The following analysis examines occupancy and year-over-year changes in inventory, and same-store asking rent growth—by care segment—within CCRCs and non-CCRCs in the 99 combined NIC MAP Primary and Secondary Markets. The analysis also highlights occupancy by payment type (entrance fee CCRCs vs. rental CCRCs), and the relative performance of for-profit CCRCs and not-for-profit CCRCs during the second quarter of 2022—by region.

NIC MAP^®, powered by NIC MAP Vision, collects primary data on occupancy, asking rents, demand, inventory, and construction for more than 15,000 independent living, assisted living, memory care, skilled nursing, and continuing care retirement communities (CCRCs—also referred to as life plan communities) across 140 U.S. metropolitan markets. The dataset includes 1,173 not-for-profit and for-profit entrance fee and rental CCRCs in these 140 combined markets, including 1,097 in the 99 combined Primary and Secondary Markets.

2Q 2022 CCRC Market Fundamentals. CCRC occupancy increased to 86.0% in the second quarter of 2022 for the 99 NIC MAP Primary and Secondary Markets aggregate, up 0.5 percentage points (pps) from the prior quarter, a level 6.9pps above the occupancy rate for non-CCRCs (79.1%).

From its time series low of 84.2% reached in the second quarter of 2021, CCRC occupancy increased by 1.9pps but remained 5.5pps below its pre-pandemic level of 91.5% in the first quarter of 2020. Alternately, non-CCRC occupancy gained 4.0pps from year-earlier levels but still has the most room to make up with a gap of 6.7pps from pre-pandemic level.

In the first quarter of 2020, before the pandemic began to influence the senior housing sector, the gap between CCRC and non-CCRC occupancy rates was 5.8pps. In the second quarter of 2022, the gap between CCRC and non-CCRC occupancy rates stood at about 7.0pps, down 2.8pps from its pandemic high of 9.7pps in the first quarter of 2021 but still 1.1pps wider than it was pre-pandemic.

By Payment Type. In the second quarter of 2022, entrance fee CCRC occupancy (88.3%) was 6.2pps higher than rental CCRCs (82.1%). Compared with the first quarter of 2020, entrance fee CCRCs are now 4.7pps lower, while rental CCRCs remained far below pre-pandemic levels by 7.0pps.

While possible recession scenarios continue to develop, senior housing occupancy continues on the road to recovery, reinforcing confidence and optimism among senior housing constituents. As background, the recently released NIC Intra-Quarterly Snapshot report featuring NIC MAP data, powered by NIC MAP Vision (available for download), showed that the occupancy rate for senior housing (majority independent living and majority assisted living properties) for the 31 NIC MAP Primary Markets increased to 82.0% in the July 2022 reporting period, up 0.7pps from the June 2022 reporting period (2Q 2022) on a three-month rolling basis. This was the largest monthly gain since October 2021.

By Care Segment – CCRCs Maintained Higher Occupancy Rates but Relatively Smaller Asking Rent Growth Compared with Non-CCRCs

The table below illustrates the relative market performance of CCRCs compared with non-CCRCs by care segment in the second quarter of 2022 and includes year-over-year changes in occupancy, inventory, and asking rent growth. Note that CCRCs often offer both entrance fee and rental contracts to give residents financial choice and flexibility. NIC MAP categorizes CCRC communities by the contract type held by the majority of residents.

Occupancy. Overall, occupancy for CCRCs continued to outpace that of non-CCRCs across all care segments. The difference in second quarter occupancy between CCRCs and non-CCRCs was largest for the independent living segment (7.7pps), and smallest for the nursing care segment (2.2pps).

The CCRC independent living care segment had the highest occupancy (89.1%) in the second quarter of 2022, followed by CCRC assisted living and memory care (84.8% and 84.0%, respectively). Although in terms of occupancy improvements from one year ago, the independent living segment had the smallest gain across all care segments for both CCRCs and non-CCRCs.

Asking Rent. While monthly average asking rent for CCRCs across all care segments remained higher than non-CCRCs, non-CCRCs experienced stronger asking rent growth in the past four quarters, with assisted living reporting the highest year-over-year asking rent growth in the second quarter of 2022 of 4.2%, and nursing care reporting the lowest (2.5%).

Similarly, the highest year-over-year asking rent growth for CCRCs was noted in the assisted living segment (3.5%). Note, these figures are for asking rates and do not consider any discounting that may be occurring.

