Skilled Nursing Occupancy Downtrend Begins to Curb

Things could be looking up in the skilled nursing sector. The sector was hit hard during the pandemic, with occupancy falling dramatically, hitting a record low of 74.8% in June, according to a report from NIC. While the pandemic has been challenging for skilled nursing operators and owners, there seems to be some light at the end of the tunnel. While occupancy is continuing to trend down, the rate of decline is waning. According to the report, this new trend could indicate that the market is beginning to stabilize.

Things may be looking up for skilled nursing, but it may not be enough to offset the losses over the last few months. Since March the skilled nursing occupancy rate in the US fell by 853 basis points, and year-over-year, the occupancy rate is down 930 basis points. Urban areas are leading the decline in occupancy, down 970 basis points, while rural areas are down 539 basis points.

The pandemic hurt the market, but it wasn’t the catalyst for this downward trend in occupancy. Skilled nursing occupancy has been trending downward since 2015, when occupancy fell below 88%. The market had been trending downward; however, skilled nursing started to stabilize early last year, with hope for improvement. Following the pandemic, that trend changed, leading to occupancy effectively falling off of a cliff in March and bottoming out in June.

Skilled nursing has four main food groups that contribute to income for operators: Medicaid, Medicare, Managed Medicare and private care providers. Managed Medicare increased in June, and the revenue stream seems to be stabilizing. However, the segment is still down 303 basis points since February. The report notes that the stabilization of the revenue stream could mean that insurance enrollees have started to resume elective surgeries, which were canceled due to the pandemic.

Medicare trended down in June compared to May, but overall has been stable through the pandemic, and the patient mix has increased since March. One reason that Medicare has performed well through the pandemic is that Centers for Medicare and Medicaid Services waived the 3-Day Rule, which requires a hospital stay before staying in a skilled nursing facility.

Despite some reprieve, the skilled nursing sector is suffering from the impact of the pandemic. Most notably, legal issues that emerged during the pandemic have made nursing homes a liability. This liability and litigation stems from wrongful death lawsuits as a result of COVID-19. There have been 45,900 to 68,000 deaths in nursing homes resulting from coronavirus outbreaks. As a result, DBRS Morningstar revealed that it plans to review the ratings of CMBS with skilled nursing collateral.