Occupancy ‘Relatively Flat’ As Medicare Continues to Play a Bigger Role in SNF Revenue

Skilled nursing property occupancy has been “relatively flat” since July, a trend that continued in the month of November.

The occupancy rate sat at 75.7% by the end of November, increasing a mere 28 basis points from September to October. That’s 381 basis points higher than the low point reached in January 2021 (71.9%).

That’s according to the most recent analysis from the National Investment Center for Seniors Housing & Care (NIC). The report is based on NIC MAP data released by NIC MAP Vision from 25 skilled nursing contributors across 46 states, totaling 1,225 properties.


Occupancy continues to stagnate compared to February 2020 levels of 86%.

“It was expected that admissions to SNFs would increase at a faster pace in 2021,” researchers stated in the report. “But the COVID-19 delta variant and staffing shortages across the industry posed significant challenges to operators.”

The omicron variant is expected to cause similar disruptions and additional pressure on occupancy in the winter months, something that is already playing out for some of the most active REITs (real estate investment trusts) in the health care space.


An increase to Medicare revenue mix – up to 20.3% at the end of November, a 23 basis point increase from October – was attributed to an increase in Medicare rates implemented in October. The revenue mix is still down from its pandemic high of 24.6%.

Medicare revenue per patient day (RPPD) decreased slightly from October to November, ending at $573; NIC reported the downward trend in Medicare revenue mix was likely due to a decrease in COVID-19 cases, resulting in fewer SNFs utilizing the three-day waiver.

The waiver was instituted by the CMS at the beginning of the pandemic in order to allow hospitals to reserve beds for severely ill patients, discharging those who could recover at a SNF.

Prior to the pandemic, a patient needed to have a three-day inpatient hospital stay before Medicare would cover the SNF stay that followed.

Managed Medicare patient day mix decreased slightly from October to 7.2% in November. That number is down from its high set in February 2021 (7.7%), NIC said.

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