Updates to this article are below in RED and published on December 16, 2021. enjoy!

It’s a good thing I am not in the business of making predictions for a living.  2021 has been another year where the fallout of the Covid pandemic has provided tremendous upheaval for the SNF industry.  Let’s look back at the 5 issues identified last February and what has developed. 

What we didn’t see coming is the massive staffing crisis affecting SNFs around the country.  I have always believed, “healthcare workers don’t grow on trees.”  Healthcare workers are unique and special people.  We appreciate all you do for the patients. 

Skilled Nursing Facilities faced arguably their most challenging year in history in 2020. Even though the calendar has turned, significant challenges remain.  While there is hope thanks to vaccination success stories, how major issues play out will determine the path to recovery for SNFs around the country.

New Leadership at CMS- Chiquita Brooks-LaSure is the nominee to be the next leader of CMS. She would be accepting the post at a time where many SNFs are operating at a crisis level, therefore leadership & transparency are needed.

It is hard to look beyond the massive ripple effects of the vaccination mandate for SNF workers. I don’t think that federal and state governments anticipated the negative impact on staffing of healthcare workers who refused vaccination and left their jobs. Now we have a crisis on hand. Vaccinations have saved lives, but healthcare workers are desperately needed in post-acute care. They don’t grow on trees.

CMS has allocated resources for Infection Control Strike Teams as a tool to slow the spread of Covid and its variants.

A Different Approach from the White House – It appears that The Biden Administration will be taking a more “hands-on” approach than the Trump Administration. SNFs can expect more oversight in terms of surveys, fines for non-compliance, and the federal government providing more requirements in terms of staffing levels.

Before the staffing crisis began to crash down on the industry, the concept of minimum staffing ratios for SNFs was introduced. Facility closures continue to occur and vaccination mandates are under fire in some states.

Rebuilding Census – This appears to be tied to 3 issues – 1. Visitation 2. Return of Elective Surgeries 3. Consumer Confidence

SNF occupancy continues to struggle. Although it is true that some providers have found success. One of the most troubling ripple effects is the stories of SNFs who are unable to take admissions from the hospitals because they do not have the staffing. What happens to these patients?

Visitation – When will visitation return?  It is the question we all are asking. Many SNF industry experts predict that plummeting SNF census levels won’t return until visitation does.   Governor Parkinson remains hopeful that even if the SNF industry census improves steadily as the year goes on, the industry will recover.

Nursing Home visitation has come full circle.

PDPM – As SNF owners & operators emerge from the depths of the pandemic, the impact of PDPM will become more apparent. SNFs have been hyper-focused on Covid-related PDPM issues such as isolation, non-therapy ancillaries, and the SLP component, capturing reimbursement will again become a priority. They will need to focus on capturing all reimbursement opportunities within PDPM. In states who are planning on using PDPM for Medicaid Case Mix reimbursement, SNFs will have to prepare for even more transition.

This roller coaster ride is certain to continue. PDPM reimbursement exceeded the expectation of CMS, so the industry is bracing for cuts. Only a modest increase was provided for FY 2022. MedPAC is once again recommending cuts in spite of the objections from industry reimbursement experts.

While we all hope that life returns to normal in 2021, feeling a sense of progress will be a great start.  We’d love to hear your comments!