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Long-term care is facing the most difficult occupancy challenge to date. A recent report from the National Investment Centre (NIC) for senior housing shows the lowest numbers since they began tracking occupancy rates in long-term care back in 2005. While the decline started before the COVID-19 pandemic, it has clearly been impacted by the increased threat of potentially fatal infection, as skilled nursing facilities (SNFs) across America have seen huge drops in resident populations over the last two years. Although the COVID-19 vaccine rollout in long-term care facilities was successful, the second quarter of 2021 has shown no increase in occupancy rates around the country.

Nursing home with low Occupancy Rates
Occupancy rates often suffer from the bad press nursing homes receive.

The reasons for this decline in occupancy rates are numerous, though two trends appear to be emerging. The first is that baby boomers desire more flexibility. “We’ve looked at everything from consumer trends, [and realized that] the boomers are aging, and they want something different than their parents have traditionally wanted in senior housing,” said Lola Rain, the chief strategist at Senior Living Foresight. 

The second trend is that the reputation of nursing homes has been damaged by the media’s depiction of them. “Every single time there was a bad story that came out of senior housing it was announced in the media,” said Rain. “But the media doesn’t cover all of those other fantastic stories of lives saved and people being healthier and happier living in a community setting.” 

Rain recently appeared on the LTC Heroes podcast to speak about the distrust that results from negative media coverage. She also explained how messaging and marketing can help convey that these facilities are actually communities. 

The Importance of Resident Retention

Attracting new potential residents is often the focus of attempting to raise occupancy rates in long term care communities, though resident retention is similarly important; to populate that community is vital, but once new residents are admitted, it is everyone’s responsibility to provide an environment that gives residents the best quality of life possible. There are three major themes of resident retention: quality, a healthy work environment, and life enrichment.

Commitment to Quality

Your team must work together to ensure that a high standard of care is being met and improved over time. When the entire staff—from the receptionist to the direct caregivers—is committed to making sure residents are in capable hands, resident retention will rise.It is also crucial to stay on top of federal and state regulatory standards. This not only helps nursing homes avoid costly sanctions but also ensures that they will function at a high level and provide outstanding care for their residents; ensuring that your facility is in compliance will result in fewer deficiencies and will increase your resident’s satisfaction and therefore retention. 

Resident retention is influenced by the quality of life you provide.

Staff Satisfaction

If the people working long and stressful hours at your facility do not feel appreciated, the environment in your community will be unpleasant for your current residents. This will have a negative impact on occupancy rates and resident retention. Additionally, if your staff turnover is high, you will have to spend more resources on training than you do fixing the real issue: retaining staff members. 

Go the extra mile to ensure that staff members feel valued within your community. Your frontline workers are vital to the wellbeing of your residents and the success of your organization and their pay and treatment should reflect that fact. Finally, make sure you listen and take into consideration their issues and concerns

Life Enrichment In Long-Term Care

In addition to providing care, nursing homes must help make the lives of their residents more fulfilling. “Life enrichment not only attracts people, but it also retains them in your community,” said Rain. And without investing the relevant resources into life enrichment and activities, your community is not doing all it can to make residents feel at home. 

Unfortunately, most life enrichment departments are not sufficiently funded. Rain compared life enrichment directors struggling to fund their activities to school teachers paying for arts and crafts supplies from their own pockets. “They have small budgets, yet they want to offer so much to their residents,” she said. 

Another issue is that activities are often too limited. “Life enrichment also has tended to be a one size fits all, where residents are presented with eight activities from which to choose,” Rain said. “Then, all of a sudden, people aren’t showing up for those activities, and the life enrichment director is saying, ‘Well, I’m doing all I can do’.” The problem, she pointed out, is that they do not quite know what can and cannot be done. It is important to note the temperaments of residents and their desire for more options, especially in the case of the baby boomer generation. Below, we offer five ways to help with life enrichment at your facility. 

Contact us to get a free mini-guide to increase occupancy rates.

Attitude Shifts that Increase Occupancy Rates and Improve Profitability In Long-Term Care

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Life enrichment can help improve profitability.

For long-term care residents to receive quality care, not only do you need to utilize the best technology, including the right long-term care EHR software, and hire the most qualified professionals, but your establishment needs to be profitable as well. That means having sufficient occupancy rates and resident retention to remain sustainable. Below we will highlight some resident retention strategies to keep in mind as you move through these tough times and try to improve your occupancy ratio and, in turn, profitability. 

Embrace and Convey the Idea of Community Over Facility

Perception is key, and that is particularly relevant in nursing homes, which have been represented in poor light by the media. That is why Rain said that one of her biggest initiatives has been to change the consumers’ attitudes towards senior housing. “We’ve gotten rid of the f-word, ‘facilities’,” she said. “We’ve worked really hard at trying to eliminate that word from our vernacular because when people hear the word ‘facilities,’ they think of institutional living and senior housing from decades ago, when it had a terrible reputation.” 

