Medicare Patient Day Mix Continues Decline.

NIC MAP^® Data Service, powered by NIC MAP Vision, released its latest Skilled Nursing Monthly Report on June 3, 2021, which includes key monthly data points from January 2012 through March 2021.

Here are some key takeaways from the report:

NIC provided a grant to NORC at the University of Chicago (NORC) to study the disparate effects of the pandemic on different seniors housing and care settings. The study results have just been released.

The analysis examines mortality rates by property level of care – independent living, assisted living, memory care, and skilled nursing – and provides a comparison to seniors aged 75 and older living in non-congregate settings (single family homes and apartments).

The study focused on data from 3,817 seniors housing properties across 113 counties in five states – Colorado, Connecticut, Florida, Georgia, and Pennsylvania. About two-thirds of independent living properties (67%), assisted living properties (64%), and memory care properties (61%) experienced no COVID-19-related deaths. Thirty-nine percent (39%) of skilled nursing facilities (also known as nursing homes) experienced no COVID-19-related deaths during the same period.

Also, among the study’s key findings is that COVID-19 mortality rates across seniors housing increased as the health and caregiving complexity of residents increased, with the highest percentages occurring in memory care settings and skilled nursing properties. By including a comparison to seniors aged 75 and older living in non-congregate settings in the broader geographical areas, study findings suggest that residents who live in independent living properties were not at higher risk by virtue of their congregate care setting.

Throughout 2020, average adjusted mortality rates from COVID-19 in skilled nursing were 59.6 per 1,000, likely driven by the advanced age, frailty, and comorbidities of the residents. By contrast to skilled nursing, assisted living mortality rates were two-thirds lower at 19.3 deaths per 1,000 residents. Resident deaths in independent living settings were statistically comparable to the experience of older adults living in non-congregate settings in the broader county.

Adjusted mortality rates in memory care were 50.4 per 1,000 residents, which is statistically comparable to skilled nursing. Memory care units faced particular challenges with infection control, since seniors who have cognitive impairments are more likely to require additional care and support for basic needs.

In a secondary analysis that looked specifically at continuing care retirement communities (CCRCs) residents, CCRCs were associated with a significantly lower expected mortality rate when compared to non-CCRCs. The mean expected mortality rates for CCRCs across all care segments was 10.0 per 1,000 as compared to 19.9 per 1,000 in non-CCRCs.

The study also included a dozen interviews with seniors housing operators and eight state affiliates of LeadingAge and Argentum, organizations that serve non-profit and for-profit aging services, to understand the context of the COVID-19 case and death data, and the challenges they faced during the pandemic. These qualitative interviews helped place the study’s quantitative results in context and help readers understand some of the challenges faced in managing COVID-19 in these settings, including PPE shortages, delayed testing results, and a rapidly changing regulatory environment across all levels of government.

A second phase of the study is being planned to build upon these findings by comparing death rates across levels of care while risk-adjusting for age, health status, and demographic characteristics, as well as understanding the impact of COVID-19 on all-cause mortality by care setting. These data findings will be critical to improving the public’s understanding of the safety levels within the various seniors housing care segments. Phase 2 of the COVID-19 research study is expected to be completed by November 2021.

To view the study’s complete findings and conclusions, please see the Final Report and detailed Technical Report by visiting NIC’s COVID-19 study landing page.

The Labor Department reported that nonfarm payrolls rose by 559,000 in May 2021. The consensus estimates for May had been for a gain of 675,000. Revisions did little to improve the disappointing April 2021 gain of 278,000. Recent monthly job increases have been disappointing for this point in the recovery. Indeed, despite the increase, job levels remain 7.6 million below the pre-pandemic levels of February 2020.

Notable job gains occurred in leisure and hospitality (292,000), in public and private education (144,000) and in health care and social assistance (46,000). These were employment sectors most hurt during the pandemic.  

