With COVID-19 Cases Plummeting, Nursing Homes ‘May Have Seen the Bottom’ of Record-Low Occupancy

The push to vaccinate nursing home residents and staff that has unfolded across the U.S. over the course of late December and January appears to be having some effect, at least in the number of COVID-19 cases among residents.

From January 3 to January 31, COVID-19 cases among nursing home residents went from 26,860 to 9,802, according to a new analysis from the professional services firm CliftonLarsonAllen (CLA) that drew on nursing home data publicly reported to the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC).

And though gains for occupancy appear to be incremental thus far, the numbers nationally are stabilizing after 2021 dawned with 80% census or lower in all of the 48 continental United States; occupancy sat at 68.6% nationally on January 3, and rose slightly to 69.2% by January 31.


“We may have seen the bottom in national median occupancy at the start of 2021,” CLA observed in the report.

But even with the vaccines “being aggressively rolled out,” that reduction in COVID-19 cases is not likely to result in an immediate census boost, Stephen Taylor, principal at CLA, told Skilled Nursing News on Wednesday.

“I’m not necessarily surprised that we’re seeing more of a stabilization of the occupancy, and then a small trend up, because I just don’t think that it’s going to be an immediate snap of the finger: Boom, our occupancy’s back up at 75%, 80%, 85%,” he told SNN. “Because there’s a lot of occupancy that has been taken out of the system, in essence.”


That said, the declines in occupancy have not been uniform across the U.S., as CLA’s last update noted, and the newest report highlighted some of the disparities across states. In some states where facilities have particularly high occupancies, there has been a slight uptick in median occupancy levels from January 3 to January 31 — but on the other end of the occupancy spectrum, some have actually seen their occupancies fall over the course of January.

Source: CLA

In CLA’s first occupancy dive, Texas emerged as the state with the lowest median occupancy, at 55.7%, and by the end of January, it had only fractionally improved, up to 55.9%.

But Texas is not a state that had 85% occupancy pre-COVID-19, Taylor pointed out, and at least some of the operators in the Lone Star State have familiarity with that reality; in some ways, it is apparent in the fact that Texas did not have a significant plunge in occupancy from the baseline of May 31, 2020.

But some other states did. Georgia, for example, saw SNF occupancy fall almost 10 percentage points from May 31, 2020, to the start of 2021. North Carolina’s fell about 9 percentage points, while occupancy in the state of Washington — where the first major COVID-19 outbreak in the country occurred in a SNF — fell 8 percentage points.

“You look at Texas — I don’t know why I keep picking on Texas — they certainly had a reduction in census, but it wasn’t like they lost eight or nine or 10 percentage points of occupancy,” Taylor observed. “Where some states like Georgia or Washington — Washington lost eight percentage points of occupancy, Georgia’s almost at 10. That’s a pretty significant reduction. And then you step back and think: Okay, how long is it going to take for them to potentially recapture where they were operating in the first place? And how long is that road to their recovery?”

Bar chart showing declines in occupancy, in percentage points, from the baseline date of 5/31/20 to 2021
Source: CLA

This is especially critical for operators in those states, which were chosen for notable declines in occupancy. The states include, from left to right above: Virginia, Rhode Island, Illinois, Indiana, Washington, Iowa, Mississippi, Alabama, Georgia and North Carolina.

Their recovery will depend on how well they can manipulate their various “operating levers,” Taylor said, such as adjusting staffing and managing operating expenses.

This is one area where the Pacific Northwest region might struggle, for instance; the states of Washington, Oregon, Idaho, and Montana reported staffing shortages at rates significantly above the national median throughout January, even though occupancy in those four states was below the national median from June 2020 to the end of January.

In January, the Pacific Northwest saw reported shortages of nursing and aide staffing at approximately 31%, compared with 19.5% reported as the national median, according to the CLA analysis.

How well operators adjust will depend on how good they were at using those operating levers before the pandemic, Taylor argued.

The significant amounts of relief funding from various government sources allowed some cushion for operators trying to manage those factors during the pandemic, Taylor said, but that will not last forever.

An operator’s ranking for referrals and discharges in their local market and their margins in operations pre-COVID-19 might be indicators of how well they will fare when federal aid runs out, he said.

“When inevitably those funding sources don’t continue, I think then that’s when you have to step back and say: Okay, without those additional funding sources, how proficient are these operators at operating at these compressed revenue numbers and pulling those various levers?” Taylor said. “How quickly would they be able to react to [a] rebound in census, and how long can they operate at this depressed census level?”

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