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It is no secret that, during the pandemic, nursing home census levels plummeted. In addition to infection control challenges, facilities are still reeling from the aftermath of negative sentiments over nursing home safety, vaccinations statuses, and faith in residents’ visitation rights. 

The state of the industry: In 2020, Clifton Larson Allen (CLA) conducted a national study on nursing home census and occupancy trends. It revealed that the maximum occupancy level in facilities was recorded at 80%, while the lowest occupancy level was only 56%. Even more worrying is that, while other industries have bounced back after the pandemic, the long term care industry and nursing home census levels have continued to decline. 

Caregiver improving nursing home census by spending more time with resident.
Nursing home census levels plummeted during the pandemic.

Temporary solutions: Despite recent reports that nursing home census levels are improving, the reality is that facilities are voluntarily taking beds out of service and reporting inaccurate occupancy levels. For example, a facility may have a capacity of one-hundred beds but only reports eighty beds and voluntarily removes twenty beds. In such cases, the facility artificially boosts its relative occupancy levels so it can maintain a steady occupancy of seventy beds. 

This risky approach is unsustainable, as facilities will still have the same overhead, just with lower census levels. In the long run, facilities cannot maintain the same quality of care or re-produce their pre-pandemic profit levels.  This practice also hurts the long term care industry as a whole, as government agencies think the industry is recovering, but instead, it is falling short of pre-pandemic levels. 

Reason for hope: Meanwhile, public opinion on long term care is slowly improving, thanks to the CMS, which has shown more transparency with its new requirements on publishing the vaccination statuses for both residents and staff. The CMS hopes to assure families of resident safety by reaffirming its commitment to the protection of residents and staff. Thanks to the CMS, families, and members of the public now have access to regular updates from nursing homes across the nation. Still, it will take years to convince families that nursing homes are once again a haven for the elderly. 

The Impact of Low Census Levels on Healthcare

It is clear that low census levels are having a devastating impact on the long term care industry and, eventually, will impact a facility’s financial position. During the COVID pandemic, facilities that qualified for the Paycheck Protection Program (PPP) received some much-needed financial assistance to help them maintain operations, subsidize payroll, hire staff, and cover applicable overhead. However, these resources are dwindling fast, putting even more pressure on facilities to improve their nursing home census levels.  

Facilities that have implemented an efficient long term care software system can use advanced analytics tools like CareMetrics to collect, format, and analyze data. By looking at visually-dynamic graphs and charts, facility administrators can determine which buildings deserve the most attention for their low census levels. 

The Impact on Home Health Services

One of the biggest worries of nursing home administrators is the increasing popularity of home health services and they are being preferred over nursing homes. Because the pandemic hit nursing homes so hard, public opinion plunged to an all-time low. Skilled Nursing News recently conducted a poll on the public’s opinion of the long term care industry. The results show that 54% of respondents have a worse view of nursing homes since the pandemic, with people aged fifty-five years and above having the most strongly negative opinions about nursing homes. 

Meanwhile, with an aging population of approximately 10,000 seniors turning sixty-five years and older, the demand for senior care assistance is expected to increase, especially in the home health sector. According to the Bureau of Labor Statistics (BLS), in 2020, there were approximately 3,470,700 home health jobs. These figures are predicted to increase by 33% by 2030, a staggering growth rate that is seven times faster than other industries. 

Furthermore, home health services show no signs of decline, especially with the steady COVID infection rates. Families are keeping their elderly relatives at home in fear that the previously enacted visitation restrictions might return. They are avoiding nursing homes in case of another mass outbreak that may cut them off from their relatives. Studies also show that residents living in nursing homes during the pandemic experienced low psychosocial and emotional well-being, further dissuading families from sending their elderly relatives to a nursing home.  

The Impact on Nursing Home Staff

Another problem arising from low nursing home census levels concerns the facility staff. While some facilities are struggling with a staffing shortage, others are dealing with the fallout of having fewer residents, consequently, needing less staff. Facilities that have implemented an efficient long term care software system with automotive financial processes like CareMetrics are better equipped to assign resources more efficiently, thus, increasing job security for nursing home staff. 

From a facility’s perspective, it must avoid being overstaffed for an extended period, as this will severely impact its finances, payroll, and accounts. However, from the standpoint of its staff, low census numbers impact the nurses’ and CNAs’ work stability, as the facility may cut back on their work hours due to overstaffing. This negatively affects their salaries, and work satisfaction and ultimately negatively impacts the quality of care in a facility. 

It is also common for facilities to “float” staff to other understaffed facilities. While this offers nurses and CNAs an alternative opportunity to continue working, it only results in more instability. This, in part, is because the new facility may use an alternative long term care EHR system that requires additional training, or have other responsibilities beyond the CNA’s current training and experience.   

Should a facility continue to experience low census levels, it may eventually be forced to lay off some of its nurses. RNs and CNAs should know their employment options and rights to protect themselves in such cases.  

