Skilled Nursing Outlook 2024: Leaders Bullish on Occupancy But Recruitment, Retention Emerge as Significant Concerns

The year 2024 will pose a challenging landscape for skilled nursing professionals, with staffing problems still creating headaches. And yet, optimism is increasing and providers seem eager to drive expansion amid overall positive expectations for occupancy growth.

The Skilled Nursing Outlook 2024 survey, which SNN conducted in partnership with Net Health, points to leaders perceiving opportunities for mergers and acquisitions, advancing workforce initiatives, favoring value-based options and striving to attain accuracy for documenting Minimum Data Sets (MDS) in the coming year. Leaders expressed a keen interest in the development of Institutional Special Needs Plans (I-SNPs) and the integration of predictive analytics into operations.

Given this flurry of activity in the sector to achieve better quality of care outcomes and overcome challenges, more than half of respondents believe occupancy rates for skilled nursing, post-acute rehab and long-term care will all increase over the next year, according to SNN’s survey.


The latest survey featured responses from 123 industry leaders, the majority of respondents (54.47%) identifying themselves as skilled nursing owners or operators. Private investors or private equity companies constituted 0.81%. The survey also reflected a robust representation of leadership roles within the skilled nursing sector. C-suite level executives and owners accounted for 26.83%, while those in Senior Vice President (SVP), Vice President (VP), or Director positions constituted 36.59% of the respondents.

The survey represented the views of a wide variety of providers offering a range of skilled services, including a small minority (4.8%) of respondents offering both short-term rehabilitation and long-term care (LTC).

A significant portion of respondents (29.27%) reported managing two to 10 facilities, and another noteworthy group (18.70%) oversaw 26 to 100 facilities.


From November to December 2023, SNN conducted this survey to gain insights on the top trends, challenges and opportunities in the year ahead, as well as to gauge how providers will navigate the changing operating environment.

To get a deeper look at the skilled nursing landscape, download the complete results here.

Staffing challenges shaping the future

Respondents were candid about the challenges shaping the skilled nursing landscape in 2024. Recruitment and retention emerged as the most significant concern, with a substantial 50.41% ranking it as the primary challenge. This emphasizes the critical importance of workforce strategies in sustaining and advancing the sector.

Jen Gross, Post-Acute Informatics Specialist with Net Health, told SNN that her organization was seeing the same challenges with staffing during the “Skilled Nursing 2024 Executive Outlook: Staffing, Reimbursement, M&A in Turbulent Times” webinar.

“And we’re seeing [challenges] both in black and white from the data from Five-Star and from various state staffing metrics, but also anecdotally from our clients in the amount of turnover that they’re having with the staff who interface directly with us via their MDS submissions,” she said.

Gross said that it is key for providers to ensure that the staff that they do have are being used appropriately for the acuity in the high risk areas in their facilities.

Yet looking into the future, survey respondents expressed a cautiously optimistic outlook for the next 12 months. About 50.41% anticipate an increase in occupancy rates for skilled nursing and post-acute rehab.

Financing preferences and impact of value-based care

On the questions pertaining to M&A plans – and the type of financing sought – for 2024, leaders were open to a carefully considered approach within the industry. Of the respondents who were seeking financing in 2024, about 17% stated a preference for banks or financing companies (17%), followed by private equity (14%). Moreover, about 26% of the respondents plan to hold on to their SNF assets, although a majority of respondents (56.10%), noted that the question of buying, selling, or holding SNF assets was not applicable to their organizations.

Meanwhile, private equity was predicted to be the most substantial buyer of skilled nursing assets in 2024, with 46.34% of respondents sharing this view.

In delving into their investment strategy for 2024, respondents highlighted multiple areas of interest. Deepening relationships with Accountable Care Organizations (ACOs) (21.14%) and embracing new technology platforms (17.89%) were key priorities, showcasing a strategic alignment with evolving healthcare models.

Furthermore, about 16% of SNF leaders said value-based care initiatives had a positive impact on their organization, with almost 11% of respondents saying that they were planning to invest in an I-SNP in 2024.

Steve Nee, CEO of Diversicare Healthcare Services, said that there will be “winners and losers” in the value-based care market.

“We have begun to see a significant shift in recent years with many, including ourselves, focusing more diligently on providing better care at a lower cost through strategic partnerships,” he said. “Those that provide exceptional care deliver positive clinical outcomes and reduced shared costs will be the winners in that scenario, and will be compensated accordingly, which underscores the need for SNFs to properly align themselves rather with strategic partners.”

Nee said that 16 of Diversicare’s 45 centers are currently using an I-SNP plan.

“We are actively in discussions with additional I-SNP providers to grow in our other states, specifically Texas,” he said. “Another strategic approach for us has been co-memberships. So, presently 41 of our 45 centers are participating in ACOs and or preferred partnerships with local hospital systems with an additional two centers beginning participation.”

The survey also showed that the impact of value-based care on revenue and success in 2023 was varied, with 43.09% of respondents reporting no impact and 33.33% indicating a somewhat negative impact, suggesting ongoing adaptation to the evolving reimbursement landscape.

Innovations for future preparedness

As far as technologies that are effectively helping organizations prepare for the future of skilled nursing, predictive analytics to improve resident outcomes emerged as the most favored (48.78%).

Yet technological adoption, while recognized as critical for future preparedness, faces challenge due to costs and logistics. Respondents identified the primary barrier to be cost (53.66%), followed by integration with existing technology (14.63%).

Peggy Connorton, Associate VP of Healthcare Regulation at Covenant Retirement Communities, emphasized the importance of using predictive analytics to ensure accurate data, particularly in coding MDS correctly before submission to CMS.

This accuracy not only affects reimbursement but also ensures that quality measures accurately reflect facility performance, she said. Secondly, with accurate data in hand, Connorton suggested moving into prediction and prevention using resident-level predictive analytics.

“Using resident level predictive analytics helps to manage risks and prevent any further quality measure triggers or any unplanned hospitalizations or other adverse outcomes that could negatively impact your residence in your facility of course, but also your performance in the BBP program,” she said.

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