Senior Living Outlook Series: Rebuilding Census in a Post-COVID-19 Environment

COVID-19 Impact on the Long-Term Care Industry 
COVID-19 has and continues to present extraordinary and unprecedented challenges—effectively placing life on hold for many and creating unparalleled adversity throughout the healthcare industry. Many of the systemic challenges exposed during the pandemic have continued, not the least of which is building and maintaining census and occupancy, which has always been a top priority for senior care providers but is an even more crucial concern in the wake of COVID-19. The pandemic has had a national impact, and while some providers did well—in terms of maintaining or increasing occupancy and retaining workforce—for a variety of reasons, much of the skilled nursing industry has experienced substantial strain. 

Census challenges continue to impact the industry’s recovery. Facility self-reported data compiled and published by the CMS as of January 9, 2022, reports national nursing home occupancy at 72.9 percent, a slight increase over previous levels but significantly lower than pre-pandemic levels of approximately 85.5 percent. With the emergence of variants in conjunction with ever-increasing staff shortage concerns, additional issues are arising and further threatening the industry’s recovery.  

Skilled nursing facility (SNF) closures were reported throughout 2020 and into 2021, but as some facilities closed, others opted to employ partial bed/unit closures and other facility repurposing strategies as they assess their position and develop recovery strategies.

Developing a Path Forward – Census Rebuilding/Recovery 
While COVID-19 has resulted in an unprecedented wave of challenges through 2022, the imperative to improve census/occupancy—essential to long-term survival—also presents opportunities to innovate and improve. An effective and comprehensive programmatic approach to census recovery that acknowledges the size, scope, and financial position of your organization includes market assessment, workforce rebuilding, technology assessment, focus on quality, awareness of consumer/family requirements and preferences, partnership/affiliation development and/or strengthening, and a multipronged marketing strategy. In short, proactive facilities should begin to reframe and reimagine their programmatic/operational model based on identified programmatic requirements and through selective employment of several concurrent strategic approaches:

Market Assessment 
Gain insight into your organization relative to your market. Identify and utilize key metrics to establish a baseline to evaluate historical and ongoing market position, organizational strengths, and opportunities arising from post-COVID-19 market and regulatory changes/initiatives and other shifts in consumer preferences. This can be accomplished through analysis of publicly available and proprietary data, e.g., occupancy, market share, and referral data as well as cost, care outcomes, and quality metrics.

• Evaluate your existing position within your service area.
  • Identify and understand your current market share, primary competitors, key referral sources, and other entities with whom you seek to build or strengthen relationships.
  • Assess and compare your metrics (average length of stay, readmission rates, quality indicators) with those of your market peers and other competitors.
  • Identify/understand unmet or emerging programmatic or service needs in the community, i.e., what new programs, services, or modifications might be implemented that would address community needs?
• Recognize and strategize the ability to address competitive pressures related to the increasing imperative of consumers’ desire to stay at home. Importantly, your recovery and marketing strategy should incorporate and emphasize transparency to enhance and re-establish public trust.
  • Seek and evaluate opportunities to facilitate the delivery of remote or outpatient services, either through new program development, e.g., home care, or continuum building through strategic partnerships.
  • Of key importance in all planning and marketing activities is the necessity to adequately address “how we will keep you safe” within and external to the facility.
  • Effectively communicate your value proposition to consumers as well as referral sources/potential partners.

Adoption of Technology
Explore, embrace, and invest in technology. Not only is the integration of telehealth and other health-related technology, including electronic health records, crucial to facilitate improved health outcomes through ease of access, continuity, and quality in resident-centered care, but families also will evaluate the ways in which facilities use technology to maintain communication and resident engagement.

• Employ a “make or buy” approach to the most timely, efficient, and effective integration of telehealth and other IT solutions throughout the care continuum, recognizing the potential benefit of partnering with an outside vendor.
• Recognize the utility of technology for outreach and connecting with potential consumers, including development of a social media presence, website flexibility and enhancements, virtual tours and referral follow-ups, and ongoing and rapid communication with families.
• Acknowledge the ability of technology to enhance workforce engagement, satisfaction, and retention, inclusive of increased flexibility through ease of scheduling, accessing payroll and other benefits, communications, and employee recognition strategies. 

Partnership Development/Relationship Building
Hospitals, physician groups, accountable care organizations, and managed care networks are more likely to seek and maintain strong referral relationships with high-performing providers. This will require outreach to potential partners/referral sources and demonstration of clinical excellence, cost efficiency and value, investment in technology, the ability to effectively manage complex issues, and IT sophistication. 

• Messaging your clinical excellence, value proposition, and reassurance of smooth and safe care transitions from hospitals is more important than ever. Hospitals are seeking to work with facilities that can prevent or minimize rehospitalization.
• Recognize and incorporate shifts in payor mix, including continued growth in Medicare Advantage enrollment, and accompanying opportunities for value-based purchasing (VBP) arrangements and other risk-reduction arrangements.
  • This presents potential new opportunities for partnerships as well as strengthened referral sources with the attendant census building potential. 
• Be an active listener with your partners and referral agencies. Insights gleaned from these key relationships may assist with the identification of additional program or service opportunities. 

Summary
COVID-19 was a landmark disruption event for the skilled nursing industry, and it continues to challenge SNFs throughout the nation as never before. However, the nursing home industry will continue its vital mission to serve those who require its services. It is similarly recognized that to survive and prosper, proactive organizations will seek and avail themselves of available tools, strategies, and opportunities for growth and change in recognition of the “new normal.” It is important that planning start now with targeted actions and companion marketing strategies. It also is important to remain agile and react quickly to market changes and opportunities and remain flexible and reset as needed. In addition, facilities should seek to address additional operational, financial, or competitive factors that present challenges to moving forward with identified strategies through capital partnership development and/or operational restructuring. By employing lessons learned from COVID-19 and considering market, clinical, financial, and operational tools for recovery, providers will be better equipped to remain vital and solvent in the long term, as well as prepared for future public health emergencies.

Please reach out to your advisor or use the Contact Us form below for additional information or assistance in navigating the strategy development process for census recovery.