Slow and uneven recovery of occupancy raises questions about long-term care home stability

While many qualified providers in the nursing industry expect the resumption of occupation to be at least a year away, as the census climbs to numbers not seen since 2020, some remain less convinced that nursing of long duration will rebound completely.

“I think the truth for most of the industry is that we now thought we would be in the new normal,” Ray Thivierge, SavaSeniorCare’s chief strategy officer, told Skilled Nursing News. “We knew the occupancy was going to be somewhat diminished from where we were, but I think now we realize that our long-term care occupancy may never recover.”

As SavaSeniorCare continues to divest from the skilled nursing space after moving a long-term care portfolio of 29 assets last September, it remains one of the largest short- and long-term healthcare providers term with SNFs in 23 states.

A recent Pulse survey conducted by Skilled Nursing News also gave a window into current expectations for resuming occupation. Although unscientific and relatively small in size, the survey showed that providers believe staffing issues will continue to prevent a full recovery that some had hoped would happen now.

Of the survey respondents – 30 in all, ranging from small, medium and large operators – 86.7% had not returned to pre-pandemic levels. In fact, more than 20% of respondents said they didn’t expect occupancy to fully recover until the second half of 2023, while 6.9% said it wouldn’t. before 2024 or later.

Only 13.33% of respondents said facility occupancy had already returned to pre-pandemic levels.

The resumption of the occupation remains difficult to predict

American Health Care Association President and CEO Mark Parkinson recently told Skilled Nursing News that despite some encouraging signs in early 2022, the industry is likely still a full year away from a full recovery. .

With occupancy still falling and operational challenges forcing some facilities to close, Parkinson said he’s concerned that the timing of Medicare’s proposed cuts could further hamper the industry.

Earlier this month, CMS unveiled a 4.6% reduction in the patient-oriented payment model (PDPM) and a 3.9% increase in Medicare payments for the sector. The reduction in PDPM equates to a total loss of $320 million in Medicare funding, according to the agency.

Although not quite at pre-pandemic levels yet, Wesley Rogers, President and CEO of Brickyard Healthcare, is more optimistic that Brickyard will get there sooner rather than later.

He told SNN that after hitting a pandemic low around November and December, Brickyard installations have steadily increased.

“I don’t think it’s going to take another year, as long as we can be in a good position with low levels of Covid positivity,” he explained. “The past two months have been better for us with less Covid positivity and more stabilized staffing for our care centers.”

Since January 2021, the number of occupants at Brickyard has increased from 1,596 to 1,917 patients, a growth of approximately 20%.

Growing from a large, multi-state operator of skilled nursing facilities to a Midwest-based healthcare provider group, Brickyard Healthcare changed its name from Golden Living earlier this year as it appears to be a provider more regional.

“What we’re seeing now is a higher volume of referrals and inquiries about nursing home placements, more than we even saw before the pandemic,” Rogers said.

Rogers attributed the census improvements seen at its facilities to improving Covid numbers and dwindling agency staff.

But this transition was not so easy for everyone.

For vendors that operate in states with a minimum staffing requirement, including 13 SNN Pulse survey respondents, most – 84.62% – said their need to meet the requirement resulted in an increase in agency staff.

In states like New York, which reportedly has the largest Medicaid reimbursement shortfall in the nation, staffing agency cost spikes would be exorbitant, with some agencies charging as much as $70 per hour for certified practical nurses (CNAs ).

With a new staffing law now in effect in the state, such budget shortfalls may not be realistic for some operators in the future, especially if federal funding dries up.

References come back for some but not for others

Hospital referrals continue to drive care home enumeration and for operators who said their enumeration was back to pre-pandemic levels, getting those referrals proved to be a big reason.

Half of respondents to SNN’s survey said the return of hospital referrals helped increase occupancy, followed by higher acuity (25%) and the ability to fully staff buildings in personal (25%).

“There have been situations where we’ve had to suspend admissions at certain times over the past year, but we’re no longer in a position where we feel compelled to do so,” Rogers said. “We were able to get to a much better place with our staffing levels.”

While that may be the case for a regional carrier like Brickyard, Biden’s efforts to expand home and community services (HCBS) have put some smaller, single-installation carriers like Wisconsin-based Odd Fellow Home in a worse position. difficult.

CEO Charlene Everett said she’s seen a decrease in referrals to Medicare as long-term care moves to the home.

“One of the things I see that’s preventing a full recovery…is that I think the healthcare community has realized they can skip the nursing stage on discharge,” she said. told SNN. “There are people who historically would have been referred to a nursing home for therapy following hip replacement surgery and they are sent home without treatment for the patient.”

In fact, for operators who had not returned to pre-pandemic occupancy levels, most cited staffing issues limiting admissions as the main reason (57.69%), while decrease in referrals from hospitals and acute care partners (15.38%) was also taken into account. an overriding factor as well, according to the survey.

Everett is dealing with both right now.

“We are suffering from staffing issues,” she said. “I have a fully closed wing and am planning a second closed wing because we can’t stop it.”

Odd Fellow Home, an 88-bed skilled nursing facility part of Odd Fellow Rebekah Home Association Inc., hit 70% occupancy at one point during the pandemic, but that number fluctuated throughout.

“When Medicare resumes, then our census improves. The long-term care census has remained fairly stable, so it’s basically whether or not we get the referrals and that’s down right now,” she said.

Before Covid, the Odd Fellow Home daily tally was between 82% and 84% but as of this month that number has dropped to 59%.

“Covid pretty much destroyed my campus and it started with the census,” Everett said. “The census that stayed high was the state-funded census, medical assistance.”

Short-term solutions without long-term solutions

The skilled nursing sector faces strong headwinds in the near future as Medicare cuts, staffing minimums and therapy cuts have all been on the table in recent months.

More than a third of U.S. nursing homes could be at financial risk if the Centers for Medicare & Medicaid Services sticks with its funding cut proposal and federal Medicaid dollars tied to the public health emergency end in 2022.

Since 2015, more than 1,000 nursing homes have closed, including 327 during the pandemic. That number could jump to more than 400 SNFs in 2022 alone, according to a report by AHCA/NCAL.

“The last two years have been a nightmare,” Everett said.

A silver lining for Odd Fellow Home was when the National Guard was sent to help nursing homes in several states, including Wisconsin. More than twenty states called in the National Guard to support nursing homes most recently during the winter months of 2021.

For Odd Fellow Home, the 11 National Guard members sent to the facility proved invaluable, but with them gone, Everett must wonder what to do next.

The National Guard worked as CNAs at the nursing home as they cared for patients who were ready to be discharged to nursing but had previously remained in the hospital due to staffing limitations.

Odd Fellow opened part of a 20-bed wing for patients, providing the right level of care at the right time.

“I’m sorry to see them go,” Everett said. “The downside is that we were able to take a few more admissions because we have the guard here, but now the guard is leaving and the residents aren’t. So we are faced with this.

Everett said she again had to stop admissions.

“I’m hesitant to quit my job because I don’t know where this campus is going. We are too small to hold the weight for a very long time,” she said. “I don’t know what’s going to happen to long-term care, that’s a concern. The county houses, the little houses, the county-funded houses, the non-profit organizations, they are the ones who are going to suffer.

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