Skilled Nursing Admissions Shrink as Home Health Stabilizes

Skilled nursing admissions continue to stumble toward recovery “with no clear end in sight” as others along the care continuum – like home health – are starting to steady.

That’s according to the 2021 post-acute industry trends report from Atlanta-based health analytics company Trella Health. The report spans topics including admissions and utilization data in skilled nursing, home health and hospice, as well as Medicare Advantage enrollment, among others.  

Specifically, skilled nursing admissions declined more than 24% between Q1 2019 and Q3 2021 – from 511,100 to 436,100 respectively.


Nursing home admissions saw a minimal increase from 432,200 in Q2 2021 to 436,100 in Q3 2021, according to the data.

“The skilled nursing industry has suffered massively due to the ongoing pandemic,” the report states. “Staffing shortages continue to plague agencies to the point where, anecdotally, some facilities have been forced to turn patients away.”

Nursing homes have lost nearly 238,000 nursing home employees – amounting to 15 percent of its total workforce – since the start of the COVID-19 pandemic, Bureau of Labor Statistics data shows.


The report also noted that between Q3 2020 and Q3 2021, skilled nursing admissions correlated with COVID-19 cases in the U.S., and therefore it is expected that Q4 2021 admissions would also show a similar increase.

“Despite billions of dollars provided through the Provider Relief Fund (PRF) to skilled nursing facilities, the decrease in admissions and increase in costs associated

with the pandemic has left many agencies in precarious financial positions,” the report states.

Skilled nursing utilization declined 3.2% from Q3 2019 to Q3 2021 – dropping from 24.7% to 21.5%. Meanwhile, adherence to SNF instructions after an inpatient discharge remained stable.

Trella Health noted those two factors – the decrease in utilization combined with consistent adherence to inpatient discharge instructions to SNFs – shows a decrease in Medicare beneficiaries voluntarily entering skilled nursing care without instruction.

This decrease could be attributed to patients’ fears of COVID-19 outbreaks in SNFs, the report notes.

“To gain more admissions, the skilled nursing industry must rebuild its reputation of

delivering safe and effective care while immediately targeting inpatient discharges with

skilled nursing instructions to gain more admissions,” according to the report.

Meanwhile, quarter home health admissions between Q4 2020 and Q3 2021 indicate market stabilization, the report notes. The biggest issue the home health industry faces, like many other health care sectors, are the challenges surrounding staffing.

“The demand for home health care services currently appears to outstrip the supply, indicating a need for investment in acquiring and retaining caregivers,” according to the report.

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