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Insights in Seniors Housing & Care


By: Bill Kauffman  |  November 10, 2021

Skilled Nursing Occupancy Increased at Slower Rate in August 2021

Market Trends  |  Skilled Nursing

Labor shortages and the delta variant likely limited further occupancy gains. 

NIC MAP® data, powered by NIC MAP Vision, released its latest Skilled Nursing Monthly Report on November 4, 2021, which includes key monthly data points from January 2012 through August 2021.   

Here are some key takeaways from the report: 

Skilled nursing property occupancy increased for a seventh consecutive month in August, albeit at a slower pace than recent monthly gains, rising only 14 basis points from July to 75.2%. The occupancy rate is now 378 basis points above the low point reached in January 2021 (71.4%).  At the beginning of the year there was cautious optimism for increased occupancy through 2021. However, the rapid spread of the contagious COVID-19 delta variant created additional challenges for skilled nursing operators to increase occupancy at a faster pace.  In addition, considerable labor availability issues within the skilled nursing sector have caused some properties to limit admissions due to staff shortages.  The question remains as to how fast the industry can increase occupancy to a sustainable level as staffing shortages are likely to remain. Occupancy remains low compared to February 2020 pre-pandemic levels of 85.6%. 

SNF Blog Slides August 2021 Slide 15 v3

Medicaid patient day mix edged higher, ending August at 66.1%.  It has increased 278 basis points from the pandemic low of 63.3% set in January 2021 and is close to its pre-pandemic levels. Meanwhile, Medicaid revenue mix increased slightly from the prior month, ending August at 50.4%. One element of the Medicaid revenue share of a property’s revenue is revenue per patient day (RPPD) and that has declined 0.8% ($2.08) since the pandemic high of $246.17 set in February 2021. RPPD has likely declined due to less reimbursement support from most states as COVID-19 cases within skilled nursing properties declined.   

Medicare revenue mix ended August at 20.3% and is down from its pandemic high of 25.0% set in January 2021. Medicare RPPD is down 2.4% ($14.03) from its pandemic peak of $576 in June 2020. Medicare revenue mix and RPPD continue to decline as fewer COVID-19 cases in properties have resulted in less need for utilizing the 3-Day rule waiver and per day reimbursement for COVD-19 positive patients.   Meanwhile, Managed Medicare revenue mix decreased slightly ending August at 10.4%.  However, this is 211 basis points above the pandemic low of 8.3% set in May 2020. 

SNF Blog Slides August 2021 Slide 13 v3

Managed Medicare revenue per patient day (RPPD) decreased in August and is down 4.1% ($18.90) from August 2020. The persistent decline in managed Medicare revenue per patient day continues to pose a challenge to skilled nursing operators as the reimbursement differential between Medicare fee-for-service and managed Medicare has accelerated during the pandemic. Medicare fee-for-service RPPD ended August 2021 at $562 and managed Medicare ended at $445, representing a $117 differential. Pre-pandemic, in February of 2020, the differential was $98.  As prior reports show, this trend will be monitored closely as operators and investors continue to adjust to the dynamics within healthcare delivery.  

To get more trends from the latest data you can download 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 in order to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form. NIC maintains strict confidentiality of all data it receives. 


Interested in learning more about NIC MAP data? To learn more about NIC MAP data, powered by NIC MAP Vision, and about accessing the data featured in this article, schedule a meeting with a product expert today.

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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