John O'Connor

A new study from the Kaiser Family Foundation confirms a shift that most skilled care operators can relate to. While resident occupancy levels continue to bottom out, the new arrivals are in worse shape than ever.

By way of example: People with a dementia diagnosis represented about half of the total resident population by 2016, the last year examined in the study. Moreover, two-in-three residents are now taking psychoactive medications. These include antipsychotics, hypnotics and anti-depressants. Total nursing hours have also increased to 4.1 a day, on average. People, these are very sick people.

At the same time, skilled care occupancy remains anemic. A new update courtesy of the National Investment Center for Seniors Housing & Care puts the average at 86.5% for the first quarter. The same report reveals a slight downturn in inventory levels.

Overlap these studies and what we seem to have here is a classic case of quality (higher-need residents) replacing quantity (total resident volume), right? But do we, really?

Because there’s another emerging trend that has become a part of the mix: A shift to shorter-stay care.

Thanks to rehab therapy, reimbursement changes and other adjustments, many nursing homes have essentially become post-acute recovery centers. That may mean more new arrivals. Just don’t spend too much time learning their names. It’s not uncommon for facilities that once saw a couple of new admissions a week to now get more than a dozen. But the tradeoff is that many of these same residents may be staying for only a few days, rather than for weeks or months.

So it’s probably not too hard to imagine why nursing home operators seem to be such a stressed-out bunch these days. They must admit far more residents than ever, make sure they are the right kinds of residents, get them out the door ASAP and hope that somebody down the street isn’t stealing what’s left of their lunch.

If that’s not scary enough, consider the fact that the changes are just getting started. We don’t know how skilled care is going to look in 10 years. But it’s probably safe to say it’s going to look very different. Frankly, it’s starting to look different already.

John O’Connor is McKnight’s Editorial Director.