Separately and from a separate survey, the Labor Department reported that the unemployment rate fell back 0.3 percentage point to 5.8% in May from 6.1% in April. The jobless rate is now 2.3 percentage points above the pre-pandemic level of 3.5% seen in February 2020, but well below the 14.7% peak seen in April 2020. The underemployment rate or the U-6 jobless rate was unchanged at 10.2% down from 10.4% in April 2021. 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.  

The number of long-term unemployed (those jobless for 27 weeks or more) declined by 438,000 to 3.8 million but is 2.6 million higher than in February 2020, suggesting that this continues to be a very challenging time for many Americans. Long-term unemployed persons account for 40.9% of the total number of unemployed persons.  

The labor force participation rate, which is a measure of the share of working age people who are employed or looking for work was steady at 61.6% in May but is lower than in February 2020. Many workers have dropped out of the labor force since the pandemic began to take care of family members or out of fear of working and catching the virus. Indeed, in May, the number of persons not in the labor force who currently want a job was essentially unchanged over the month at 6.6 million but is up by 1.6 million since February 2020. These individuals were not counted as unemployed because they were not actively looking for work during the last 4 weeks or were unavailable to take a job. 

Average hourly earnings for all employees on private nonfarm payrolls rose by $0.15 in May to $30.33, a gain of 2.2% from a year earlier and followed an increase of $0.21 in April. The data suggests that rising demand for labor associated with the recover from the pandemic may be putting upward pressure on wages. That said, the Labor Department warns that the pandemic has affected the ability to fully interpret the wage data due to the wide swings in employment trends. 

The change in total nonfarm payroll employment for March was revised up by 15,000 from a gain of 770,000 to 785,000 and the change for April was revised up by 12,000 from 266,000 to 278,000. With these revisions, employment in April and March combined is 27,000 higher 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.  

The May data was disappointing after weak job gains in April. It may reflect ongoing health-related concerns about the pandemic and the need for workers to still take care of family members, especially school-aged children. That said, the ongoing drop in COVID cases, the widespread distribution of vaccines, and a shift in consumer confidence should support a more complete re-opening of the economy and a fuller recovery in jobs in the coming months. The weak May number also suggests that the Fed will continue in its resolve to keep interest rates low as it pursues its full employment objective.

The NIC MAP^® Data Service, powered by NIC MAP Vision, recently released national monthly data through March 2021 for actual rates and leasing velocity. In this release, NIC MAP also provided data on three metropolitan areas:  Atlanta, Philadelphia, and Phoenix.   

A few key takeaways from the 1Q2021 NIC MAP^® Seniors Housing Actual Rates Report are listed below. These key takeaways are from the Segment Type report. Care segments refer to the levels of care and services provided to a resident living in an assisted living, memory care or independent living unit. Full access to the reports and other takeaways is available to NIC MAP Vision clients with access to NIC MAP Data.   

• For the first time since the onset of the pandemic in March 2020, the pace of move-ins exceeded the pace of move-outs for both the independent living and the assisted living care segments in March 2021.Since March 2020, voluntary or mandated move-in moratoriums had often been in place for many operators as they tried to prevent the spread of infection in their properties.  For the memory care segment, move-ins also exceeded move-outs in March 2021, but the 12-month pattern was less consistent than for AL and IL. 
• Average initial rates for residents moving into independent living, assisted living and memory care segments were below average asking rates, with monthly spreads generally largest for assisted living.
• The average discount for all three care segments was between 0.9 and 1.0 month in the January-March reporting periods.  With the exception of the memory care segment, these discounts are higher than the discounting that occurred during the pre-pandemic period in the first quarter of 2020.
• As of March 2021, initial rates for memory care units averaged 8.0% ($527) below average asking rates. This equates to an average initial rate discount of 1.0 month on an annualized basis, down from 1.2 months one year earlier.
• Average in-place rates for residents in assisted living and memory care segments were below average asking rates. The discount was smaller for in-place rates than initial rates compared with asking rates.
• For the assisted living segment, average in-place rates were consistently below average asking rates since reporting began in January 2017. However, the monthly gap between these two rates was narrower during the first quarter, dropping to a mere 0.2% difference (or $11) in January 2021 and only rising to 0.6% in March 2021.  

