affect long-term care providers nationwide, but distance can make the consequences more serious in rural communities. Fewer nursing homes, home care agencies, physicians, nurses, therapists, and other healthcare providers may be nearby. When one facility closes, reduces capacity, or cannot accept a particular resident, the next option may be many miles away.

If a family is relying on Medicaid, this can become a major concern. While workforce shortages affect everyone, families paying privately, through LongTerm Care Insurance or personal assets, generally have more options. Still, the overall demand for longterm care keeps rising, making access and availability a growing challenge for all.

Distance affects families, too. Adult children may have to travel farther to visit a parent, participate in care planning or provide additional support. Transportation can become especially difficult for a frail older adult who needs dialysis or frequent medical appointments.

Vermont's Rural Health Transformation Program identifies workforce shortages and access to timely care among the problems the state is trying to address.

Part of a $50 Billion National Program

The Vermont projects are part of a much larger federal investment in rural healthcare. Congress created the Rural Health Transformation Program as a five-year, $50 billion initiative. The program provides $10 billion annually from fiscal years 2026 through 2030.

All 50 states received funding for the first year. Vermont's fiscal 2026 award totals approximately $195.1 million. Vermont has established three goals for the money: strengthen its rural healthcare workforce, improve timely access to care, and use new approaches to improve quality while reducing healthcare costs. The state has identified 35 activities across five strategic initiatives.

The program covers much more than long-term care. States are using the money for workforce development, healthcare infrastructure, technology, chronic disease management, and new ways of delivering care. Vermont's decision to direct some of the funding toward nursing homes and LNA training shows how the broader rural health initiative can affect older adults who need extended care.

CMS Administrator Dr. Mehmet Oz said the federal investment is intended to produce lasting improvements in rural healthcare.

This is what rural health transformation should look like: federal investment that is putting patients first, driving lasting improvements and expanding healthcare." — Dr. Mehmet Oz. 

An Aging Population Will Need More Caregivers

America's need for long-term care will grow as millions of Baby Boomers reach ages when disabilities, chronic illnesses and cognitive impairment become more common. Federal research estimates that 56 percent of people turning 65 will need long-term services and supports.

Some will need help for months. Others will need care for years. Professional caregivers are only part of the long-term care system.

About 63 million Americans provided ongoing care, according to the 2025 Caregiving in the U.S. report from AARP and the National Alliance for Caregiving. That represents nearly one in four U.S. adults. About 59 million were caring for an adult. Nearly one in four caregivers provided at least 40 hours of care each week. When paid care is unavailable or unaffordable, spouses, adult children, and other family members frequently shoulder more of the responsibility.

That makes the supply of professional caregivers important not only to long-term care providers but also to families trying to keep loved ones at home.

More Beds Alone Won't Solve the Problem

Increasing long-term care capacity involves more than adding beds. A nursing home can expand its building or purchase new equipment. An assisted living community can add apartments. A home care agency can expand its service area. All of them still need people to provide care.

Nurses, nursing assistants, home health aides, personal care aides, therapists, and other workers provide the hands-on help and clinical care older adults need. State officials in Vermont tell LTC News that they are trying to build a larger local workforce while helping existing nursing homes care for residents with more complicated medical conditions.

The $9 million tuition initiative also addresses retention. Healthcare professionals who receive the tuition benefits must commit to working in rural Vermont for at least five years after graduation.

Families Still Need to Prepare for Long-Term Care

Government investments can improve access to care and support the healthcare workforce. They do not eliminate the financial consequences families face when someone needs extended care.

Medicare pays for short-term skilled care when its requirements are met. It generally does not pay for ongoing custodial long-term care. Medicaid is the nation's largest government payer of long-term services and supports, but eligibility depends on financial and functional requirements. People with income and assets often pay for care themselves unless they have Long-Term Care Insurance or personal income and assets.

Qualified Long-Term Care Insurance can provide benefits for care at home, adult day care, assisted living, memory care, and nursing homes when a policyholder meets the policy's benefit requirements. Most people buy long-term care coverage between ages 47 and 67, when age and health can make it easier to qualify, and premiums are generally lower than at older ages.

The LTC News Cost of Long-Term Care Services Calculatorshows current long-term care costs throughout the United States. In Vermont, LTC News research shows longterm care services cost more than the national average, making the state one of the most expensive places in the country for extended care.

NOTE: LTC News also provides free LTC Insurance claims assistance for families with an existing Long-Term Care Insurance policy, making it easier to get benefits for quality long-term care options.

What Happens Next in Vermont

The $11.7 million announcement provides the funding. What it produces will take longer to determine. These measures will determine how many healthcare professionals enter the tuition program, how many new LNAs are trained and remain in rural Vermont, whether nursing homes reduce their reliance on agency workers, and whether more people with complex medical needs can receive care closer to home.

Vermont Agency of Human Services Secretary Jenney Samuelson has described the broader Rural Health Transformation Program as a "once in a lifetime" opportunity for the state. For older adults and their families, the results will be more tangible: whether appropriate care and enough trained caregivers are available when they need them.