NIC Notes

Insights in Seniors Housing & Care


By: Bill Kauffman  |  March 02, 2023

Skilled Nursing Occupancy Remains Below 80%

NIC MAP Data  |  NIC MAP Vision  |  Skilled Nursing  |  medicaid  |  medicare  |  occupancy

NIC MAP Vision released its latest Skilled Nursing Monthly Report on March 2, 2023. The report includes key monthly data points from January 2012 through December 2022.

Here are some key takeaways from the report:


Skilled nursing occupancy declined slightly, dropping one basis point from November to end December at 79.6%. Occupancy is up 182 basis points from one year ago in December 2021 as it continues to recover since the pandemic low of 73.6% set in January 2021. Occupancy has oscillated between 79.0% and 79.7% since May. Challenges do persist as staffing shortages continue to create difficulties within skilled nursing properties limiting the ability to admit new residents in some markets. However, the current occupancy trend does suggest that demand for skilled nursing properties is recovering, given the increase in occupancy in 2022. Occupancy remains low compared to February 2020 pre-pandemic levels of 87.8% (8.2 percentage points).

2023 NIC Notes Blog SNF Blog Slides Dec 2022 Graph 1


Medicare revenue per patient day (RPPD) increased slightly from November to end December 2022 at $593. It has increased 3.1% since September. Most of this increase in reimbursement is likely a result of the increase in Medicare rates to skilled nursing properties for fiscal year 2023 and potentially higher acuity patients, which also increases RPPD to care for more complex patients. Meanwhile, Medicare revenue mix increased for the third month in a row. It increased 56 basis points from November to end December at 22.6%. It is up from one year ago as well, increasing 196 basis points from December 2021.

Managed Care

Managed Medicare revenue mix declined slightly, dropping 25 basis points from November to end December at 10.2%. It has declined 163 basis points since its recent high of 11.8% in February 2022. However, it is up by 171 basis points from the pandemic low set in May 2020 of 8.5%. 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 $473 to $472 in December and is down 1.2% from last year in December 2021. It has decreased $120 (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 decreased to 63.8 % in December. However, it has increased 175 basis points from the pandemic low of 62.1% set in January 2021. In addition, Medicaid revenue mix decreased in December, representing just less than half of property revenue at 49.4%. However, it has increased 210 basis points from the pandemic low of 47.3% set in February 2022. Meanwhile, Medicaid revenue per patient day (RPPD) declined slightly to $265 in December. It increased 0.73% from $263 one year ago in December 2021.

Get more trends from the latest data by 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 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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