Inventory. From year-earlier levels, inventory for CCRCs decreased (or shifted) across all care segments except memory care, while non-CCRCs saw increased inventory in all but nursing care. Nursing care inventory for both CCRCs and non-CCRCs decreased by 3.4% and 1.0%, respectively. Negative inventory growth can occur when units/beds are temporarily or permanently taken offline or converted to another care segment, outweighing added inventory.

Historically, CCRCs had reported lower rates of inventory growth (year-over-year change in inventory) by segment than non-CCRCs. In the second quarter of 2022, the highest year-over-year inventory growth was reported for the non-CCRC independent living and memory care segments (5.4% and 3.0%, respectively).

Not-for-Profit CCRC Occupancy is Relatively Higher Compared with For-Profit CCRCs

Among the 1,097 CCRCs spread across the 99 Primary and Secondary Markets tracked by NIC MAP Vision, approximately 70% are operated as not-for-profit, and 30% are operated as for-profit.

In the second quarter of 2022, not-for-profit CCRC occupancy (87.3%) was 5.0pps higher than that of for-profit CCRCs (82.3%) within the NIC MAP Primary and Secondary Markets. As shown in the table below, not-for-profit CCRCs have higher occupancy rates than for-profit CCRCs across all regions except in the Pacific. The largest differences in the second quarter occupancy between not-for-profit CCRCs and for-profit CCRCs were in the West North Central (11.8pps), followed by the Southwest (10.0pps), and the Southeast (6.8pps).

For not-for-profit CCRCs, the Mid-Atlantic (89.7%), West North Central (89.5%), and Southeast (88.1%) regions had the strongest occupancy rates in the second quarter of 2022. The East North Central region had the lowest occupancy at 83.9%.

For for-profit CCRCs, the Pacific (90.0%), Northeast (83.9%), and Mid-Atlantic (83.7%) regions had the strongest occupancy rates in the second quarter of 2022. The Southwest region had the lowest occupancy at 76.6%.

Look for future blog posts from NIC to delve deep into the performance of CCRCs.

Are you interested in learning more?

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

It’s simple, right? Increase revenue or decrease expenses. Those are the two ways to boost net operating income (NOI). Ideally, senior housing and skilled nursing operators can do both.

But in today’s inflationary economic environment, increasing NOI and profitability can be a challenge. Higher wages and the cost of supplies are cutting into NOI. Occupancies are still recovering from the fallout of the pandemic, though operators do report some pricing power with recent rate hikes.

“We are looking at ways to create operating efficiencies, increase occupancy and drive rates,” said Adam Kaplan, CEO at Solera Senior Living.

Kaplan spoke on a panel at the 2022 NIC Spring Conference titled, “How to Increase NOI Today, Tomorrow and into the Future.” He was joined by Lynne Katzmann, president & CEO at Juniper Communities, and Peter Longo, managing partner at Cantex Continuing Care Network. The session was moderated by Joel Mendes, senior director, Seniors Housing Capital Markets at JLL.

Each panelist showcased their proven strategies to boost NOI.

Solera positions itself as the price leader in the market. “We are focused on quality and being the best in every market where we operate,” said Kaplan. Solera provides a premium level of services, high-quality food options, robust engagement programs, and the latest technology.

The strategy has helped to sustain high occupancy levels along with the ability to raise rental rates by as much as 7-10%. Kaplan added that local supply and demand dynamics determine how much rents can be raised. “We take a very granular approach,” he said.

Efficient building designs help drive top line results and generate attractive yields for investors, Kaplan said. For example, new Solera properties have a single community entrance for all levels of care. The design creates a better resident experience and reduces expenses — only one entrance has to be staffed.

Juniper Communities leverages care integration to increase length of stay and augment care charges to boost NOI. Katzmann noted that care coordination is not the same as care integration. The approaches have some commonalities such as developing care plans and monitoring residents around the clock.

Care integration also includes primary care practitioners on site. Juniper’s Connect4Life model integrates onsite primary care, pharmacy, and lab services. “We started our own primary care practice,” said Katzmann. The practitioners can note changes in resident health and take quick action. They also serve as a support for the community team.

Primary care practitioners enter their notes into an electronic system at the community, so coordination is seamless. “We act as a bridge between chronic care management and the medical system,” said Katzmann. “Our resident outcomes are better which impacts NOI.”

Higher NOI, Higher Value

Juniper conducted research on the impact of care integration on NOI. Juniper compared its population to the general population and found that the hospital readmission rate was 80% lower among its residents. The use of the emergency department was 15% lower.

