Leadership Huddle: Brokers are Optimistic

Leadership Huddle: Brokers are Optimistic

The latest installment of NIC’s highly popular “Leadership Huddle” webinar series, titled “A Conversation with Brokers During a Pandemic,” took place Thursday, June 4. As thousands of attendees have come to expect, a panel of industry leaders provided timely insights in a lively discussion moderated by NIC Chief Economist, Beth Mace. Thursday’s discussion focused on the perspectives of the nation’s top brokerage firms on the impact of COVID-19 on their businesses.

In her opening remarks, Mace reflected on the continuing need for the webinar series, which was launched in the middle of March in response to the need for information as the seniors housing and care sectors found themselves on the frontlines of the COVID-19 pandemic. “We continue to hold them because so much uncertainty remains in the market today.” She acknowledged that operators across the sector, “continue to work around-the-clock to protect residents and support front line workers,” adding that, “many of the challenges that were evident in the first days of the pandemic remain, unfortunately, especially when it comes to testing and tracing.” As in previous webinars, Mace highlighted the ongoing need for sufficient PPE, testing, and tracing in seniors housing and care properties, and acknowledged the tireless efforts and sacrifice of operators and frontline care workers who are fighting to protect residents’ lives across the country.

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Mace also addressed the need for transparency across the sector: “In a continuation of our mission, NIC encourages transparency in our collective understanding of the virus. As the COVID-19 pandemic has developed, it has become increasingly clear that the availability of data on impact of the virus on the seniors housing and skilled nursing communities is vitally important.” She expressed gratitude to the many operators and capital providers who continue to provide NIC with their data, “even during these very difficult times, so that we can provide transparency into the market. These data providersare improving transparency which leads to credibility, and ultimately trust, by educating not just investors and other operators, but also policy-makers and the general public.”

As the discussion kicked off, Charles Bissell, Managing Director in JLL’s Seniors Housing Capital Markets Group, reflected on his experience dating back to 1986 during the savings and loan crisis, which he experienced in hard-hit Texas. “I can tell you that was probably the deepest cycle that I’ve seen in my career. In Texas not a deal was getting done for a period of several years,” he said. “I’ve seen a few cycles and learned how to get through them, and I do know there’s light at the end of the tunnel here with the COVID pandemic.”

Panelists shared how their businesses are being impacted today. Bissell said, “I’d say, from a broad perspective it’s slowed down a little. We had a lot of things in the pipeline that we were starting to market. Those deals that got signed up pre-COVID ultimately have closed, but some have had some adjustments. Depending on the nature of the seller, some deals are ploughing forward, while other sellers have asked us to put things on hold to see when things become a little more normalized. Now, we are also getting some new requirements: re-financings, people that are having to restructure their debt situations, some sales where people have a need for liquidity or they may have had very successful projects that are still doing well and they don’t want to sit around for who knows how long and they want to test the market. So…we’re busy, but it’s different.”

Richard Swartz, Vice Chairman, Cushman & Wakefield, has had a similar experience. “At the time COVID hit the U.S., we had about $2 billion of assets somewhere in our pipeline, either in marketing or under letter of intent (LOI) or under contract. The vast majority of that has been put on pause. Some of the transactions have continued to move forward slowly. There are significant barriers to getting a transaction done at present. Everything from how do you get a lender to tour the building, how do you get your third parties done, how do you effect a license transfer, how do you even record the deeds when in some cases the county offices are closed. Those barriers have really slowed the transaction flow down. Like Rick said, we are starting to get more inquiries. I’d say the last two weeks have probably been more active than all of April and May together in terms of calls and people starting to look at going back to market, looking for financing, looking for equity for new developments, even. So, we are starting to see signs of life and hope that continues forward.”

Ben Firestone, Executive Managing Director and Co-Founder, Blueprint Healthcare Real Estate Advisors, said that about half of his business is skilled nursing focused. “That submarket has been impacted perhaps more greatly as it relates to actual census and operating expenses. But, it’s a little bit more resilient and need-driven. The capital markets and buyers and the cap rate environment continue to prevail.”

Asked whether government reimbursement was adding investor confidence in skilled nursing, Firestone replied that stimulus money could be temporary relief for a sector hard-hit with dropping occupancy rates and rising costs. He pointed to recent actions from HUD to loosen restrictions and provide an easier path to financing as playing a role, as well as the nature of skilled nursing buyers. “The behavior of the buyers in the (skilled nursing) market is a little bit different,” he said, contrasting them to seniors housing buyers’ behavior, “which is more in line with commercial real estate, traditionally.”

