There are only 11 county-run nursing homes left across eight New Jersey counties, down from 14 counties operating facilities as recently as two years ago, and more closures are possible as the state shifts to managed long-term care.

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Union and Warren counties are currently exploring the idea of selling their nursing homes, according to John Donnadio, executive director of the New Jersey Association of Counties.

"Managed long-term care forces all nursing homes to negotiate with Medicaid for reimbursements," Donnadio said. "We're going to see a drop in that revenue and it's going to force more counties, I think, to sell their nursing homes."

More funding would help, Donnadio said, but he acknowledged that is not likely because the state is in difficult financial times. County-operated nursing homes have a high percentage of Medicaid patients. If reimbursements drop dramatically, that is why those facilities are most at risk of closing down.

"County governments provide a safety net care for the aged," he said. "The majority of our patients are Medicaid patients. In fact, 80 percent of the population in county nursing homes is Medicaid patients, who can't typically afford health insurance on their own."

If more county-run facilities close down, Donnadio said it would also adversely impact those with loved ones being cared for in the homes . People might have to scramble to find a bed in another county and if they can't find one, families would be faced with the prospect of having to put their loved one in an expensive, private nursing home.

Because of recent state Medicaid funding cuts, Donnadio said the remaining county nursing homes run by Atlantic, Bergen, Cape May, Gloucester, Middlesex, Monmouth, Morris and Passaic counties have been forced to reduce, privatize or eliminate housekeeping, food, social and other necessary services just to make ends meet.