The Impact on Employment Rights

Some facilities offer work contracts that include a “guaranteed hours” clause to protect workers against low census levels. In such cases, nurses and CNAs will continue to be paid by their agency or facility should a shift be canceled. Another contract clause that nurses and CNAs should look for is a “cancelation rule” that exempts pay for a certain number of canceled shifts. For example, the contract may specify that a nurse will not be paid for the first three-shift cancelations. However, for any shifts canceled after that, the facility is liable to pay even if the shift is canceled. 

Contact us here if you would like to test drive our user-friendly long term care software.

3 Tips for Filling Nursing Home Beds 

While some facilities may include clauses protecting their workers’ rights, not all will.

In such cases, the best way to keep their staff happy and, ultimately, their residents are to improve their nursing home census. So how can a facility keep its nursing home beds filled? Gross Mendelsohn & Associates shared these key steps facilities can take to build a stronger nursing home census

  1. Make a Good First Impression

The importance of making an excellent first impression cannot be stressed enough. Nursing home weekly bed census levels are directly impacted by how many visitors go to a facility and consequently move in. 

Making a good first impression is everything. When visitors (potential residents and their families) visit a facility, they will be taken on a tour or walkthrough. During the facility tour, the admissions staff will highlight the most impressive aspects of the facility and answer any questions. 

It is important to remember that visitors coming to the facility are looking for a comfortable, home-like, safe place for their loved ones. Furthermore, it’s not just the seniors who need to be impressed but also their adult children, who are more likely to be the key decision-makers

Therefore, when visitors go on a facility tour, the ultimate purpose is to show the facility in its best light. In such cases, facilities can employ several cost-effective methods to improve their aesthetics. 

These simple touches can make a facility look more appealing:

Residents suffer when there are low census numbers, as there are not enough staff.
Low census numbers negatively impact the facility, staff, and residents.
  • Displaying festive decorations (e.g., Christmas, Easter, and Valentine’s Day)
  • Placing fresh flowers in the entrance and waiting room
  • Making the most of natural light with large windows, skylights, and non-fluorescent lighting
  • Playing ambient background music that is uplifting in your facility
  • Placing a welcome sign in the reception area
  • Ensuring there are no foul odors in the facility
  • Preparing and taking visitors to a designated “showroom” (a pre-prepared, clean resident room) 
  1. Provide Sufficient Staff Training

A facility’s staff is the first port of call. It is inevitable that visitors will see and interact with licensed nurses and CNAs. Furthermore, these will be the primary caregivers for their elderly parents should they move into the facility. Therefore, it is essential to train staff members to impress visitors during the tour.

Some easy methods to improve low census levels with better staff training include:

  • Ensuring the admissions staff are well-versed on how to answer the most commonly asked questions. They need to answer every question with confidence and assurance, covering all the essential aspects of the facility.
  • Training staff with tried and tested tour processes. For example, taking visitors to see the different amenities, like the dining area and communal areas. This can then be followed by a tour of relevant services, like meeting the onsite physiotherapist who assists with rehabilitative services.   
  • Creating a friendly and approachable team, especially during tours. Visitors will likely speak with other staff members when they come for a tour. In such cases, having them interact with friendly staff will create a better first impression.   
  1. Take On Problematic Patients to Improve Referral Relationships With Hospitals

Low census in a nursing home should be avoided whenever possible. Should facilities find themselves in a situation where they need to improve their nursing home census levels, there are several strategies they can employ:

  • Befriending the hospital case manager, who will likely refer residents when appropriate. Contrary to popular belief, befriending case managers is not about buying them gifts but rather about building meaningful, professional, mutually beneficial relationships with respect and honesty at the core.
  • Sometimes, a case manager may ask a facility to admit an undesirable hospital patient. While the undesirable patient may come with their problems (they may be insulting or refuse to take medications), accepting the patient will help improve relations between the facility and hospitals, which will help with future referrals.  

Changing Attitudes to Improve Nursing Home Census

A nurse providing more attentive care to change attitudes and keep nursing home beds up.
Facilities need to change attitudes to keep nursing home beds up.

There are several tactics that facilities can use to improve nursing home census levels and attract more potential residents and their families. But the first challenge is to overcome the negative impact of the pandemic. Recent studies show that systematic problems in long term care have been further exacerbated by media stories on poor care, bad organization, and staff shortages in long term care.

What is clear is there is a need for change and a shift in attitudes toward long term care facilities. Lola Rain, a growth strategist with Senior Living Foresight, recently highlighted the importance of eliminating the f-word, “facility,” from communication with potential residents, as this word suggests institutional living. She argued that what is needed is a new messaging approach from facilities to the public. They need to highlight their core values of creating a safe space where seniors can live in peace and comfort. 

Ultimately, running a facility entails more than balancing figures and keeping census levels high. Caring for residents in their senior years such that they can live a life of dignity, independence, and respect is the goal. And that means improving the culture at your organization, community engagement, and elevating the dining experience, among other new standards in the industry. 

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast

Cindy Wong
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