Going back to underwriting, Bissell acknowledged a lack of comparable sales, saying “we’re not even trying to look at comps now. It is very much property by property and it’s very much focused on discounted cash flow. Take the pre-COVID financials, see what happens to the property during COVID, and then make some reasonable go-forward assumptions over a five or seven-year hold period. Some properties experience a significant hit to occupancy. We’ve heard of some dropping 10, maybe even 15 percentage points. Some, on the other hand, have really experienced no change. So, obviously the underwriting for those two properties would be quite different.”

He said investors don’t expect much rental-rate growth for the next 18 months, “but in tight markets you may see some growth.” He also pointed to elevated expenses, “We’ve had elevated expenses due to COVID in relation to the purchase of PPE, hero pay, and  higher staffing expenses just overall, using agency and other sources. So, depending on how aggressive you want to get, you burn those down over time. What we try to do is talk to the buyers, find out what they’re doing, and if the buyers are forecasting a burn down of those expenses over twelve months, that’s how we would model it.”

On finance, Bissell pointed out that rates are attractive for Fannie, Freddie, and HUD, and activity in lending markets is beginning to pick up. “You’re able to layer that debt in and do an after-debt cash-flow analysis. The leveraged cash-flow returns for most of the investors we’re talking to haven’t really changed. They’re still seeking the same type of leveraged return. They’re just being more selective, and they may stress-test that cash-flow a lot more aggressively and run a lot more variations to determine their pricing at the end of the day.”

On the elevated expenses associated with fighting COVID, such as PPE and additional staffing costs, Bissell said, “buyers and lenders will recognize those as one-time non-recurring expenses. The properties will not be hit with those (expenses) going forward. Any operator out there that’s not isolating those expenses, should be.”

Firestone agreed, “we’re underwriting one-time expenses and trying to put those ‘below the line’ where possible.” On cap rates, he said, “I think cap rates on skilled nursing in particular will stay stable. From a leveraged stand-point, from the seniors side you’re still seeing attractive rates…but you’re seeing sizing go down, which is an indication of risk and how the institutions are looking at risk and…that’s going to affect pricing eventually.” He sees pro formas “stretching out to longer time horizons,” impacting seniors housing.

In skilled nursing, Firestone said, “in the short run we are going to see Medicaid rate increases in various states, which is going to help, and probably out-pace that seniors housing private-pay rent growth acceleration.” He pointed out that economic factors that impact consumers’ willingness to pay, such as jobs and home values, will have less impact on skilled nursing, which is “far more based on entitlement programs and reimbursement rates.”

Mace asked Swartz for his perspective, particularly on whether the agencies are requiring greater reserves. “Yeah, the agency requirements for reserve sizing have definitely tightened up.” he said. “I would say we still look, as a metric, at stabilized NOI with a traditional cap rate as a starting point, and then we’ll maybe deduct out of that capitalized costs for additional COVID-related expenses over, say, 18-24 months and we’ll do the same thing for occupancy. Even pre-COVID we were used to marketing a lot of properties that were still in their lease-up.” Swartz said buyers are looking for safety in those 12-24 months, “so, I think we’re going to see some structured deals as well, to help compensate for that.”

Despite the impacts of COVID-19, and a barrage of headlines, capital remains available, according to the panelists. “There’s a lot of capital in the market. The groups that we know that were running funds are still raising capital. I think they believe that long-term the demand for seniors housing is not going to change. In fact, we all know demographically its going to keep growing; it’s a need-based service.” Said Swartz.

“It seems every phone call I get is a little bit more optimistic,” said Bissell. “I agree with Rick. The long-term outlook for seniors housing hasn’t changed. There could be a few side-effects of this situation that benefit us. We could see a slow-down in new development, which will eventually result in increasing occupancy levels.” He also pointed to decreased construction costs and the prospect of a “much more favorable” labor market as potential boons to the sector in the long-term.

Firestone’s perspective is similar, “There’s so much capital on the sidelines that needs to enter into this space and will support pricing in the long-run.” Comparing seniors housing to other property types, such as hospitality, retail, and industrial, Firestone said, “We saw last recession seniors housing was last in, first out, and I think hopefully we’ll see that again, with therapies and vaccines and different ways to contain the pandemic…I like the 80 million baby boomers coming on line and I like that eventually that story of putting your loved one in a seniors housing community will come back with a vengeance; so, I’m optimistic.”

