Ensign CEO: SNF-at-Home Models Are More Than Just a COVID Trend

As skilled nursing facilities across the U.S. have begun to see occupancy rates rise, policymakers continue to reevaluate where care is delivered in the post-acute setting. The pendulum continues to shift toward at-home care.

Just last month, the Biden administration unveiled a $400 billion plan to expand coverage of home-and community-based services, noting, in particular, that “more people should have the opportunity to receive care at home,” according to a White House fact sheet describing the plan.

Barry Port, CEO of The Ensign Group (Nasdaq: ENSG), said he sees the SNF-at-home model as more of an opportunity than a threat.


“This kind of concept has been raised by home health for a while now. What you are really talking about here is if there is an alternative model for taking care of a traditional custodial geriatric patient,” Port said Tuesday at the 2021 RBC Capital Markets Global Healthcare Conference. “The answer to that is, and has always been, ‘yes.’”

The San Juan Capistrano, California-based Ensign and its network of independent operating subsidiaries provide a range of skilled nursing and senior living services across 236 facilities in over a dozen states. Compared to industry peers, the operator has been relatively immune from COVID-era pressures.

The Ensign Group also offers physical, occupational and speech therapies, plus other rehabilitative and healthcare services.


Part of the reason Port isn’t overly concerned about SNF-at-home programs is because he sees a patient population that may not be best suited for at-home models.

“Our focus has been taking on more complex patients, and these are patients that have highly acute needs and need regular nursing therapy,” he said.

Still, he felt different strategies could be utilized in the coordination of care, where a traditional short-term patient needing continued services could be referred to a home instead of an outpatient facility.

“We’ve had some discussions at a high level about how we could potentially shift in alternative views and do some work in the home setting out of a skilled nursing facility,” he said. “The SNF at-home model is feasible and really something that we have been looking at for a long time with our partner Pennant.”

The Pennant Group (Nasdaq: PNTG) is a home health, hospice and senior living operator that spun off from Ensign two years ago.

A March 2021 report from Plante Moran, “How SNFs can emerge strong,” suggest that SNFs need to to get creative as they emerge from the pandemic. They could look into diversifying and specializing in one area, focusing clinical capabilities to care for a specific patient population that may be currently underserved.

SNF occupancy numbers coming back

According to the latest Stephens SNF Capacity Tracker, Ensign’s occupancy rose moderately throughout April, while the overall SNF industry’s occupancy levels also improved as vaccine distribution in nursing homes is largely complete.

In May 2021, Ensign’s skilled nursing occupancy was at 71.4%, while the industry was at 69.7%.

Port felt that Ensign’s ingenuity, particularly from its leadership, is how it was able to show industry-leading numbers through the pandemic.

“We saw many of our leaders flex and adapt to work within the storm rather than hunker down and let it pass,” he said.

Two of Ensign’s properties, one in Salt Lake City and the other in Arizona, exemplified this in particular.

“We saw one facility in the greater Salt Lake City market work directly with the COVID task force team in Utah and local acute hospitals to modify the entire facility and become a one-of-a-kind COVID-positive facility,” he explained. “It became an important offloading of acuity at hospitals, particularly with COVID-positive patients. Other facilities, like one in Arizona, positioned themselves with COVID-positive wings.”

Still, he expected post-acute care to return to near normal once the pandemic is behind it.

“I think there’s a little bit of an over-exuberance, as you’re talking about what can be accomplished in a home setting versus a health care setting,” he added. “Our expectation is that the managed care mix will return to pre-COVID levels as things start to normalize and occupancy grows. Managed care mix will start to look more like it did before.”

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