Skilled Nursing Occupancy Fell to 78.9% in April as Medicaid Rates Jumped 5%

Occupancy at the nation’s skilled nursing facilities slid to 78.9% during the first peak of the COVID-19 pandemic in April, according to the most recent set of data from the National Investment Center for Seniors Housing & Care (NIC).

That figure compares to 84.4% occupancy in April 2019, and 84.7% in February, before the novel coronavirus spread nationwide.

“Skilled nursing facility occupancy typically slows in April after an uptick during the flu season, but we haven’t seen anything like this in recent memory,” NIC senior principal Bill Kauffman said in a statement announcing the latest data Tuesday. “The long-term effect of COVID-19 on skilled nursing occupancy remains to be seen as the industry adjusts to a new normal.”


The Annapolis, Md.-based group pointed to bans on elective surgeries — which in turn dried up demand for post-acute care — as well as general efforts to “flatten the curve” on the state and local level in explaining the declines.

Medicare Advantage plans may also have reduced referrals from hospitals to skilled nursing facilities during the pandemic, NIC observed; managed care revenue mix dropped from 9.8% to 7.8% between March and April, the group observed.

The most recent NIC data tracks with other estimates of COVID-19’s impact on occupancy at the nation’s more than 15,000 nursing homes. The Wall Street Journal in early June reported that census had declined about 10% nationally, while an earlier data release from NIC put the occupancy rate in March at 83.4% — the lowest such number since the group began tracking the data in 2012.


More than 33,000 people in nursing homes died of COVID-19 through the week of June 21, according to the most recent count from the Centers for Medicare & Medicaid Services (CMS). Confirmed infections have exceeded 118,000, with a further 74,561 suspected COVID-19 cases.

State-level efforts to boost rates during the crisis led to a 4.9% bump in Medicaid revenue per patient day from last April, NIC determined, with an average $10.53 increase nationwide. Still, NIC cautioned that the gains may still fall short of the expenses associated with caring for Medicaid residents.

In addition, while the federal government authorized a 6.2% increase in its Medicaid match early in the coronavirus crisis, it’s up to state governors to decide which providers will receive the largesse — and many elected not to include long-term care operators in the gains.

Amid historically high unemployment rates, individual states may also find their often chronically underfunded Medicaid budgets straining under the weight of new enrollees who lost their employer-sponsored health care coverage.

“Already strapped state Medicaid budgets are going to have to do more with less, and the growth in reimbursements to fight COVID-19 won’t last forever,” NIC chief economist Beth Burnham Mace warned in a statement. “States must consider how to best serve skilled nursing patients in one of the most challenging times in history.”

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