Panelists see signs that investors are beginning to see opportunities in the market. “There’s a lot of private equity capital out there that has been waiting years for the opportunity to buy on a distressed basis in the senior housing space.” Said Bissell, who described several deals currently in the works on distressed properties. “I think we’re going to see quite a lot of activity and…a lot of it will be lender-driven.”

Although also seeing interest from potential buyers, Firestone doesn’t see distressed properties becoming “bottom-feeding” deals. “I just don’t think it’s there yet…that bid/ask spread is still too wide. You’ve got so many bidders and so much money and so many buyers out there, so that’s eventually going to support pricing. I don’t think we’re going to see an environment of deeply discounted sweetheart deals. They’re going to be few and far between.”

Jobs Increase by 2.5 million in May and Jobless Rate Retreats

Jobs Increase by 2.5 million in May and Jobless Rate Retreats

The Labor Department reported that jobs rose by 2.5 million in May, while the jobless rate fell to 13.3%, a surprising outcome given the severity of pandemic-related lockdowns on the economy and other recent less bullish measures of economic performance. The increase in May followed a loss in jobs of 20.7 million in April, which was the largest decline in records dating back to 1939. Analysts had predicted an increase in the employment rate to 19% and a decline of 7.5 million jobs in payrolls.

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The May unemployment rate was down 1.4 percentage points from 14.7% in April to 13.3% in May. As recently as February it was at a 50-year low of 3.5%. During the 2008/2009 recession, the unemployment rate peaked at 10%.

The underemployment rate or the U-6 jobless rate slipped back to 21.2% from 22.8% in April.
This figure includes those who have quit looking for a job because they are discouraged about their prospects and people working part-time but desiring a full work week. In the previous 2008/2009 recession, this rate peaked at 17.2%.

In the BLS report, the following comment was provided to explain the surprising drop in jobless number: “If the workers who were recorded as employed but absent from work due to “other reasons” (over and above the number absent for other reasons in a typical May) had been classified as unemployed on temporary layoff, the overall unemployment rate would have been about 3 percentage points higher than reported (on a not seasonally adjusted basis). However, according to usual practice, the data from the household survey are accepted as recorded. To maintain data integrity, no ad hoc actions are taken to reclassify survey responses.”

Revisions also subtracted thousands of jobs in the prior two months. The change in total nonfarm payroll employment for March was revised down by 492,000 from a loss of 881,000 to a loss of 1.4 million and the change for April was revised down by 150,000 from a loss of 20.5 million to a loss of 20.7 million. With these revisions, employment in March and April combined was 642,000 less than previously reported. Monthly revisions result from additional reports received from businesses and government agencies since the last published estimates and from the recalculation of seasonal factors.

unemploymentindustryadjusted

Average hourly earnings for all employees on private nonfarm payrolls rose in May fell by 29 cents to $29.75 but was up 6.7% from year-earlier levels.

The labor force participation rate, which is a measure of the share of working age people who are employed or looking for work edged up by 0.6 percentage point to 60.8%. Total employment, as measured by the household survey rose by 3.8 million in May to 137.2 million, following a large decline in April.

Separately, the Labor Department reported yesterday that initial claims for unemployment insurance totaled 1.9 million jobs in the week ending May 30. Continuing claims, a measure of ongoing unemployment reported with a one-week lag increased to 21.5 million. Also the Federal Reserve’s Beige Book showed economic activity continuing to deteriorate even in regions that started to remove lockdown measures at the end of April and the beginning of May, suggesting a rebound in jobs will still be limited.

Today’s report was much stronger than expected and is welcome news because it could indicate that the labor market is starting to stabilize. However, while some businesses may gradually return to “normal”, not every sector will recover at the same pace. In the meanwhile, and tragically, millions of people are suffering from illnesses, anxieties and deaths associated with the pandemic and from the human tragedies associated with of the collapse in the national and global economies.

Executive Survey Insights Special Report: Owner/Operators of CCRCs

This report on the findings from NIC’s Executive Survey highlights responses from CCRC organizations compared to responses from non-CCRC organizations

NIC’s Executive Survey of operators in seniors housing and skilled nursing is designed to deliver transparency into market fundamentals in the seniors housing and care space at a time where market conditions are rapidly changing—providing both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions.