The study showed an increase in NOI of $113,000 a year per property, Katzmann said. Assuming an 8% cap rate, for example, property value would be increased by $1.4 million.

Juniper also introduced a Medicare Advantage Plan. This allows Juniper to be paid for care integration from the savings it produces for Medicare.

Panelist Longo at Cantex, which owns and operates a number of skilled nursing facilities, started a Medicare Advantage plan for residents. “It’s had a major impact on how we deliver care and the outcomes,” he said. Residents can sign up for the Medicare Advantage plan. Nurse practitioners deliver care. Cantex is rewarded for better outcomes since healthier residents need less care and fewer expensive interventions.

Practitioners can coordinate home health and hospice care for residents not in the plan. Another benefit: The staff at the building has embraced the approach. “Nurse practitioners proved their worth during the pandemic,” said Longo.

Session moderator Mendes posed a question to the panelists: How much does it cost to set up a Medicare Advantage plan?

“You need capital,” said Longo, adding that it could cost $1 million or more depending on state regulations and other requirements. Scale is also necessary. He said that 60-80 residents are needed for it to make sense to hire a nurse practitioner. About 5-10 facilities should be geographically clustered to share services and circulating nurse practitioners.

Kaplan agreed that a wellness approach is integral to a high-quality operation. At Solera, nurses are available 12 hours a day, every day. But the healthcare operations run in the background. “We focus on lifestyle,” he said. “We are at the intersection of healthcare, real estate and hospitality.”

As the session concluded, panelists agreed that technology, while expensive, is a must-have to boost NOI. The right technology allows the company and the staff to operate efficiently. The ability to capture and communicate real time data is also critical to demonstrate value to partners.

The 2022 NIC Fall Conference is coming up next month. See upcoming sessions and register today.

NIC Analytics released the 1Q2022 NIC Lending Trends Report today. The quarterly report, available for free to NIC’s constituents, currently tracks $86.5 billion in senior housing and nursing care loans. The report includes data for over five years of construction loans, mini-perm/bridge loans, and permanent loans from 3Q2016 through 1Q2022.

While there was a 39.4% quarter-over-quarter increase in new senior housing construction loans closed in first quarter 2022, new nursing care construction loans closed increased quite notably (over 600% on a same-store quarter-over-quarter basis). Though this increase is partially explained by a very small number of new nursing care construction loans closed in the prior quarter, it is still the largest same-store quarter-over-quarter increase for nursing care new construction loans in the recorded time series to date. This blog discusses the key takeaways from the first quarter report.

Takeaways from the 1Q22 NIC Lending Trends Report.

• Nursing care new construction loan closings were very strong in first quarter 2022 following a weak fourth quarter 2021. Partially due to the low fourth quarter, the quarter-over-quarter same-store growth for nursing care new construction loan closings was 645.8% in first quarter 2022. Senior housing new construction loan closings also picked up in first quarter 2022 from fourth quarter 2021 at a growth of 39.4% on a same-store quarter-over-quarter basis. However, the senior housing new construction loan volume closed was below its recent peak in third quarter 2021.
• Delinquencies were quite flat in first quarter 2022. Nursing care delinquencies remained unchanged from fourth quarter 2021, and senior housing delinquencies had a modest increase of 5.0% on a same-store quarter-over-quarter basis. This increase for senior housing was less than half of its increase in fourth quarter 2021 (13.6%). Delinquencies for both senior housing and nursing care were below 1.5% of total loans (1.1% for senior housing, 1.4% for nursing care). There were no foreclosures for the sample in first quarter 2022.
• New mini-perm/bridge loans closed for senior housing were down in first quarter 2022 from their recorded high in fourth quarter 2021, but were still well above the levels from second quarter 2020 through third quarter 2021. On a same-store basis, the quarter-over-quarter decline was 50.7% for senior housing. Nursing care mini-perm/bridge loan closings remained at a high level, but also had a decline in first quarter 2022 from the fourth quarter 2021. However, the decline for nursing care mini-perm/bridge loan closings was more modest at 7.2%. Last quarter we posited that the heightened mini-perm/bridge loans in combination with the lowered permanent loans may reflect that some lenders may currently be more comfortable issuing a mini-perm over permanent loan for some deals.

These data are not to be interpreted as a census of all senior housing and skilled nursing lending activity in the U.S., but rather reflect lending activity from participants included in the survey sample only.

The 2Q2022 NIC Lending Trends Report is scheduled be released in mid-November 2022.

