NIC Notes

Insights in Seniors Housing & Care


By: Bill Kauffman  |  December 01, 2022

Skilled Nursing Occupancy Declined in September 2022

Business Environment  |  Market Trends  |  Skilled Nursing  |  medicaid  |  medicare  |  occupancy

“Medicaid represents over half of the revenue for skilled nursing properties. It is vital for operators and investors to pay close attention to the reimbursement trends in their states as most states do not cover the cost of care.”

- Bill Kauffman

NIC MAP Vision released its latest Skilled Nursing Monthly Report on December 1, 2022. The report includes key monthly data points from January 2012 through September 2022.
Here are some key takeaways from the report:


After increasing for two months in a row, skilled nursing property occupancy declined from August to September, decreasing 40 basis points to 78.4%. Nevertheless, occupancy was up 188 basis points from one year earlier in September 2021 as it continues to recover since the pandemic low of 73.0% set in January 2021. Some challenges do persist as staffing shortages continue to create difficulties within skilled nursing properties limiting the ability to admit new patients in some markets. However, the current occupancy trend does suggest that demand for skilled nursing properties is recovering, given the 172-basis point increase from January to September this year (2022). That said, occupancy remained low compared to February 2020 pre-pandemic levels of 87.2% (8.8 percentage points).

SNF Blog Slides Sept 2022_working_Page_15


Medicare revenue per patient day (RPPD) decreased slightly from August to end September 2022 at $572. It has declined 3.1% since January when cases of COVID-19 were increasing in skilled nursing properties. The RPPD was higher in January likely because the Public Health Emergency (PHE) was still in place and the federal government had implemented initiatives to aid Medicare fee-for-service reimbursements to help care for COVID-19 positive patients requiring isolation. Meanwhile, Medicare revenue mix declined, falling 50 basis points from August to end September at 21.2%. It has also declined since January of this year when it was 24.4%.

Managed Care

Managed Medicare revenue mix declined slightly in September, dropping 19 basis points from August to to 10.2% and 130 basis points from its recent high of 11.5% in February. However, it is up by 211 basis points from the pandemic low set in May 2020 of 8.4%. Expectations are that it will continue to increase over time with the growth of Managed Medicare. Meanwhile, Managed Medicare revenue per patient day (RPPD) decreased from $461 to $460 in September and is down 1.7% from last year in September 2021. It has decreased $117 (20.2%) from January 2012 and continues to pressure some operators’ revenue as managed Medicare enrollment grows around the country. However, some operators see managed Medicare as an opportunity for growth in patient volume.


Medicaid patient day mix increased to 65.1 % in September and was up210 basis points from the pandemic low of 63.0% set in January 2021. In addition, Medicaid revenue mix increased in September, representing over half of property revenue. It has increased 345 basis points from the pandemic low of 48.3% set in February 2022. Meanwhile, Medicaid revenue per patient day (RPPD) held steady at $257 in September. It increased 1.2% from $254 one year ago in September 2021.

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Get more trends from the latest data by downloading the Skilled Nursing Monthly Report. There is no charge for this report.

The report provides aggregate data at the national level from a sampling of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form on our website. NIC maintains strict confidentiality of all data it receives.

About Bill Kauffman

Senior Principal Bill Kauffman works with the research team in providing research and analysis in various areas including sales transactions and skilled nursing. He has lead roles in creating new and enhanced products and implementation of new processes. Prior to joining NIC he worked at Shelter Development in investing/acquiring, financing, and asset management for over $1 billion in assets. He also had key roles in the value creation and strategic planning and analysis for over 65 entities. He received his Bachelor of Business Administration in Finance from the College of Business and Economics at Radford University and his Master of Science in Finance from Loyola College in Maryland. He also holds the Chartered Financial Analyst Designation (CFA).

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