This report is a subset of the findings from NIC’s Executive Survey. Highlights of the responses from owner/operators of CCRC organizations are compared to responses from non-CCRC owner/operator organizations collected near the beginning of the COVID-19 pandemic through the end of May. Detailed reports for each “wave” of the survey can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Key Findings

  1. The COVID-19 pandemic has caused the pace of move-ins for all seniors housing and care communities to slow. However, CCRC properties have experienced less disruption on move-in rates and have seen greater stability in occupancy rates than non-CCRC properties.
  2. The impact of the virus among non-CCRC seniors housing and care properties has been swifter and more significant than for CCRCs.
  3. The pace of move-outs for CCRC properties has been less effected than for non-CCRC properties over the course of the pandemic to date. More non-CCRC organizations have reported growing shares of acceleration in move-outs by care segment than CCRCs.
  4. The largest impact on move-ins and move-outs among care segments has been on nursing care. As the highest acuity care segment, nursing care has experienced the most negative impact of the COVID-19 pandemic on occupancy levels and this has grown over time.

Pace of Move-Ins and Move-Outs

  • Approximately one-third to one half of CCRC organizations reporting on their independent living, assisted living, and memory care units in Waves 6 and 7, across their respective portfolios of properties, saw a deceleration in move-ins from the prior month (52%, 42% and 32%, respectively). This compares to 42%, 31% and 21% in Waves 1 and 2—amounting to roughly a ten-percentage point difference—highlighting the growing influence of the COVID-19 pandemic on move-ins as time has passed.
  • In contrast, the virus’s effect on move-in patterns among non-CCRC seniors housing and care segments was more significant. Approximately two-thirds to three-quarters of non-CCRC organizations reporting on their independent living, assisted living, and memory care units in Waves 6 and 7 saw a deceleration in move-ins from the prior month (65%, 72% and 68%, respectively). This compares to 67%, 69% and 62% in Waves 1 and 2.
  • The CCRC memory care and assisted living segments reported the least change in the pace of move-ins in both timeframes, and the CCRC memory care segment saw a greater share of acceleration in move-ins in across the board in Waves 6 and 7.

NIC Executive Survey CCRC pace of move insNIC Executive Survey non-CCRC pace of move ins

  • The largest impact among care segments has been on nursing care. Nearly two-thirds of the sample’s CCRC organizations with nursing care beds (65%) saw decelerations in the pace of move-ins in Waves 6 and 7, compared to just over half in Waves 1 and 2 (53%). However, more non-CCRC organizations with nursing care beds noted declines in the pace of-move-ins. Nearly three-quarters of the survey sample’s non-CCRC organizations with nursing care beds (73%) noted decelerations in the pace of move-ins more recently than in the earlier days of the COVID-19 crisis (68%).
  • There is greater stability in the pace of move-outs reported by CCRC organizations compared to non-CCRC organizations. A potential reason for this survey finding could be that CCRCs offer multiple care segments (at a minimum, independent living and nursing care) typically by a single provider on one campus, and this full range of services allows residents to remain within the community as their care needs change.
  • The majority of both CCRC and non-CCRC respondents noted no change in the pace of move-outs across the duration of the pandemic to date, apart from the non-CCRC nursing care segment. However, for non-CCRC properties, each care segment showed larger shares of organizations reporting an acceleration in move-outs as the COVID-19 pandemic progressed.

NIC Executive Survey CCRC pace of move outsNIC Executive Survey non-CCRC pace of move outs

  • Some possible explanations for the relatively better performance of CCRCs during the pandemic may include the following considerations:
    • While many CCRCs accept nursing care residents from outside of the community, the majority guarantee access to current residents. Furthermore, non-CCRC organizations with nursing care beds may have seen a greater effect on move-ins as the virus caused hospitals to curtail elective surgeries, reducing the amount of short-term, rehabilitation residents.
    • Non-CCRC residents tend to move in older and have more care needs, especially in the higher acuity settings. CCRC residents, on the other hand, tend to enter the independent living care segment of the community at younger ages and in better health both physically and cognitively, having planned to live on a campus that can meet any care needs they may have in the future without having to make a move from the community.
    • Multiple levels of care often spread out across a large footprint may make it easier for CCRC operators to distance vulnerable residents from others augmenting protection from contagion that is harder to do in properties that are home to residents with more diversity of care needs under one roof.

