In a promising sign for the sector, no new COVID-19 cases were reported in 93% of U.S. skilled nursing facilities for the week ending February 21, according to data available in the NIC Skilled Nursing COVID-19 Tracker

It’s been a year since the coronavirus pandemic first unfolded in the U.S., disproportionately impacting older Americans. Thanks to increasing vaccination rates, many hospitalizations and fatalities have been, and will be, avoided among the population most susceptible to serious complications from COVID-19.

The most recent CMS data compiled by NIC’s Skilled Nursing COVID-19 Tracker show that 93% of skilled nursing facilities reported no new COVID-19 cases for the week ending February 21, 2021, up 28 percentage points from 65% recorded on December 20. The drop in case counts is coincident with more widespread distribution and administration of the vaccines across skilled nursing facilities.

The chart below depicts that for the week ending December 20, 2021, 9.8% of skilled nursing facilities reported 10% or more of their residents tested positive for COVID-19, but on February 21, 2021, only 0.2% reported infections of 10%+. The share of skilled nursing facilities reporting new confirmed cases appears to be declining across all infection rate cohorts.

98% of skilled nursing facilities with less than 50 units reported no new COVID-19 infections for the week ending February 21, 2021, the highest share among all skilled nursing facilities with respect to size. The smallest share of skilled nursing facilities reporting no new COVID-19 infections was among large facilities (150 Units +) at 87%.

Newly confirmed cases of COVID-19 among skilled nursing residents fell to another pandemic record low during the reporting week, down 94% over the last nine weeks since the launch of the Long-Term Care vaccination program – from 32,588 on December 20, 2020 to 1,903 on February 21, 2021. U.S. weekly infections fell 71% over the span of those same nine weeks.

Per-resident rate of new COVID-19 infections within skilled nursing facilities plummeted to a new low point on February 21 (0.20%). Only 1 in 500 residents tested positive for COVID-19 on February 21 compared to 15 in 500 residents on December 20 (3.03%).

As shown below, new cases among residents have fallen faster than new cases among staff since the start of vaccine rollout. For the week ending December 20, new COVID-19 cases among skilled nursing residents were 21% higher than among staff. By February 21, newly confirmed cases among residents were 24% lower than among staff for the first time in months. This speaks to the higher vaccination rates among residents.

As of February 21, 2021, 2.2 million residents living in long term care communities have been fully vaccinated in the Federal Pharmacy Partnership Program, according to the CDC. The average vaccination rate in the U.S has recently picked up to two million per day and will likely continue to increase, suggesting that 100 million Americans who are most vulnerable to the coronavirus will likely be fully vaccinated in the next month or two.

In addition to three approved vaccines to fight the virus, the FDA has recently issued first emergency use authorization for a molecular non-prescription at-home COVID test. This self-administered and over-the-counter technology could help significantly with isolating new cases and mitigating the risk of spread of new variants until vaccines are more widely distributed. CUE Health plans to produce over 100,000 over the counter COVID tests per day by summer 2021, according to its co-founder and chief product officer.

Furthermore, recent lab analysis indicate that the Pfizer-BioNTech Covid-19 vaccine is effective against new variants of the coronavirus. This can only encourage the CDC to ease restrictions on visitation at long term care settings, a long-awaited relief for residents and their loved ones.

Protecting all of America’s seniors and ensuring the safety and wellbeing of our role models should continue to be our priority. The older adult generation include heroes—scientists, doctors, nurses—of yesterday, whose contributions to our society allow us today to continue to carry the torch forward and create a better future for ourselves and generations to follow.

To gain in-depth insights and track the week-over-week change rate for new resident cases and fatalities of COVID-19 within skilled nursing facilities at the state and county levels, visit NIC.org. You can also access the Skilled Nursing COVID-19 Tracker along with a rich trove of analysis and insight on the NIC COVID-19 Resource Center.

NIC is committed to provide timely data, analyses and insights that increase transparency and understanding of the sector, especially in this difficult time of COVID-19. We strongly support all actions and efforts that prioritize distribution of COVID-19 vaccines, testing, and availability of PPE to protect frontline workers and residents.

NIC MAP^® Data Service released its latest Skilled Nursing Monthly Report on March 4, 2021, which includes key monthly data points from January 2012 through December 2020.

Key takeaways from the report are available below.

Occupancy

Skilled nursing property occupancy continued to be pressured through year-end 2020, hitting a new low of 71.7% in December. This was down 1.4 percentage points from November (73.1%) and 13.3 percentage points from February 2020 (84.9%), the month before the pandemic started. The pandemic has significantly impacted skilled nursing operations across the country creating challenges for patient census. However, since the vaccine rollout began in December and continues to date, there is an expectation that COVID-19 cases will continue to decline, and occupancy will pick up. The question remains, however, of how quickly this bounce back will occur.

