The dramatic spread of the COVID-19 delta variant has helped splinter the opinions of long-term care administrative and nursing leaders about when census might return to pre-pandemic levels.

Nearly 22% of respondents in the third annual McKnight’s Mood of the Market Survey said census was “already there” at their respective facilities, while another 19% felt they would be back by the end of 2021. 

There also were nearly 10% of respondents, however, who said that census would “never” return to pre-pandemic levels. An additional 14% estimated it would take until 2023 (10%) or “2024 or beyond” (4%) to return to them.

The figures constitute key findings from the third annual McKnight’s Mood of the Market Survey. The industry’s largest independent gauge of skilled nursing leader sentiment gathered the attitudes of 627 long-term care administrators and nurse managers between July 28 and Aug. 3, 2021. A random drawing for five $100 gift cards was offered as incentive to participate.

On a national average, nursing home census fell more than 13 percentage points after pandemic conditions were declared in March 2020. It hit a record low average of about 67% in February of this year, according to Mark Parkinson, the president and CEO of the American Health Care Association. His census goal for the industry was growth of at least 1% per month, which has been a struggle to achieve. 

“If census doesn’t recover at all, or recovers slower than that, the sector has a real problem,” Parkinson said at the time.

The National Investment Center for Seniors Housing & Care reported Wednesday that skilled nursing census rose from 71.2% in January to 74.1% at the end of June. That is still more than 11% below pre-pandemic levels, according to NIC senior principal Bill Kauffman.

Census levels’ financial implications are huge. Some operators have had to restrict admissions due to staff shortages, creating a vicious cycle of depressed occupancy levels.

“I talked to a CEO in Michigan who has probably 14 or 15 facilities, and he said they were having to turn people away because they don’t have enough workers,” Total Compensation Solutions Principal and senior consultant Matt Leach told McKnight’s Long-Term Care News. “So census isn’t always about residents. It’s the workers.”

One way or another, lagging census means problems for providers — and there is no consensus when occupancy will fully return, as seen in the survey results.

More nods to mandates 

Respondents also revealed growing acceptance of COVID-19 staff vaccine mandates. In a McKnight’s reader survey conducted in December 2020, only 14% said their companies would likely make vaccination a condition of employment, while 47% said they would not.

By the first week of August, however — less than three weeks before President Biden announced a federal vaccination mandate for all nursing home employees would be put in place — the tide had already turned.

The percentage of providers saying they would impose their own mandates had more than doubled, to 30% — 8% had already issued a mandate, 12% said one was in the works and 10% said they were planning for one once vaccines were given full federal approval. (The Pfizer vaccine has since been fully approved and had the EUA label taken off.)

Meanwhile, those who said they wouldn’t impose a mandate had plummeted by half, to just under 24%. The percentage saying they didn’t know if a mandate would be put in place rose to 47%, from 38%, in the seven months between surveys.

In the most recent McKnight’s survey, nurses managers were slightly more pessimistic about the return of census levels than their administrator counterparts. Nearly 11% on the nurse side said census levels would “never” return, while only 8% of administrators felt the same way. In addition, 42% of administrators felt census would return to pre-pandemic levels by the end of this year, while only 38% of nurse leaders were as optimistic.

On the question of staff vaccine mandates, about 20% from both groups said they either “already do” have such conditions of employment or had them “in the works.” Administrators, however, took a harder line after that, with 12.5% saying that a staff mandate would be put in place once Emergency Use Authorization (EUA) labels started to come off vaccine choices. Only 7% of nurses felt the same way.

Meanwhile, by the beginning of August, 27% of nurse managers said their company would not mandate staff vaccinations, while 19% of administrators said the same.