NIC Executive Survey CCRC change in occupancyNIC Executive Survey non-CCRC change in occupancy

Changes in Occupancy Rates

  • The highest acuity segments have experienced the most negative impact of the coronavirus on occupancy levels and this has grown over time. Shares of CCRC and non-CCRC organizations reporting a decrease in occupancy in the past 30-days are higher in Waves 6 and 7 than in Waves 1 and 2.
  • The nursing care segment for both CCRCs and non-CCRCs reported the highest shares of organizations with occupancy declines over time (from 61% to 67% for CCRCs and from 68% to 78% for non-CCRCs).
  • The memory care and assisted living care segments have seen the most change in occupancy from earlier in the pandemic to recently. Roughly three-quarters of CCRC organizations with memory care segment units (73%) and more than half with assisted living (59%) reported no change in occupancy from the month prior in Waves 1 and 2 compared to 43% and 47%, respectively, in Waves 6 and 7.
  • Conversely, among the same non-CCRC care segments, there were more organizations reporting a deceleration in occupancy which widened over time—from 49% to 75% in assisted living—and from 42% to 70% for memory care.
  • The independent living care segment has seen less downward pressure on occupancy compared to the assisted living, memory care and nursing care segments. Only about one-third of CCRC organizations reported occupancy declines in independent living between when the survey began to recent times (29% and 33%, respectively). However, more non-CCRC organizations with independent living reported occupancy declines in both timeframes (42% and 63%, respectively).

In conclusion, while the pace of move-ins has decelerated with the progression of the COVID-19 pandemic across all types of seniors housing and care communities, CCRCs have experienced less disruption, translating into more occupancy stability than non-CCRCs. 

These survey results are consistent with what has been reported in the NIC MAP® data analysis of the performance of CCRC care segments compared to non-CCRC care segments in the past. As detailed in a recent blog post breaking down the market fundamentals at the care segment-level, CCRCs have reported stronger occupancy rates than freestanding and combined non-CCRC care segments.

During the great recession, CCRCs struggled with declining occupancy due to a strong development pipeline that delivered inventory during a devastated housing market, which made it difficult for residents to sell their homes to move into CCRCs. Additionally, adverse and uncertain economic conditions raised barriers to moving into choice-based, lifestyle-focused CCRCs. However, CCRC occupancy rebounded during the recovery period following the great recession, and since then, CCRC inventory growth has been muted compared to other seniors housing property types. For the past several years, CCRC occupancy rates have outpaced their non-CCRC counterparts.

Going forward, CCRCs entered the COVID-19 pandemic from a position of relative occupancy strength and have performed better than non-CCRCs in terms of move-ins, move-outs and changes in occupancy rates. Time will tell how well CCRCs will weather the current COVID-19 crisis and potential economic consequences to come.

Survey Demographics

  • Waves 1 and 2 responses combined, collected between March 24 and April 12, 2020, included 48 responses from owners and executives of CCRC operators. Single-site CCRC operators made up 60% of the sample, and 96% of the organizations responding were exclusively nonprofit owner/operators.
  • Non-CCRC operators included 148 responses from owners and executives. The Waves 1 & 2 combined sample was comprised of 75% multi-site operators (5 or more properties). The majority (82%) were exclusively for-profit providers.
  • Waves 6 and 7 responses combined, collected between April 27 and May 24, 2020, included 51 responses from owners and executives of CCRC operators. Single-site CCRC operators made up 75% of the sample, and 94% of the organizations responding were exclusively nonprofit owner/operators.
  • Non-CCRC operators included 218 responses from owners and executives. The Waves 6 & 7 combined sample was comprised of 74% multi-site operators (5 or more properties). The majority (78%) were exclusively for-profit providers.

NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and transparency into market fundamentals in the seniors housing and care space at a time where trends are rapidly changing. Your support helps provide both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions. 

 

If you are an owner or C-suite executive of seniors housing and care properties and have not received an email invitation but would like to participate in the Executive Survey, please click here for the current online questionnaire.

 

COVID-19 Rapid Response Network for Nursing Homes

The Institute for Healthcare Improvement, with support from John A. Hartford Foundation, offers a free COVID-19 Rapid Response Network for Nursing Homes. 

Operators and staff of nursing homes are facing enormous challenges. To help nursing homes tackle these challenges with pragmatic and real-time solutions, the Institute for Healthcare Improvement, with support from the John A. Hartford Foundation, has launched a free COVID-19 Rapid Response Network for Nursing Homes. 

The Rapid Response Network offers a daily 20-minute National Nursing Home Huddle that includes solutions that can be implemented immediately to address key challenges posed by COVID-19. Its goal is to support nursing home leadership, staff, residents, families, and communities impacted by the pandemic.

