SNF Occupancy Recovery in 2021 Hampered by Staffing Shortages, Lingering Covid Effects

Ongoing staffing shortages and the lingering effects of the Covid-19 pandemic hampered skilled nursing census recovery in 2021. Occupancy during that time frame was down 11.2 percentage points compared to pre-pandemic levels in 2019.

That’s according to the NIC MAP Vision skilled nursing annual data report, which includes metrics calculated based on a 12-month rolling basis. Data was collected from 25 contributors across 46 states – with a total of 1,226 skilled nursing properties represented.

As occupancy showed signs of recovery in early 2021, and there were expectations for continued improvement, both the delta and omicron variants impeded that upward trajectory.

Despite those challenges, occupancy “held steady” through the delta variant and the same appears to be the case so far when it comes to omicron.

Staffing shortages in 2021, and now through the first half of 2022, have continued to limit new admissions for many operators as well.

Medicare patient day mix decreased 72 basis points from 2020 to the end of 2021, a reversal from 2020 when it increased 61 basis points over a similar timeframe.

The authors of the report attributed this reversal to the fact that more patients were sick with COVID-19 in the first year of the pandemic leading to a “higher utilization” of the three-day rule waiver.

Suspension of the three-day stay requirement allowed Medicare patients to be discharged to a skilled nursing facility without having to stay at a hospital for at least three days, but the expectation among some of the top industry gurus is that the waiver will not become a permanent fixture.

Similarly, the Managed Medicare patient day mix increased 141 basis points from 2020 to 2021, ending the year at 7.4%. The authors attributed this to the growth in elective surgeries from the early days of the pandemic, which created additional referrals to SNFs.

The patient day decline from 2020 to 2021, along with a 80 basis point decline in Medicare revenue suggests operators utilized the 3-day waiver less in 2021, the report said.

Medicare revenue per patient day (RPPD) declined slightly to $567 at the end of 2021, down 0.9% from $572 at the end of 2021.

Despite reaching considerable lows in 2021, there appears to be some optimism as occupancy reached 77.1% at the end of March of this year, according to monthly data from the NIC MAP Data Service powered by NIC MAP Vision. The sector’s occupancy has increased 1.2% since January, according to the data.