The Actual Rates Data Initiative is driven by the need to continually increase transparency in the seniors housing sector and achieve greater parity to data that is available in other real estate asset types. Now, more than ever, in the world of the COVID-19 pandemic, having access to accurate data on the actual monthly rates that a seniors housing resident pays as compared to property level asking rates helps the sector achieve this goal.  

About the Report 

The NIC MAP^® Seniors Housing Actual Rates Report provides aggregate national data from approximately 300,000 units within more than 2,600 properties across the U.S. operated by 25 to 30 seniors housing providers. The operators included in the current sample tend to be larger, professionally managed, and investment-grade operators as we currently require participating operators to manage five or more properties. Note that this monthly time series is comprised of end-of-month data for each respective month.  

While these trends are certainly interesting aggregated across the states, actual rates data is even more useful at the metro level. NIC MAP Vision is continuing to work towards reporting more markets. 

Interested in Participating? 

The Actual Rates Data Initiative is an effort to expand seniors housing data and we are looking for operators who have five or more properties to participate. We have expertise in extracting data from industry leading software systems, such as Yardi, PointClickCare, Alis and MatrixCare, and can facilitate the process for you.  

Your organization benefits through: 

• More informed benchmarking, strategic planning, and day-to-day business operations, 
• Increased transparency, aligning with other commercial real estate assets in terms of data availability, and
• Enhanced investment and efficiency across the sector. 

Learn more about participating in the Actual Rates Data Initiative by visiting nic.org/actual-rates. 

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. 

A look back at a year’s worth of data on COVID-19 case counts in U.S. nursing homes reveals some surprising insights, and some important questions. The data indicate that U.S. skilled nursing facilities (SNFs) are currently the safest places to be for frail older adults, who are most susceptible to the virus. In fact, case counts within SNFs are down 98% since the December 20^th launch of the long-term care vaccination program. By May 16, they accounted for about 0.3% of U.S. cases.

The drop in nursing home cases has outstripped the drop in case counts amongst surrounding populations, which in some areas were on the rise, even as vaccines become more readily available. In December 2020, new nursing home fatalities accounted for about 74% of overall fatalities for older adults over 85 years of age. By April 2021, that share dropped to 28%. Currently, more fatalities are occurring in the general population of older adults over 85 years of age than in those living in nursing homes.

At NIC, we’ve been analyzing and tracking Centers for Medicare and Medicaid (CMS) data throughout the pandemic, since March of last year. Our interactive “Skilled Nursing COVID-19 Tracker” (Tracker) tool is updated weekly with fresh CMS data. The tool can be used to compare weekly infections of COVID-19 in skilled nursing facilities, as well as in the U.S. general population, and can be geographically searched across regions, sub regions, and states.

Nursing Homes vs Local Populations 

The data clearly tracks with the nationwide effort to prioritize nursing home residents for vaccinations. Case counts began to steeply decline as the Pfizer, and then the Moderna vaccines began to be distributed to nursing homes across the country on December 20, 2020. Nursing home case counts remain low, particularly when compared to infection rates among the general population, which have roared back in recent weeks.  

In the Midwest, over three months into the U.S. vaccination program, Michigan reported the highest statewide general population increase in COVID-19 cases, jumping 612% from February 21 to April 11, reaching highs not seen since vaccines first became available. The state’s case count among residents in SNFs, however, declined 25% over the same period. Meanwhile, cases among staff increased 281%. Between the weeks ending March 21 and April 11, COVID-19 vaccines prevented at least 2,000 new infections among SNFs residents in Michigan.

