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Nursing homes face high vacancies amid pandemic, raising fears for future

Demonstrators gather beside a presentation depicting the number

Demonstrators gather beside a presentation depicting the number 15,000 to denote estimated nursing home deaths on March 25 in New York.  Credit: AP/John Minchillo

ALBANY — The vacancy rate at nursing homes in New York has jumped to three times the pre-pandemic level and is raising fears about the fiscal viability of the facilities, according to state records obtained by Newsday.

Driving the historic vacancy rate are the more than 15,000 deaths of nursing home residents from COVID-19 combined with families who are increasingly reluctant to send their relatives to the homes, said home operators and researchers in the field.

"This was the biggest vacancy we’ve seen," said Stephen Hanse, president and CEO of New York State Health Facilities Association, which represents skilled nursing providers. "You could see some nursing homes going out of business — they can’t pay their mortgage."

What to know

  • The nursing home vacancy rate in the state has jumped to three times the pre-pandemic level.
  • In February 2020, nursing homes had a vacancy rate of 7.3%;. this February, the rate was 21.3%,
  • Factors include the hesitancy on the part of families to send relatives to the homes after the large number of deaths in the homes during the pandemic.

Some researchers, however, say the low occupancy presents an opportunity to encourage funding and use of more community-based and at-home services to keep the elderly in assisted living apartments, with relatives or in their own home.

In February 2020, just before New York started to be hit hard by COVID-19, nursing homes statewide had 8,242 open beds, 104,110 residents and a vacancy rate of 7.3%. At the same point this February, nursing homes had 29,955 open beds, 88,403 residents and a vacancy rate of 21.3%, according to the latest data from state Health Department records.

That’s the highest vacancy rate in nursing homes statewide ever recorded, according to operators. State records show the 21.3% vacancy rate in February compared to 6.9% at the same time in 2019 and 7% in 2018. In February 2011, the rate was 5.6%, according to state records.

"This pandemic targeted the elderly and infirm, especially in congregate care settings like nursing homes and assisted living facilities," said Michael Balboni, executive director of Greater New York Health Care Facilities Association, which represents nursing homes and assisted living facilities.

"These are people’s homes, some are here for five, 10, 15 years, so when you lose these great residents of these homes, building that population back is going to take time."

4 in 10 Adults nationally who said the pandemic eroded their confidence in nursing homes, according to November 2020 survey by AARP.

In addition, a November survey by AARP, the powerful lobbying force for older people, found four in 10 adults nationally said the pandemic eroded their confidence in nursing homes and assisted living facilities and nearly three in 10 said they were less likely to choose the facilities for themselves or an older relative.

The vacancy numbers come at a time when U.S. Justice Department is investigating the Cuomo administration’s handling of deaths in nursing homes. In February, Cuomo’s top aide, Melissa de Rosa, told legislators that the administration delayed releasing the total number because it feared the Trump administration would use it for political attacks. Cuomo said the release was delayed because he wanted to ensure the data was accurate.

Cuomo, who has published a book about his handling of the pandemic, was being pressed for the total number by families and lawmakers who feared that a March 25 guidance issued by the administration telling nursing homes to accept COVID-19 patients may have exacerbated deaths. Cuomo said that the guidance followed federal guidelines and that the virus was more likely to have been introduced into the homes by staff and visitors.

Concerning the vacancy rate, Balboni said some of the hesitancy on the part of families stems from the state's suspension of family visits to nursing homes to stem the spread of the virus. "For the longest time, families couldn’t visit their loved ones. Why would you send a loved one to a nursing home when you couldn’t see them?" he said. "With more people working at home, many decided to keep them home."

Another factor is that hospitals had stopped for months sending patients to nursing homes for short rehab after elective surgery, which the state suspended during the worst months of the pandemic. Today, although elective surgeries have resumed, some hospitals are trying to send these patients directly home with part-time care and some patients are avoiding rehab in nursing homes, experts said.

Further, states including New York and the federal government are trying to move more patients to home care or community-based care, which is less expensive than nursing home care. The state also cut 1% of funding last year, after a 1.5% cut the year before as part of the state's overall effort to control Medicaid spending that funds health care facilities.

"All these factors have really driven the census numbers down," Balboni said.

The vacancy trend is nationwide.

'They should never have locked families out the way they did.'

Charlene Harrington, professor emeritus at the University of California at San Francisco who studies the nursing home market

"I think hospitals and health plans may be reluctant to send people to nursing homes and certainly people are afraid," said Charlene Harrington, professor emeritus at the University of California at San Francisco who has studied the nursing home market and nurse staffing at the facilities.

Suspending visitation left residents lonely and depressed. "They should never have locked families out the way they did," Harrington said. "Families realized (residents) suffered tremendously during the pandemic … people won’t forget."

Nursing homes are reimbursed by government health care programs and some private insurance carriers based on a per-patient formula. A low occupancy rate means less compensation for nursing homes, which still must maintain most of the same spending on staffing and building costs, according to operators of nursing homes.

'Most nursing homes in New York state right now are in the red.'

Stephen Hanse, president and CEO of New York State Health Facilities Association

"Most nursing homes in New York state right now are in the red — the vast majority," Hanse said. "They are struggling financially, struggling to get staff."

Nationally, vacancy rates among the 15,000 facilities serving 1.2 million people are spiking in most states, according to federal data.

"Getting back to pre-COVID occupancy levels is a significant concern for operators," said an analysis of the data by the consulting firm CliftonLarsonAllen.

The long-term prognosis is uncertain. Some gains in occupancy have been posted in recent weeks, but experts are unsure when and if occupancy rates will return to pre-COVID levels. For example, the COVID-19 vaccines helps make nursing homes safer as residents get doses, but state officials have lamented that a high percentage of nursing home staff still refuse to get the vaccine.

"I see the census numbers coming back … there are gradual increases in bed census, but some places are flat," Hanse said. "It’s going to take time."

Harrington said she hopes occupancy rates stay low: "We don’t need this many beds because people are healthier and live longer and they are getting services at home. We don’t need to be warehousing people in nursing homes the way we have done."

Harrington said the for-profit sector of nursing homes has lobbied to keep many states from expanding their home care services.

"We aren’t going to get rid of nursing homes," she said. "We need nursing homes because some people are always going to be sick and not have relatives and not have appropriate housing and will need that level of care. But we could certainly cut it back."

Cutting back is a concern to people such as Hanse who must keep nursing homes open now, and for the near future.

"By 2030, the Baby Boomer population will see a dramatic increase of people 65 to 85 and a dramatic increase in geriatric morbidity," Hanse said. "At the same time, the census data shows us that there is an increase in people living longer. New York will need every bed it can get as we get closer to 2030."

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