Interested in participating? The NIC Lending Trends Report helps NIC Analytics to deliver on NIC’s mission to enable access and choice by further enhancing transparency of capital market trends in the senior housing and care sectors. We very much appreciate our data contributors. This report would not be possible without them.

If you would like to participate and contribute your data, please contact us at analytics@nic.org. As a courtesy for providing data, data contributors receive this report early before publication on the website. The information provided as part of the survey will be kept strictly confidential. Individual answers will be combined with the answers of all other respondents. Data acquired from this survey will only be reported in the aggregate, and therefore, the resulting aggregated data will not be attributed to you or your company upon distribution.

The Endemic Staffing Crisis

NIC Co-Founder and Strategic Advisor Robert Kramer has identified “Six Key
Drivers” that will shape the senior living industry over the next 10 years. Kramer
is also Founder & Fellow at Nexus Insights, a think tank to advance the well-being of older adults through innovative models of housing, community, and healthcare. What follows is an analysis of the second key driver: the workforce.

While senior living providers struggled with labor shortages prior to the pandemic, the crisis not only exacerbated the problem but brought into bold relief the enormous staffing challenge the senior living industry will continue to face over the next 10 years. Just as the pandemic has become endemic—a situation we must adjust to and live with—so too the staffing crisis will be an ongoing issue that requires radical new approaches.

Our industry has historically struggled with workforce issues that were often viewed as correlated with the economy. Low unemployment rates have always been a challenge for the industry.

The crisis today, however, is clearly not just a question of a tight labor market. It is rather a recognition that senior care providers are not just competing to be the employer of choice among other senior care and aging services providers but also with the broad scope of employers in retail, hospitality and healthcare.

It is critical that we compete for the best workers. Staff shortages are a detriment to our residents and our business. The quality of care suffers when too few workers are trying their best to take care of residents. Overworked employees can get stressed, leading to absenteeism and turnover. Providers that face a staffing shortage often have to limit new admissions.

The old approaches alone won’t work. New, innovative ideas are essential to meet this ongoing endemic labor challenge. Here are five short- and long-term strategies to consider:

1. Recast our relationships with frontline and other hourly employees.

   We need to rethink how we view and interact with our hourly employees. Prior to the COVID-19 outbreak, many operators and providers were focused on their hourly staff only from the time they clocked in for a shift to the time they clocked out. What happened outside that shift was not really relevant to us. That approach became totally inadequate during the pandemic. Workers with young children at home needed to care for them when the schools were closed. Workers were worried about feeding their kids who received free, nutritious meals at school which were no longer available. Our hourly workers weren’t just worried about providing dinner but having to provide three meals a day. Added to that, family members, and the workers themselves, got sick and needed help. Scheduling disruptions were common.

   
   

   I believe that a significant shift in our approach is needed for our providers to be successful employers of choice in the future. We need to move from a transactional relationship with hourly employees to one of empathy and understanding.

   
   

   We can’t solve their problems, but we can help to address the issues these hourly workers bring with them to work. What does that mean? This is often a population in poverty or struggling to stay out of poverty. They are often juggling multiple jobs as well as multiple assistance programs that they hope to qualify for or continue to qualify for. They are overwhelmingly female, and a significant number are people of color. About a quarter are immigrants. Many are single mothers with children. Understanding these issues means addressing everything from daycare and housing to that last mile of transportation to get to work and even domestic and spousal abuse.

   
   

   In her book, Workforce Stability, author Ruth K. Weirich, shows that increased worker stability boosts productivity, retention, and morale, leading to greater profitability. The question is how to create an environment that supports workforce stability.

   
   

   Weirich points to the huge gap that exists between management and employees. Management is often so far removed from the world of the hourly worker that it’s hard to have any understanding, let alone empathy for the daily world of survival that these employees and their families face. We have to start there. Without understanding and empathy we cannot do what’s necessary to boost morale and retain good workers.

   
   

   Let me emphasize that we are not going to solve all their problems. But we can demonstrate our empathy and be willing to partner with them to be part of the solution.

   
   

   For example, maybe that means providing day care on site, or partnering with a childcare program. Maybe it means aligning with a domestic abuse center so employees can get free access to confidential services. Perhaps the human resources team needs to be trained on how to navigate various housing and government assistance programs. That’s not what you normally think of as a duty for your HR/benefits team. But if your employees are struggling to get support from these programs, you either need to contract with someone to provide that assistance or you have to offer that expertise in house.