Instead, facilities should convey that they are communities. “Long term care is a community because it creates an infrastructure for a village-like life,” said Rain. By that, she means that it provides a social structure, health structure, and dietary and wellness resources.

So how does a long term care facility convey that it is, in reality, a community? “Like with any company, it starts with your branding and your marketing messaging,” Rain said. “You need to dive in and make sure that that messaging resonates with the people who are interested in living in your community, building your brand, and communicating the value of living in your community to a broader audience.”

Some of the differentiating factors for reframing long term care facilities as communities are: 

Telling your community’s stories:

Rain shared that she leveraged social media to make her staff members feel like they were part of a community. “When I was the director of digital media at Eskaton in Northern California, part of my job was to find stories and highlight them through all of our digital channels, including social media,” she said. If a facility does not employ a social media person, they can simply request that individuals submit a story and photo of themselves. All you need to do is prepare questions for them to answer. “You can rotate through your staff and highlight a different staff member each month, a healthcare hero, just like you would in a normal newsletter,” she said. These stories can then be shared on social media. Rain emphasized the significance of accentuating the contributions of care providers during the pandemic, when they may feel particularly underappreciated. 

Comfort foods:

As mentioned above, the baby boomer generation is demanding more options in terms of amenities. One area of particular sensitivity is dining. “Food is always a huge complaint in the community,” Rain said. “Satisfaction scores are often low for food. Comfort foods are something that everybody can just gravitate towards.” She mentioned macaroni and cheese and Salisbury steak as examples. She said that providing the foods that get residents excited will make them “huge cheerleaders” for your facility. “Get that testimonial out there and show that as proof of something that your new residents can really gravitate towards—that thing that your dining staff or chef or cooks do a fantastic job of preparing—and focus on that,” she said.

Community outreach

Because the media has had a detrimental effect on the perception of nursing homes, it is important that you reverse that by connecting your residents with their surroundings. This serves two purposes: it allows outsiders to get a better idea of the reality of long-term care and also makes residents feel more at home and fulfilled. 

Rain mentioned the value of intergenerational programs, or, inviting children into facilities, though these have had to become virtual meetings during the current pandemic. “This, in effect, builds the next generation of people who will work in senior housing,” she said. “It opens up the children’s eyes and shows them that life can be good as you grow older. It also allows their parents to understand this is a safe community for my child to enter.” She mentioned how, as a child, she visited senior living communities as part of a dance troupe, “and it was fantastic.” She was also heavily involved in the lives of her grandparents, which is why she was never intimidated by such environments. “I’ve seen the inside of many different types of senior community centers, and that made me an activist for the industry because I believe in what we do,” she said. “But if you’ve never set foot in one, you’re scared of it. You don’t know what’s behind that door,” she continued. “All you know is what you’ve heard in the media. And so to change that perception, we have to invite people in and give them reasons to come in our doors.”

Create lifestyle programs:

Care is not limited to providing food, medication, and therapy. It is also about overall wellness. Emphasizing that is key to building a community. Rain mentioned that she has organized brain fitness groups that visit malls and classes for fall prevention. But she did not limit herself to those two. “You can build events out of any topic, like decluttering or cooking healthy meals,” she said. “Even if it’s on Zoom, you just need to get as many people participating as possible, because when they’re exposed to your brand and what you’re offering, they’re gonna build trust with you.”

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Forward-Thinking Long-Term Care Facilities Are Thriving, Even During the COVID-19 Pandemic

Occupancy has become more of an issue during the COVID-19 pandemic. While Rain mentioned that facilities with “good finances and good investors” will “definitely” survive this difficult period, she added that predictions suggest that larger organizations could “shake out” companies that have failed to take the appropriate measures. “What we did note is that a lot of companies that struggled with infections during the pandemic may have already had bad star ratings and maybe not have had the best internal practices,” she said. “Hopefully, these companies learned quickly how to adjust.”

The facilities that have not encountered issues during these times are those that are forward-thinking. “The companies that are succeeding right now are the ones that invested in technology and innovation a long time ago, the companies who have been doing stuff differently and were already evolving,” Rain said. “They’ve survived and even thrived because of being proactive.” 

Rain then mentioned that tech companies have shared with her that certain organizations just decided to embrace technology that they had been offering to them for years. “They say, ‘I’ve been selling this product for five or 10 years, and nobody would listen. Now, all of a sudden, there’s a pandemic, and my phone’s ringing off the hook, and everybody wants the product today,” Rain said. 

The Entire Long-Term Care Facility Must Be Part of the Sales Pitch

Recruiting potential residents requires that your entire team provide a pleasant experience from the start of their visit to or contact with the nursing home to when they sign on the dotted line and beyond. “It’s not just about those two people with the titles of sales and marketing,” Rain said. “It’s the responsibility of every single person in that building—from the front desk to dining services to those on the front line—to fill it and keep it full.” Rain added that this commitment to filling the facility with the people who need care the most goes hand in hand with your team’s commitment to caring as a whole.  