Overall, COVID-19 cases among residents dropped to lowest point in pandemic, only 6 in 10,000 nursing home residents tested positive for COVID-19 for the week ending May 16, which, compared to over 300 in 10,000 back on December 20, 2020, reflects the magnitude of the impact of the U.S. vaccination program on nursing home residents. Five months into the vaccination program, 42 states and geographies were reporting 20 cases or less across their entire nursing home populations.

The Risk of Unvaccinated Staff 

Tracking back one year, from this month to last May, Tracker data reveals that despite the swift and immense impact of vaccinations, a troubling risk persists. At the height of the pandemic, new cases among skilled nursing residents were 20% higher than among staff. However, the trend has reversed in recent weeks: newly confirmed cases among residents were 74% lower than among staff on May 16. We already know that, even with the proper safety protocols and equipment, this vector represents a grave risk to the nursing home community.

Other NIC data sources, such as the Executive Survey Insights (ESI), a bi-weekly survey of senior living operators, help to support and explain some of the patterns we can see in the Tracker data. Yielding data on properties of every size, type, ownership structure, and across each care segment, every completed ESI questionnaire delivers information from the perspective of an owner/operator’s entire portfolio of seniors housing and nursing care properties. The ESI has been providing real-time insights on hundreds of buildings and thousands of units across the country every two weeks since near the beginning of the pandemic.

Roughly nine out of ten respondents in the Wave 22 ESI survey indicated that educating and motivating staff to take the vaccine was a challenge. This data, though anecdotal, may help explain why Tracker data is now showing that COVID-19 cases amongst staff, though significantly lowered, are failing to keep pace with the drop in resident infection rates. Already struggling with staffing shortages and high turnover rates, and often resorting to hiring temp agency workers, some nursing home operators may be unable to achieve a 100% staff vaccination rate, even when they have access to vaccines. Given the risks once COVID-19, and its variants, enters any congregate living setting, this dynamic represents a persistent threat that vaccine availability alone cannot remedy.

Not All Nursing Homes Are the Same 

Tracking cases from the beginning of the pandemic to May 16, 2021, at which point nursing homes residents across the country were nearly universally vaccinated, it becomes clear that nursing home safety varies widely. In fact, nearly one third of U.S. nursing homes reported no more than 20 COVID-19 cases in total over that period, since CMS started reporting data. Sadly, fewer than 20 cases is a relatively low number. NIC looked more closely at this category of nursing home.

Data suggests that nursing home size may be a factor. Of all the nursing homes reporting fewer than 20 total cases throughout the pandemic, 44% were in the 50-100 unit size range. Six percent were in the largest category of 150+ unit facilities. Small nursing homes, with fewer than 50 units, performed slightly better, at 28% nationally, than those in the 100-150 unit size range, 21% of which reported fewer than 20 cases overall. The 50-100 unit size range outperformed the others.

Some nursing homes managed to completely block COVID-19 from infecting their residents. This was the case, even in geographic locations that saw significant community spread. Overall, about 4.5% of U.S. nursing homes reported 0 cases throughout the pandemic, from the time CMS began reporting data to May 16, 2021. This data indicates that there may be lessons to learn from those facilities, particularly as they kept out COVID-19 even before the vaccine was made available.

Questions on Safety 

According to CMS pandemic data through May 16, 2021, 25% of nursing homes are responsible for 54% of total resident cases. The remaining 75% are responsible for only 46% of overall cases. For the largest properties of over 150 units, 80% of cases were reported by only 56% of communities. 

Why did some nursing homes outperform others in keeping residents safe from COVID-19? Is there a ‘Goldilocks principle’ on the ideal size for a nursing home? Data suggests that communities of 50-100 units are safer than those that are bigger and smaller. But, as is so often the case, the data fails to provide all the answers. The questions that this data raises, however, may be the right ones to ask, as we work to ensure the safety of older adults, even as the pandemic continues.