Skilled Nursing Facilities

Latest Takeaways

March 21, 2024
Reporter
Post-Acute
"The nursing home industry is making a slow recovery from the COVID-19 pandemic, but the sector continues to face headwinds in 2024.
Occupancy in skilled nursing facilities was 82.7% in the fourth quarter of 2023 compared with a pandemic low of 73.4% in 2021’s first quarter and 83.8% in 2019’s fourth quarter, according to the National Investment Center for Seniors Housing and Care, a nonprofit that tracks the industry. A labor shortage is part of the reason occupancy hasn't bounced back from the pandemic.
Nearly half of 441 nursing homes polled by industry trade group American Health Care Association said they were limiting admissions due to a shortage of nurses and nurse assistants, and 94% said they were having difficulty recruiting new workers."

Executive Summary

Updated: March 21, 2024

  • The January 2024 release of skilled nursing facility cost reports included a very complete set of fiscal 2022 data. 13,390 cost reports were used to calculate medians of key financial measures. Of the reports submitted, 70.3% were from for-profit owners, 20.2% from nonprofits and 9.5% from government-owned facilities. Of the for-profit homes, 41.4% were owned by corporations and 11% by partnerships. Less than 1% of homes identified as owned by individuals. The "for-profit, other" category made up 17.2% of ownership. This category, which is not defined, has seen the largest increase since fiscal 2000, when it constituted 4% of homes.

  • Annual median net patient revenue increased almost 8% in 2022, to $8.8 million. Median operating expenses rose 7%, to $9.6 million. Median operating margin was -7.2% in 2022, a slight improvement from 2021's -8.4%.

  • Overall net margins fell to -0.57%, from 3.06% in 2021. In its March 2024 report to Congress, the Medicaid and CHIP Payment and Access Commission attributed the drop to "lower pandemic-related relief funds, the end of the sequestration suspension, and the expiration of temporary Medicaid payment increases in many states." Only a small number – 2,047 – of fiscal 2023 cost reports have been released as of January 2024, but the median net margin calculated from them of -1.36% suggests skilled nursing financials worsened last year.

  • Payments from facilities to related organizations remained about the same in fiscal 2022. Related organizations are people or business entities with some relationship to the nursing home that are required to be listed in cost reports due to costs or adjustments as a result of transactions. As a percentage of total patient revenue, 10,601 facilities reported a median for these costs of 8.1% in fiscal 2022. In fiscal 2021, 10,614 facilities reported a median of 8.2%. The percentage has risen since 2018, when it was 7.3%.

  • For a breakdown of these measures by detailed ownership types, see the Trend Selector below.

 

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