As skilled nursing facilities roll up their sleeves at varying rates for the vaccine against COVID-19, their clinical situation amid the pandemic is improving rapidly, a turnaround from 2020 made almost fully complete with the distribution of vaccines.
But the financial outlook, shaped by dismal occupancy numbers that show no signs of recovery, is becoming dire, Mark Parkinson, the president and CEO of the American Health Care Association (AHCA), said during a Wednesday discussion at Skilled Nursing News’ virtual Payments, Policy, and Capital Summit.
Toward the end of 2020, occupancy was at roughly 71% to 72%, down from roughly 80% at the start of the pandemic — but that was before the third wave of COVID-19 that hit in November and December of 2020.
Ultimately, that third wave led to a hit on SNF census that led to them being down roughly 13% to 14%, “a much tougher hole to dig out of,” Parkinson said.
But there are some grounds for optimism in the vaccine rollout, at least in terms of the impact the inoculations will have. While staff uptake rates of the COVID-19 vaccine have been slower than most operators would like, high rates of resident participation could signal a light at the end of the tunnel in terms of new cases, which hit a peak the week of December 20, 2020 with more than 30,000 new COVID-19 cases in facilities.
That number fell to 17,000 in the last reporting period, and based on his conversations with providers, Parkinson believes the numbers will continue to decline.
“I believe there’s a very real possibility that in the next 30 to 60 days, we’re going to see continued plummeting in the number of new cases of COVID in our facilities, and therefore a real, significant reduction in deaths,” he said. “As the vaccination program rolls out, as more people in the general public become vaccinated, and certainly the vaccination in our buildings, I really think that 2021 will be a year of recovery on the clinical side, and the worst numbers are behind us.”
No recovery without visitation
The vaccine clinics will help considerably in ending the “clinical part of the nightmare” that has been COVID-19 for SNFs. Once two to three weeks pass after the second clinic, those who have been vaccinated will have developed antibodies to COVID-19, Parkinson noted.
After that comes the hard part. The recovery needs to be significant, and it needs to come significantly faster than it did before the third COVID-19 wave, he said.
“I think the census needs to recover about 1% a month. If we can recover 1% a month on a steady basis, you know, that gets us to the end of 2021,” Parkinson said. “And we’re still down, but we’re down 5% or 6%; we’re not down 13% or 14%. If we recover a half a percent, some businesses will be okay, but not all. If we only recover half a percent, we don’t get any more money, folks are going to have problems. If we don’t have any recovery on census … things are very, very bad.”
SNFs have been hammered on occupancy since the start of the pandemic, and unlike their home health counterparts, they have not seen referrals recover even as hospitals have begun to reinstate elective surgeries.
In some parts of the country, occupancy rates are as low as 55.7%, according to a recent analysis from the professional services firm CliftonLarsonAlan (CLA).
At least on the clinical side, Parkinson sees 2021 as a year of recovery. While the rollout of vaccines to a wider population has been the target of widespread criticism, the Pharmacy Partnership for Long-Term Care Program has been fairly successful, he said. Though staff uptake has been disappointing – at around 37.5%, according to the Centers for Disease Control and Prevention (CDC) – resident uptake has been quite high, somewhere around 80% to 90%, he noted.
The success of vaccination, both in communities in long-term care facilities is directly linked to several factors that tie into COVID-19 in nursing homes, Parkinson stressed. If more members of a community are vaccinated, community spread will decline — reducing the risk of one of the top predicting factors of COVID-19 outbreaks in nursing facilities. That in turn would send hospitals back to a more normal mode of operations, which might in turn make them more inclined to send referrals to SNFs.
“There are a number of layers to it,” Parkinson said of recovery. “But they all start with the vaccine. We’ve got to get the vaccines in the buildings, and we’ve got to get people to actually take the shots.”
Several operators have indicated to SNN that nursing home visitation rules are based on the policies of their local health departments and case counts in the surrounding area, rather than vaccination rates. But Parkinson believes that operators who are able to convince their staff to get vaccinated in large numbers “are going to have an enormous competitive advantage,” when it comes to making a case for hospital referrals and restoring trust among the public.
“I really think the market is going to require that in order to recover on census,” he said. “I also think that CMS could easily issue some regulations here, fairly soon, that’ll open up visitation — but only if there has been a certain threshold met in terms of staff uptake, like 70% or 80% of the staff have taken the vaccine.”
And visitation is emerging as one of the most critical considerations for occupancy; family members are naturally wary of putting their loved ones into facilities with the possibility of COVID-related lockdowns looming large, and those who have loved ones in the SNF setting are increasingly anxious to see them as the vaccination program rolls out.
That makes it all the more paramount for facilities to ensure vaccine uptake among staff, especially as CMS and the CDC evaluate the data on vaccines and COVID-19 rates in SNFs.
“I think that recovery of the sector is completely tied to visitation,” Parkinson said. “People do not want to have their loved ones admitted into a facility when they can’t visit them, and nobody wants to move to a facility when they can’t have visitors.”