Nursing Homes in Crisis: Marcum LLP’s Three-Year Nursing Home Statistical Review Exposes Economic Strains and Staffing Shortages

FEBRUARY 13, 2024 (New York, NY) – Marcum LLP, one of the nation’s largest accounting and advisory firms, announced the publication of its comprehensive 2024 Three-Year Nursing Home Statistical Review, providing an extensive overview of the industry from 2020 through 2022.

The annual report delves into the significant challenges and trends within the nursing home sector, including the implications of a controversial federal staffing mandate proposal by the Centers for Medicare & Medicaid Services (CMS).

As the industry emerges from the shadows of the pandemic, Marcum’s analysis highlights several key areas of progress and concern. The study reveals substantial strides in patient census recovery post-pandemic, indicating a promising direction for the sector. However, the report raises the alarm on the stark rise in operational costs due to double-digit inflation in 2022, leading to a significant decline in nursing home operators throughout the country.

The analysis shines a spotlight on the CMS proposal that requires nursing homes to meet minimum staffing standards, which, without adequate funding or support, threatens to increase labor costs and intensify staffing challenges.

“We stand at a pivotal moment in the history of long-term care. Our analysis reveals the undeniable perseverance of the nursing home industry amidst trying times and the formidable challenges ahead. As we navigate the intricate balance between regulatory requirements and the financial realities of care delivery, the priority remains to ensure the highest quality of care for our aging population. The insights from this report underscore our commitment to that goal and to advocating for policies that support the sustainability of the industry,” said Matthew Bavolack, the national leader of Marcum’s Healthcare Services practice.

The key findings of the report include the following:

• The first rise in nursing home occupancy rates since the pandemic began, with a 5.33% increase in 2022, signals a potential recovery in the sector.
• Staffing costs have soared, with notable increases in RN and CNA hourly rates, intensifying financial strains on facilities.
• The net cost report operational loss per patient day for nursing homes increased by 16.78% in 2022, highlighting the economic pressures in the industry.
• A decline in the number of nursing homes, especially in the Northeast, could lead to challenges in accessing elderly care services.
• CMS’s proposed staffing mandate revealed that 75.46% of nursing homes do not meet the recommended standards, potentially adding substantial costs.
• Non-compliance fines for nursing homes have doubled between 2017 and 2022, raising concerns about the financial impact on providers.
• The increased demand for contract nursing due to the pandemic has resulted in a spike in hourly rates, adding to the rising cost of nursing care per resident day.
• Wage inflation has caused a nationwide increase in the average hourly wage for nursing home staff by 15.71% between 2020 and 2022.

The full 2024 Three-Year Nursing Home Statistical Review is available on Marcum’s website. It offers a comprehensive examination of an industry at a crossroads, calling for strategic planning and support to ensure the continued provision of quality care for the aging population.

About the Study

The annual Marcum Three-Year Nursing Home Statistical Review critically examines historical trends and future impacts to help skilled nursing facilities improve operational and financial performance and guide strategic planning. The study is based on a meticulous review of the Center for Medicare and Medicaid Services (CMS) database of Medicare cost reports (Form 2540-10) filed annually by the nation’s nursing homes.

More than 38,000 Medicare cost reports were reviewed for the 2020-2022 analysis. Data is presented nationally and regionally to illustrate trends and identify local deviations from the norm. Regions include the Midwest, Northeast, Pacific, Southeast, Rocky Mountains, and Southwest.

Data are analyzed in 15 financial and operational categories. These include:

• Occupancy and payor mix
• Occupancy percentage by state
• Average of total cost PPD by state
• Average length of stay
• Nursing
• Dietary
• Laundry
• Housekeeping
• General service cost per patient day
• Therapy
• Average hourly wage
• Employee benefits to total salary
• Revenue analytics
• Medicare gross revenue per patient day
• Balance sheet analytics

Data reference tables are also provided for each of the three years covered by the study.

About Marcum LLP
Marcum LLP is a top-ranked national accounting and advisory firm dedicated to helping entrepreneurial, middle-market companies and high net worth individuals achieve their goals. Marcum’s industry-focused practices offer deep insight and specialized services to privately held and publicly registered companies, and nonprofit and social sector organizations. The Firm also provides a full complement of technology, wealth management, and executive search and staffing services. Headquartered in New York City, Marcum has offices in major business markets across the U.S. and select international locations. #AskMarcum.