Skilled Nursing Occupancy Declined in September 2021

December 8, 2021


NIC MAP® data, powered by NIC MAP Vision, released its latest Skilled Nursing Monthly Report on December 2, 2021, which includes key monthly data points from January 2012 through September 2021.

Here are some key takeaways from the report.


After seven months in a row of increases, skilled nursing property occupancy declined from August to September, decreasing 27 basis points to 75.1%. Nevertheless, occupancy was still 355 basis points above the low point of 71.5% reached in January 2021. In general, there remains cautious optimism about improving occupancy trends but there remain challenges including the rapid spread of the contagious COVID-19 delta variant in the summer and fall months as well as labor shortages, which have caused some properties to limit new patient admissions. In addition, there is potential for additional challenges due to a lack of booster shot prioritization among skilled nursing properties, the arrival of the fall/winter season, spread of the new omicron variant, and persistent labor shortages. Occupancy remains very low compared to February 2020 pre-pandemic levels of 85.7% (10.6 percentage points).


Medicare revenue per patient day (RPPD) increased by $2.82 (0.5%) from August, to end September 2021 at $565. Despite the gain, it remained 1.5% below its December 2020 level ($573.68) when cases in skilled nursing properties were spiking and RPPD was higher likely because the federal government had implemented initiatives to aid Medicare fee-for-service reimbursements for situations such as providing higher rates to help care for COVID-19 positive patients requiring isolation. Meanwhile, Medicare revenue mix continued to decline, falling 33 basis points from August to end September at 19.9%, a time-series low. It has been falling since January 2021 when it was 24.9%, the time of peak COVID-19 cases.

Managed Care

Managed Medicare revenue mix held relatively steady from August to September at 10.5%. It was down from its recent high of 11.2% in February but was up from the pandemic low set in May 2020 of 8.4%. The increase may be due to growth in elective surgeries from the prior year; elective surgeries often create additional referrals to skilled nursing properties. Meanwhile, Managed Medicare revenue per patient day (RPPD) increased from $447 to $449 in September but was down 3.2% from last year in September 2020. It has decreased $104 (18.8%) from January 2012 and continues to create pressure on operators’ revenue as Managed Medicare enrollments grow around the country.


Medicaid patient day mix increased to 66.3% in September, up from the pandemic low of 63.2% set in January 2021. On the other hand, Medicaid revenue mix deceased in September to 50.0%, representing half of all property revenue. In addition, it has increased 314 basis points from the pandemic low of 46.9% set in December 2020. Meanwhile, Medicaid revenue per patient day (RPPD) decreased $1 from August to end September 2021 at $242. However, the latest monthly data in September still represents a 3.3% increase from pre-pandemic levels of February 2020 ($235). Medicaid reimbursement has increased more than usual as many states embraced measures to increase reimbursement related to the number of COVID-19 cases.

To get more trends from the latest data, download the Skilled Nursing Monthly Report. 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. NIC maintains strict confidentiality of all data it receives.

Interested in learning more about NIC MAP data? To learn more about NIC MAP data, powered by NIC MAP Vision, schedule a meeting with a product expert today.

This blog was originally published on NIC Notes.

About NIC
The National Investment Center for Seniors Housing & Care (NIC), a 501(c)(3) organization, works to enable access and choice by providing data, analytics, and connections that bring together investors and providers. The organization delivers the most trusted, objective, and timely insights and implications derived from its analytics, which benefit from NIC’s affiliation with NIC MAP Vision, the leading provider of comprehensive market data for senior housing and skilled nursing properties. NIC events, which include the industry’s premiere conferences, provide sector stakeholders with opportunities to convene, network, and drive thought-leadership through high-quality educational programming. To see all that NIC offers, visit

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