The state has licensed just one new nursing home for Medicaid payments in Lackawanna County since 1999.

Three nursing homes in the county have closed since 2002, according to the state Department of Health.

"It's virtually impossible in Pennsylvania to get a license and build a new nursing home," said Michael Kelly, president of Senior Health Care Solutions, a long-term-care company in Scranton that owns Scranton Manor Personal Care Center and is building another personal-care facility, the Gardens at Green Ridge.

The state changed its licensing criteria in 1998, in an attempt to eliminate overuse of nursing homes and rein in Medicaid spending. The federal-state health insurance program for the needy covers 71.5 percent of nursing home residents in Lackawanna County and 65 percent of senior-care facility dwellers statewide, according to the Pennsylvania Health Care Association, a Harrisburg-based nursing home industry association.

The overhaul created more incentives for home- and community-based care for senior citizens. It toughened licensing criteria for Medicaid payments to nursing homes, granting expansion or construction approval only if a project demonstrated it was in the best interest for Medicaid to provide additional services for an affected community.

At the time the licensing criteria were revised, the state estimated there was a surplus of more than 5,600 nursing-facility beds in Pennsylvania. From 2000 to 2011, state nursing home capacity decreased by 7 percent to 88,607 beds, according to the Department of Health.

Lackawanna County has 18 nursing homes with 2,350 beds, according to the state Department of Health. In 2000, the county had 20 nursing homes with 2,535 beds.

"There has been virtually no building of nursing homes in the state," said Stuart Shapiro, M.D., executive director of the Pennsylvania Health Care Association.

"The model of long-term care is changing," said Anne Bale, spokeswoman for the state Department of Public Welfare. "There is more need and less money to go around."

The result creates a profile of aging senior-care infrastructure. The average Pennsylvania nursing home is 50 years old, Dr. Shapiro said.

"There is not adequate reimbursement to pay for rebuilding," he said.

"We have a lot of physically old nursing homes," Kelly said. "How do we keep investing in the physical plant? We are working off very thin margins."

Eventually, government may be forced to address care issues for feeble seniors, said Gordon DeJong, Ph.D., a demographer at Penn State University.

"My expectation is that there would be a renewed need for the counties and the state to ramp up care for the frail elderly," Dr. DeJong said. "But it doesn't look like our health care system soon will have any public care for the elderly built into it. That's very expensive."

The scenario signifies trouble as the ranks of seniors will swell in the coming decades.

"Nursing homes now are selectively taking patients on Medicaid because the reimbursement is so inadequate," Dr. Shapiro said.

"There's a tsunami of Baby Boomers," Kelly said. "How are we going to pay for these elderly people? Who is going to fund it?"

Contact the writer: jhaggerty@timesshamrock.com