With Private Rooms ‘Non-Negotiable’ Moving Forward, Time to Renovate Nursing Homes is Now

Whether COVID-19 will usher in a permanent demographic shift toward post-acute and long-term care in the home remains uncertain, but there’s clear evidence that single-occupancy rooms are becoming less of a nursing home luxury and more of the baseline cost of doing business.

The demand for privacy had been growing before the pandemic, consulting firm Plante Moran observed in a new report, and the trend will only accelerate in the coronavirus’s wake.

“Moving forward, private rooms will become non-negotiable, as will enhanced infection control and safety protocols that may not have been part of normal operations historically,” the firm observed. “Take a look at your dining and common areas. How can you balance opportunities for social interaction with infection control?”


The pandemic has trained a harsh glare on the state of nursing home infrastructure, which typically consists of the oldest senior-care facilities in their given marketplace — and features double, triple, or even four-person rooms along with shared bathrooms. In addition to fostering an institutional culture, this reliance on multi-person rooms made physical infection control strategies such as isolation and cohorting a heavy lift for many operators, while also boosting demand for in-home services as a substitute for SNFs.

Building new long-term care inventory has long been dismissed as too expensive and impractical for investors, who blanch at the thought of putting up capital for a product that relies so heavily on state-level Medicaid reimbursements.

Plante Moran counters that narrative by encouraging operators to consider repurposing their existing structures, using the Green House Project’s model as a guide. The non-profit, which promotes the development of “small house” nursing home campuses, has touted the remarkable infection-control results achieved at Green House-style communities during the pandemic, with substantially lower COVID infection and death rates than their more traditional counterparts.


“Due to smaller facilities and tighter social circles, Green House residents are one-fifth as likely to contract COVID-19 and one-twentieth as likely to die from it,” Plante Moran observed. “You don’t have to tear down and rebuild to apply these concepts. Consider turning each wing of a building into its own neighborhood.”

Such overhauls could become more common as operators consider voluntarily reducing bed counts, both to reflect lower demand for institutional care and to capitalize on certain cost-saving efficiencies; Marc Zimmet, president of consulting firm Zimmet Healthcare Services Group, has also noted that hospital discharge planners have increasingly required the availability of single rooms before making a referral, turning privacy into an imperative to maintain any type of intake flow.

Writing in the wider context of COVID-19’s impact on skilled nursing facility operations and finances, Plante Moran emphasized that the window to make changes could be brief given the amount of financial support that Washington has pumped into the sector.

“Remember that there will be a day when that funding is no longer available, but consumers will still expect private rooms and enhanced infection control protocols,” the firm noted. “Take advantage of today’s funding to make the changes that will keep your SNF competitive in the post-COVID-19 marketplace.”

Plante Moran’s other suggestions for adapting to an uncertain future include specialization targeted at specific demographic needs in a given market, and figuring out exactly how to market each facility’s unique value to referral partners.

“If a SNF can show that they have high-quality ratings, low readmission rates, and they can care for higher-complexity patients at a lower cost than another setting, that is going to be an attractive value proposition for a hospital or health system — especially one that participates in an ACO or other value-based payment program,” the firm observed.

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