   
   

   The more employees realize that they’re getting help with these tangible issues that they struggle with outside of work, the more you will become the employer of choice. In turn, they are going to pass that word along to their family and friends.

   
   

2. Highlight our purpose-driven work.

   
   

   As the acuity level among residents continues to rise, the industry already has a reputation of paying low wages for demanding work. But we also have a good story to tell. Senior living provides the satisfaction of a job with purpose. Not every employer can say that. We can promote personal connections and how we make a difference in people’s lives which can be enormously attractive to potential workers.

   
   

   Millennials and members of Gen-Z, in particular, are looking for purpose driven work. These young people want to feel they are making a difference in what they do, not just “holding a job.” Older workers are often looking for purpose in a second career. We offer what these groups are seeking. The added benefit is that we will expand our pool of potential workers to groups that the industry has largely ignored (see point #3 below).

   
   

   Sometimes residents and employees can even find purpose together.

   
   

   For example, at two Goodwin House properties in Virginia, the staff included a large number of immigrants, many of whom for years had been seeking U.S. citizenship. So, the communities started a program to help. Residents raised money to pay the fees for filing for citizenship and tutored employees on civics. A front-page story about the program appeared in the Washington Post and the community’s recruitment efforts soared.

   
   

   At another community during COVID, a resident asked a frontline caregiver how she kept going because it was so tough. The frontline caregiver said she was concerned about her three children—ages four, six and eight—who were not learning at home. The resident was an educator and knew many of the other residents had college and graduate degrees. So, they started an online tutoring program for the staff’s children.

   
   

   Bottom line: If we want our employees to treat residents like family, we have to treat our employees like family too. We must demonstrate that we care about the details of their lives and their daily challenges, just as we want them to care for the details and daily challenges in the lives of our residents.

3. Expand our pool of workers.

   
   

   With low birth rates, competition for workers will become more intense. Though the senior living industry has typically targeted workers in the 35-55 age group, we need to expand our workforce to recruit those who are younger and those who are older.

   
   

   In the wake of the pandemic, Millennials and Gen Z now understand the effects of social isolation and loneliness and have increased empathy for older people. As I mentioned in the previous point, these younger generations don’t want just a job. They want to know their work has meaning and purpose. We need to highlight that our jobs make a real difference in people’s lives. This is enormously attractive to younger people.

   
   

   Older workers can help fill the gaps too. In Japan, for example, people aged 60-80 provide care and companionship for those age 80-110.

   
   

   Retirees here are exploring “encore careers.” These second careers combine continued income, personal meaning and social impact. The key is that these older workers, like their younger counterparts, want to help others. Take, for example, someone who has retired from decades of government service or clerical work. An “encore career” in senior living offers the spirit of service and a paycheck.

   
   

   Another interesting idea is to engage residents as volunteers. This model could be especially useful for middle market properties. The nonprofit 2Life Communities, in their new Opus middle market community, will require residents to volunteer 10 hours of their time every month to help out. Residents can help at the front desk, work in the library, coordinate activities, or perform other duties. An unexpected benefit is that new residents are attracted to the community because of its focus on volunteerism.

   
   

   Immigration initiatives are going to be key to address workforce shortage now and in the future. Immigration is critical to attract workers who both value service and esteem older adults. We must pursue opportunities to advance immigration at the state, federal and company level.

4. Emphasize training and career paths.

   Workers often leave their jobs because of an issue with their direct manager. The manager may be unaware of the worker’s situation or may not be providing the necessary support for the worker to be successful. Are our managers trained to develop a relationship with the worker? Do the managers listen? Are they engaged with the worker during those critical first 90 days on the job? The same holds true for frontline workers. Are they being properly trained? Do they understand their job and the company’s values? How are you investing in them to make them feel supported?

   
   

   Establish a career path for workers. Show them how they can advance and help them do it. A structured program can help caregivers become certified as CNAs and CNAs become LPNs. Line cooks can be trained to become chefs. Housekeepers can become supervisors. Consider a scholarship program for those seeking the credentials needed to advance. Or offer scholarships in return for a set number of years of service. Another idea is to develop relationships with community colleges and nursing schools to provide internship opportunities and a recruitment pipeline.

5. Leverage technology.

   Senior living providers are adopting innovative strategies to screen potential employees. Machine learning is being used to find applicants who want to serve others. Finding the right employees by asking the right questions can boost retention efforts.

