Crushing Despair, Glimmers of Hope: The Top Skilled Nursing Stories of 2020

Each year, Skilled Nursing News uses the end of December to look back on the stories that shaped the previous 12 months.

In the past, the exercise has occasionally revealed a few forgotten surprises from the year that was, though SNN’s lists of most-read stories often have a recurring theme. For the past two years, that common thread had been the new Patient-Driven Payment Model, which went from a proposal to reality over 2018 and 2019.

As 2020 dawned, it looked like we were gearing up for PDPM’s judgment day. Therapists decried layoffs and the early stirrings of clinical changes; financial analysts began to realize that there were far more revenue gainers than losers under a system that the federal government designed to be revenue-neutral.


Then the worst storm in the history of long-term and post-acute care directly hit a landscape that could not withstand even a glancing blow.

The year 2020 will forever be known as the annus horribilis for nursing homes. Residents and families struggled with isolation, confusion, and communication breakdowns. Operators scrambled to secure enough personal protective equipment (PPE) and testing to shield their people and meet cascading new regulations. Workers entered facilities each day not knowing if they’d contract a deadly virus that we still knew so little about, and put their own families at risk.

And most tragically, more than 100,000 families have had to deal with the loss of a loved one who they had placed in a long-term care facility that they thought would keep them safe and healthy.


So for 2020, SNN’s annual look-back contains fewer surprises, and instead provides snapshots of what we knew, and when we knew it. It’s not all bad news, as our most-read story reveals — but like so many other aspects of the year that was, the disaster dominated our coverage of the space.

CMS Issues Guidance to States on Reopening Nursing Homes: Universal Testing Needed to Lift Visitation Ban

The federal government in May took the first steps toward reopening nursing facilities to visitors after instituting a strict blanket lockdown at the start of the coronavirus crisis in March.

But with that vital glimmer of hope for loved ones, the Centers for Medicare & Medicaid Services (CMS) also emphasized that nursing homes would be among the last care settings to return to any kind of normalcy — a prediction that remains painfully true seven months later.

The agency also threw up a high testing threshold for operators to clear, a herculean — if not impossible, in many places — task given the state of testing availability in the springtime.

“CMS recommends nursing homes do not advance through any of the stages of reopening or relax any restrictions until all residents and staff have received a baseline test to establish that there are no known cases of COVID-19 in the facility,” CMS administrator Seema Verma said at the time. “In addition to the baseline test, we are calling on nursing homes to screen all staff daily and test them weekly. Further testing of residents may be necessary upon identification of coronavirus symptoms.”

It would take CMS until September to issue more forceful updated visitation guidelines that provided a path toward in-person reunions at nursing facilities, and such arrangements can still be suspended amid outbreaks and spikes in community spread.

But the fact that this story topped SNN’s list of most-read stories clearly illustrates the toll that visitation bans have taken on residents and their families — and just how much they all needed the hope of a more normal tomorrow.

House Hammers Governors Over Nursing Home Admission Orders Amid COVID-19 Pandemic

The government response to COVID-19 in nursing homes quickly became a partisan football, with the fall presidential election campaign only amplifying the divide as lawmakers looked for areas to cast blame.

This piece focuses on a group of House Republicans and their attempt to demand information about state-level nursing home policies from five Democratic governors, including New York’s Andrew Cuomo and Michigan’s Gretchen Whitmer.

Those leaders had faced criticism over controversial state-level orders requiring nursing homes to continue accepting COVID-19 patients despite the potential danger for infection and death. Cuomo in particular has borne the brunt of the vitriol, largely from Republicans, around the nursing home issue, even sparring with Verma in the media several times throughout the year.

The GOP-led call came just a few days after Democratic Rep. Jim Clyburn issued a similar call for detailed information from both CMS and several top nursing home operators, setting the stage for a federal discussion that has largely fallen along party lines.

CMS Proposes 9% Cut to Medicare Therapy Rates, Threatening PT, OT, Speech Services in Nursing Homes

In a rare non-COVID story to top the charts, readers flocked to a story about a CMS proposal to reduce rates for the therapists that serve Medicare Part B beneficiaries, a demographic that includes wide swaths of long-term residents of nursing facilities.

The federal government went ahead with these cuts in the Physician Fee Schedule finalized earlier this month, over the objections of providers that claimed the declines will put residents at risk — and add another layer of financial strain on therapy companies that have already seen cutbacks stemming from the changed incentives under PDPM.

“Right now, we’re struggling to find therapists,” Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care, said. “We want to keep people safe. We’ve been trying to, in many instances, utilize telehealth in order to keep the avenue of access open to patients, to keep services flowing to get them better. This cut is going to make that very, very difficult.”

Federal Government Will Send Point-of-Care COVID-19 Testing Units, Kits to All Nursing Homes in U.S.

The rollout of the program soon became bogged down in conflicting state edicts, confusion over accuracy, and concerns over the availability of testing-kit refills.

But in July, when the Department of Health and Human Services (HHS) announced an ambitious plan to send point-of-care testing devices to most nursing homes in the country, operators and leaders — at least temporarily — saw a real chance to solve one of the most vexing problems of the pandemic: How do I even know who has this invisible virus that often produces no symptoms?

For better or for worse, the program in many ways defined 2020, bringing with it a new set of federal rules around testing frequency and reporting — and, at least in some cases, helping to separate the infected from the healthy.

And even as the long-awaited vaccine rollout kicks into gear during the final weeks of 2020, the question of routine, rapid, and reliable testing will likely remain with the industry for months to come.

“The need for testing is with us for the foreseeable future — at least out to the end of 2021,” Genesis HealthCare (NYSE: GEN) CEO George Hager said in September.

SavaSeniorCare to Offload 48 Skilled Nursing, Assisted Living Facilities in Post-Pandemic ‘Strategic Plan’

Major transactions usually draw significant traffic to SNN, and this year was no exception — with SavaSeniorCare’s major divestment plan coming in as one of the other non-COVID stories to crack the top 10.

The Atlanta-based operator in November announced its intent to transfer operations of 48 properties as leadership looked to emerge from the pandemic as a smaller, more regional operator.

“The current state of the world brought on by the pandemic has caused us to closely examine our strategy, where we invest our resources and can achieve the greatest impact,” CEO Jerry Roles said in a statement. “We believe this decision will best prepare the company and our centers for the post-pandemic world, and allow us to continue our focus on our people, the residents who we are privileged to serve and our dedicated staff.”

Sava at the time reported that it was in active talks with its landlords to find new operators for the swath of properties, and the story could emerge as one of the top M&A headlines of next year: The provider gave a target completion date of the end of 2021 for the handoff.

“The company will in turn make investments in remaining centers in three main areas: people, through increased incentives and benefits; care, in the form of infection preventionists, physician investments, and partnerships; and innovation, through new technology and equipment,” the company noted in a statement.