Consider this scenario. Your aging parent is in her 80s, medically fragile, with worsening dementia. She’s been able to live alone in her home, but after falling and breaking her hip, that’s no longer a safe option given her growing needs. Together, you decide that she needs to move to a nursing home where she will receive 24-hour quality care and where you can visit regularly.

For nearly 30 years, Bethany Health Care Center - a sponsored ministry of the Sisters of Saint Boston - has been home to thousands of residents and rehabilitative patients in the MetroWest and its neighbors. We’re proud to say families who need us, can count on us for compassionate quality care.

But what if there are no nursing homes near you? Maybe there were, but they closed and the nearest one now is too far away. Unfortunately, that’s becoming a reality for many families and communities.

The sector is facing an unprecedented crisis that threatens its viability to provide access to quality care.

Last year, 20 nursing homes closed in the state, simply unable to stay open because of financial hardship and an inability to attract and retain staff. More will close this year.

This crisis has been brewing for many years, but we have reached a tipping point and there are three interconnected reasons for how we got here.

The first is tied to state Medicaid reimbursements. Two-thirds of nursing home residents in the commonwealth rely on MassHealth - the state’s Medicaid program - to pay for their care. But the state reimburses us based on 2007 costs. We are underfunded by about $38 per resident each day. Here at Bethany, 85 percent of residents have their care paid for by Medicaid.

The second reason concerns wages for our frontline staff. They are the backbone of our nursing homes - there for residents in the middle of the night when they need soothing, helping them with ambulating, eating, grooming, toileting, or taking them to activities. Their compassionate care is particularly admirable when you factor in that many don’t earn enough to take care of their own families without working additional jobs.

To be blunt, because of Medicaid underfunding, we are unable to pay our dedicated staff a living wage. And so, it has become harder and harder to compete for direct-care staff who can earn more, working fewer hours, at less physically demanding jobs, including at retailers like Walmart. Consequently, nursing homes in Middlesex County currently have the highest rate of unfilled job vacancies that we’ve ever had - about 13 percent. I wrote about this two years ago, and sadly, finding qualified staff has only gotten more difficult.

The third issue is that federal Medicare funding has declined over the last five years. Medicare increases have previously compensated for Medicaid shortfalls but that is no longer a viable option, since Medicare funding continues to decline. This means that an immediate investment in Medicaid funding is all the more critical to ensuring that facilities have the resources needed to provide quality care and pay a living wage.

Add to that the problem of aging infrastructures, a situation we are encountering here at Bethany. Many homes were built in the ’60s, ’70s, and ’80s. The cost of keeping the physical plant in shape is extremely high and requires ongoing investment. Think of things like providing air-conditioning.

On top of all the above reasons, we also have an obligation to keep up with the new federal regulations. It’s absolutely necessary, but also requires more staff who are not funded by the state Medicaid program.

We need the governor and lawmakers to make nursing home funding a priority for the individuals who live and work in our facilities. Without immediate support it’s not just the aging buildings that will crumble. It’s the whole paradigm of long-term nursing care.

Sister Jacquelyn M. McCarthy, CSJ R.N. is the CEO/administrator at Bethany Health Care Center in Framingham.