   
   

   Technology will also free workers from some rote tasks. The goal of technology is not efficiency, which is simply the byproduct, but to enable the staff to have more real interactions with residents. The employee has the time to chat with residents and ask how they’re feeling that day, instead of rushing to quickly perform a task and move on or being bogged down with paperwork.

   
   

   For example, the Japanese market has pioneered the use of “smart” diapers. Equipped with sensors, these diapers not only alert the staff when a resident is wet or soiled but also perform an instant urinalysis. This tells the staff whether the resident is dehydrated and at risk for developing a urinary tract infection. The technology eliminates the need for the staff to perform the routine and invasive checks that can lead to confusion and sometimes anger on the part of the resident. The worker in that situation doesn’t feel good either. The technology frees up staff time so they can engage with residents in ways that improve their quality of life.

The pandemic made a difficult staffing situation much worse and just as the pandemic looks to be endemic so too the staffing challenge is going to be endemic and require new, creative solutions. If we are only competing on wages, we are going to keep losing and will continue to have high turnover. Paying fair and competitive wages is essential, but the challenge is much deeper. We must engage workers beyond the hours of their shift and demonstrate empathy and willingness to come alongside them in their challenges. We must rethink our role and deploy a range of short- and long-term strategies to win the competition for talent.

Next Up—Key Driver #3: A New Customer Arrives with a Different Take on Longevity. Our new customers want their lifespan to match their healthspan or wellspan. We need an engagement view of aging and retirement shaped by growth and opportunity, not by deficits and decline.

“Skilled nursing occupancy held steady in May, as operators still confront a challenging operating landscape amidst high inflation and staffing challenges.”

– Bill Kauffman

NIC MAP Vision released its latest Skilled Nursing Monthly Report on August 4, 2022. The report includes key monthly data points from January 2012 through May 2022.

Here are some key takeaways from the report:

Skilled nursing property occupancy increased in May, albeit slightly. It increased 9 basis points from April, ending the month of May at 77.3%. In the last three months, skilled nursing occupancy has hovered in the range of 77% which is the highest occupancy level since April 2020, at which time occupancy began to fall rapidly due to the onset of the pandemic. Occupancy continues to recover since the pandemic low of 72.1% set in January 2021 but has encountered challenges such as new COVID-19 variants, e.g. Delta and Omicron. In addition, staffing shortages continue to create difficulties within skilled nursing properties limiting the ability to admit new residents. However, the current occupancy trend does suggest that demand for skilled nursing properties is recovering, given the 149-basis point increase from January to May. Occupancy has increased 307 basis points from one year ago and 518 basis points from its pandemic low.

Skilled mix increased 10 basis points from April to end May at 25.8%. This increase seemingly was driven by Medicare as its patient day mix increased from the prior month and managed Medicare patient day mix decreased in the same period. Managed Medicare patient day mix decreased 7 basis points to end the month of May at 7.6% and Medicare increased 13 basis points ending the month at 11.7%. Skilled mix has increased 11 basis points compared to one year ago. In addition, in a similar trend to patient day mix, Medicare revenue mix increased from the prior month. It increased 49 basis points from 20.8% to end the month of May at 21.3%. This suggests that skilled nursing operators increased the use of the 3-Day Rule waiver as COVID-19 cases increased in the month of May.

Managed Medicare revenue mix decreased 18 basis points in the month of May, ending the month at 10.6%. After increasing 13 basis points from March to April this year, it is now down 82 basis points from 11.4% in February. Historically, there has been declines in the managed Medicare revenue mix from the winter to spring months, which suggests lower volumes in the springtime whereas the winter months typically have an increase due to slips and falls, more illnesses, and elective surgeries. In addition, Managed Medicare revenue mix has increased 251 basis points from the 8.1% pandemic low set in May 2020. Meanwhile, managed Medicare revenue per patient day (RPPD) continued its decline, decreasing from $456 in April to $454 in May. It has decreased 1.84% from the prior year in May 2021.

Medicaid patient day mix increased for the third consecutive month, although only increasing slightly from April to May. It increased 3 basis points from the prior month to end May at 65.9%. Its patient day mix has increased 293 basis points from February, while Medicare patient day mix decreased 255 basis points in the same period. Some of the explanation of this increase in Medicaid patient days is due to the decline in COVID-19 cases relative to February as operators moved residents back to Medicaid days from Medicare days, after requiring isolation and higher skilled care.

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 to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form. NIC and NIC MAP Vision maintain strict confidentiality of all data received.