Managed Medicare

Managed Medicare patient day mix increased 41 basis points from November to 6.9% after hitting a 12-month low during the pandemic of 5.4% in May. However, it was down 24 basis points since February (7.1%). The increase since May suggests managed Medicare is playing an increasing role in overall operations, but this is all in the context of a significant drop in occupancy. Managed Medicare admissions are likely significantly below levels prior to the start of the pandemic given the decline in elective surgeries and competition from home health care. In addition, managed Medicare revenue mix was off its 12-month low of 8.0% set back in May. As of December, it was at 8.8% but down 230 basis points since February.

Medicare

Medicare revenue mix continued to increase as 2020 closed, ending at 23.3% in December and up 67 basis points from November. Medicare revenue mix has held up relatively well since the pandemic began in March compared with other payors. It is up 186 basis points since March compared to managed Medicare (down 150 basis points) and private pay (down 254 basis points). As overall occupancy has declined dramatically during the pandemic creating significant pressure on skilled nursing operators, Medicare patient days likely did not decrease as much as they would have given that the Centers for Medicare and Medicaid Services (CMS) waived the 3-Day Rule. The rule waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered skilled nursing stay.  

Medicaid

In contrast to the Medicare experience, Medicaid revenue mix hit a new low in December, ending at 43.7%. It has decreased 8.4 percentage points since March when it was 52.2%. This suggests total Medicaid patient days have dramatically decreased since March, due to lower overall admissions and some Medicaid patients who may have converted to Medicare due to the waiver of the 3-Day Rule during this crisis period. Medicaid revenue mix was down 9 percentage points from year-earlier levels.

To get more trends from the latest data you can download the Skilled Nursing Monthly Report here. 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 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.

The NIC MAP^® Data Service recently released national monthly data through December 2020 for actual rates and leasing velocity. In this release, NIC also provided data on three metropolitan areas:  Atlanta, Philadelphia, and Phoenix.  

A few key takeaways from the 4Q2020 NIC MAP Seniors Housing Actual Rates Report are listed below. Full access to the reports and other takeaways is available to NIC MAP^® Data Service clients.  

• 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 memory care. 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.
• The average discount for the memory care segment was the largest of the three care segments in December 2020 and averaged 10.2% below average asking rates. This equates to an average initial rate discount of 1.2 months on an annualized basis, the highest level of discounting for memory care since April 2020.
• As of December 2020, initial rates for assisted living care units averaged 7.1% ($364) below average asking rates. This equates to an average initial rate discount of 0.9 months on an annualized basis, even with one year earlier.
• The average annualized discount for independent living segments was 0.8 months in December 2020, more than in December 2019 at 0.6 months.
• 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.
• The rate of move-outs has exceeded or equaled the rate of move-ins for each of the prior twelve months for both the independent living and assisted living segments, and for five of the last twelve months for the memory care segment as of December 2020. The difference between the pace of move-outs and move-ins was widest in the immediate aftermath of the pandemic start in the March, April, and May period.

The NIC 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 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 5 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 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 by visiting nic.org/actual-rates.

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The Labor Department reported that nonfarm payrolls rose by 379,000 in February and that the unemployment rate edged lower to 6.2% from 6.3% in January. The jobless rate remains 2.7 percentage points above the pre-pandemic level of 3.5% seen in February 2020, but well below the 14.7% peak seen in April. Despite the February increase, job levels are 9.5 million below the pre-pandemic levels of February 2020 (6.2%), with 3.5 million of that gap in the leisure and hospitality sectors. The consensus estimates for February had been for a gain of 200,000.

Private service-producing jobs increased by 513,000, led by a rise of 355,000 jobs in leisure and hospitality payrolls as pandemic-related restrictions began to be relaxed and restaurant re-openings occurred. Health care added 20,000 jobs in January; this followed a loss of 85,000 in January. Nursing care facilities lost 12,000 jobs in February.

The number of long-term unemployed (those jobless for 27 weeks or more) was little changed from January at 4.1 million but is 3.0 million higher than year-earlier levels, suggesting that this continues to be a very challenging time for many Americans. Long-term unemployed persons account for 41.5% of the total number of unemployed persons.

The underemployment rate or the U-6 jobless rate was unchanged at 11.1% in February. 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.

Average hourly earnings for all employees on private nonfarm payrolls rose by $0.07 in February to $30.01, a gain of 5.3% from a year earlier. These increases largely reflect the disproportionate number of lower paid workers in leisure and hospitality who went off payrolls, which put upward pressure on the average hourly earnings estimates.

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 61.4% in February.

The change in total nonfarm payroll employment for December was revised down by 79,000 from a loss of 227,000 to a loss of 306,000 and the change for January was revised up by 117,000 from 49,000 to 166,000. Combined, 38,000 jobs were added to the original estimates. 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 February data is promising and reflects a gradual reopening of parts of the economy and some of the effects of the $600 stimulus checks. The ongoing drop in COVID cases, the widespread distribution of vaccines, and a shift in consumer confidence is needed to allow for a more complete re-opening of the economy and a fuller recovery in jobs. If the $1.9 trillion stimulus package becomes law, further economic activity and additional job growth can be expected in the coming months.