It is important for all members of the staff to take every visit or inquiry from potential residents seriously. “When somebody comes in or calls a community because they want more information, they’re not just a looky-loo,” Rain said. “They’re there for a reason. They’ve either already experienced a fall, or they’ve had a spouse pass away, or they’re just scared to live alone.” It is for this reason that each staff member must know his or her role and “believe that their job is to make everybody’s life happy, healthier and safer.”

It should not be lost on facilities that the image presented to potential residents must be a true one. That means that your staff should sustain the hospitality and welcoming attitude that secured those residents in the first place. Otherwise, your nursing home could risk losing seniors who conclude that other facilities may be more appropriate environments for them. 

4 Steps to Improving Occupancy Rates In Long-Term Care

Improving retention rates is largely about being able to view your community and what it does from afar so as to gain the perspective of residents who call your facilities home. Rain mentioned four main steps for adjusting a facility’s attitude to increase occupancy rates and widen a community’s profit margin. 

1. Refocusing:

Assess whose responsibility it is to fill your building and keep it full. As mentioned above, it is the responsibility of every single person in the building to create a pleasant environment for residents, their families, and the staff regardless of what is going on in one’s own life. “You’ve got to be nice, you’ve got to sound happy, doesn’t matter that it might be nine o’clock at night, the person calling could be in a crisis,” Rain said.

2. Alignment:

Assess why your building is not full. “We like to find reasons, and we like to blame things,” Rain said. “So we may blame a person, or the environment, you know, maybe it’s not on a good corner, maybe it doesn’t show well from the street. Maybe it’s the economic environment or the pandemic.”

The desire to assign blame or find reasons often comes from misplaced expectations. “If we believe that the building should be full, because we have great food, well, that’s misplaced expectations,” Rain said. “So when leadership and management in the sales team are misaligned, everyone is to blame, because the real culprit is a shared expectation.”

The entire team must be on the same page as to what can and should be done at the facility. “The reason that the building is not full is not one thing,” Rain said. “It’s multiple things. So everybody needs to be in alignment on what those things are that they can do to make sure that the building looks the best it can be.”

Each member of the team needs to be aware of the issues that stand in the way of progress and contribute to the plan to correct them. 

3. Acknowledgment:

Taking a step back to consider alternative ideas and perspectives can open the door for new and better ideas that will help you reach your occupancy goals. Rain encourages leaders to acknowledge their aha moments. For her, this occurred when she interviewed vice presidents of sales and marketing at various organizations and asked what they needed to improve occupancy. “I expected to hear things like a better CRM, better brand ads, better social media, very tangible things, but that’s not what I heard,” she said. “I heard people telling me, ‘I need to listen more to my staff. I need to ask people how they’re doing. I need to practice empathy. I need to understand the schedules that people need, because their kids are being homeschooled.” 

4. Finding balance:

Empathy for individuals and understanding of the jobs they do goes a long way in this industry. “There’s a lot of soft-touch that needs to happen right now because we are human beings,” Rain said. “And we do need to support one another.” Make sure that you have the tools and the emotional support that your staff needs to succeed at their tasks. And remember the importance of helping your staff balance their workload with the expectations of their supervisors. “Balancing is about making sure that we are not putting too much focus on one person’s responsibility to fill the building,” she said. “We don’t want to burn them out.” 

5 Ways to Sustain and Improve Occupancy Rates Through Life Enrichment

A promise of the best possible quality of life attracts and retains people in your community. A common misconception about life enrichment in long term care is that it requires great financial resources. 

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  1. Assess: Look at your current life enrichment activities and ask: Are they successful? How many people attend? Why are some people not participating? 
  2. Review: Research your residents’ preferences and habits. Make sure to adapt activities to your resident’s abilities and interests. Community partnerships will allow residents to connect with their surroundings and create new relationships. This will increase the overall satisfaction and involvement of your residents. 
  3. Lead: To plan and implement these activities, you will need a great management team. Leaders must explain to life enrichment directors activities what approach has or has not worked in the past. “They want flexibility,” Rain said. “If you’re only offering this one size fits all program, it’s not going to be attractive to the next generation of senior living residents.”
  4. Get feedback: Leaders must ask residents about their interests and their opinions of the activities currently in place. After all, life enrichment is about your residents. Regular feedback allows you to adjust to their needs. It is, indeed, the best way to improve life enrichment over time. 
  5. Stay curious: Never stop asking questions or exploring further improvements. Dive in and look at how life enrichment and occupancy are intertwined, and you will find ways not only to attract new residents but to keep your existing community members engaged and satisfied.


When striving to improve occupancy rates, it is important to take a step back and analyze what is and is not working. Acknowledging that resident retention plays a big part in improving occupancy rates is already a big step forward. Additionally, for your community to grow, you have to commit to quality standards and maintain high staff satisfaction. Understanding that the responsibility for the success of the community lies in everyone’s hands. Finally, investing time and effort into a strong life enrichment program will help your community feel like a home to current and potential residents.

For more about the most recent trends in long term care, check out our blog here. You can also subscribe to the LTC Heroes podcast by clicking here