So far, these huddles have included creative ideas to help with the most pressing challenges faced by nursing home and long-term care staff and residents. Representatives from organizations such as the CDC have also participated to provide data and policy updates. Topics have included PPE, testing and screening, hospital to nursing home transfers, staff illness and absences as well as the emotional well-being of staff and residents.

Institute for Healthcare Improvement states the following as benefits of participation:

  • Immediate access to specific, pragmatic guidance on clinical and operational issues confronting the nursing home community today. Guidance will be focused and ready to implement.
  • Ability to speak with a collective voice to federal and state policy makers, regulators, health care systems, and others to help remove policy and regulatory barriers to mission-critical operational challenges.
  • Access to tools and materials to help explain the work of nursing homes and promote participation in the COVID-19 Rapid Response Network for Nursing Homes. These tools will help nursing homes communicate with local media outlets about efforts to serve and protect residents and staff.

To learn more and to sign up to participate in the free daily huddles, visit the Institute for Healthcare Improvement registration page.

Skilled Nursing Occupancy Decreases in March

Skilled Nursing Occupancy Decreases in March. Monthly Data Released from NIC’s Skilled Nursing Data Initiative for March 2020.

First Monthly Data Release from NIC’s Skilled Nursing Data Initiative

Data Ending March 2020 Shows 132-Basis Point Decline in Occupancy from February.

In response to rapid market changes caused by the COVID-19 pandemic and its impact on the skilled nursing industry, NIC has increased the data release frequency for key performance metrics. Starting now and going forward, NIC will release data from its Skilled Nursing Data Initiative on a monthly basis. NIC will post data through April 2020 by July 7, 2020. Key points from the first monthly release with data from January 2012 through March 2020 are summarized below. 

  1. The initial effects of the COVID-19 pandemic were evident on skilled nursing occupancy in March, with a 132-basis point decline from the prior month and a 53-basis point decline from year-end 2019 to 83.4% in March 2020. This pushed the occupancy rate to its lowest level since NIC began collecting the data in 2012. Larger impacts are anticipated in April when the pandemic was significantly more pervasive. Occupancy usually increases from the fourth quarter to the first quarter given the flu season and higher admissions in the winter months, but the coronavirus changed that pattern as a result of hospital transfers associated with the illness and fewer admissions related to post-acute elective surgery care needs. Furthermore, occupancy decreased year-over-year as it slipped 134 basis points from March 2019.NIC Skilled Nursing Occupancy January 2012 - March 2020
  2. Skilled mix increased 17 basis points from the fourth quarter 2019 to end March 2020 at 25.3% as Medicare and managed Medicare patient day mix increased from December 2019. However, there was a drop in both Medicare and managed Medicare from February to March 2020, falling 18 basis points and 46 basis points, respectively. These declines suggest the pressure on new post-acute admissions began in the month of March as COVID-19 started to impact skilled nursing properties. The pressure on Medicare and managed Medicare in March resulted in skilled mix decreasing 59 basis points from February to March 2020. Skilled mix also showed a decline year-over-year as it decreased 60 basis points from March 2019.SNF Patient Mix 052820
  3. Overall managed Medicare revenue mix continued to hover around 10%. Managed Medicare revenue mix initially increased as expected in the first quarter of 2020, rising from 9.9% in December to 10.4% in January to 10.8% in February 2020 before slipping 76 basis points in March as COVID-19 likely started to impact managed Medicare admission due to various factors such as suspension of elective surgeries. Managed Medicare revenue mix was down almost two percentage points from a high-water mark of 11.9% in February 2019 due to continued revenue per patient day pressure and more recently the effects of the coronavirus.   However, over the longer-term since 2012, managed Medicare revenue mix has been in an upward trend increasing from 6.8% in January 2012.SNF Revenue Mix 052820
  4. Medicaid patient day mix held relatively steady in the first quarter of 2020, increasing slightly by 9 basis points from December 2019 to 67.1% at the end of March 2020. Compared with February, Medicaid patient mix increased 66 basis points as less of the patient population was likely associated with post-acute care, i.e., Medicare and managed Medicare stays were likely down due to the numerous measures implemented to contain COVID-19. This is notable and suggests that the occupancy decrease from February to March was mainly, if not all, due to the decreases in post-acute admissions.

    To get more trends from the latest data, please download the NIC Skilled Nursing Data Report. There is no charge for this report. The latest quarterly report will be released on June 10, 2020.

    This report provides aggregate data at the national level from a sample 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 here. NIC maintains strict confidentiality of all data it receives.