Decreased revenue |
Stopping admissions during COVID outbreak |
“We did stop admissions for a month. We did not have any income and revenue for a month just so we could clean up and get our residents that were COVID‐positive…you know, stable.” (S4N2.1) Midwest, 5 star, nonprofit, 50–100 beds
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Reductions in admissions for elective procedures |
“We're usually very, very busy. And all of a sudden admissions stopped. We stopped seeing people going into the hospital, the elective surgeries were off. I think people stopped going to the hospital to get any kind of treatment.” (S4N5.1) Midwest, 4 star, nonprofit, 150–200 beds
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Reductions in census due to need to isolate |
“Our occupancy took a severe hit. Because we really, to this day, are having to take that service to quarantined residents, it ends up being as many as 11 beds out of the 120 that are out of service…So that is basically 10%, ballpark of our revenue that's just gone overnight as of last March.” (S6N2rep1) Southeast, 5 star, for profit, 100–150 beds
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Increased costs |
Higher staffing expenses |
“Our census really was down and then our expenses were way up and I just was able to quantify some of this. We did $64,000 in special hero pay…We spent $63,000 in COVID, not worked, quarantine pay. So, that is people who either tested positive and had to stay home for 10 or 14 days, or they had a known exposure and still had to quarantine.…Then we spent $62,000 in pool [agency staffing]…And then we spent $34,000 in pickup bonuses in January. So, all said and done at the end of the month, we lost $426,000. In one month. Which is just devastating. My panic button is around 50,000. I've never approached anything like that before.” (S4N5.3) Midwest, 4 star, nonprofit, 150–200 beds
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Higher staffing expenses, without increase in reimbursement |
“We're rolling out a new wage scale…I have no idea how we're going to pay for that. We're already not even breaking even right now, but it's just the move that we had to make for survival sake, to be honest with you. It's tough because the state just…the legislature just ended their session in the last month or two and they did not increase our rates at all, so we've got to digest a 20% increase. It's probably going be a few hundred thousand a year minimum that we're going to pay in CNA wages, maybe up to a half a million, and there's no increase in reimbursement, so it's going to be a massive challenge….To say it's a tough business is like cliché. It's a pretty unprofitable one right now and with no relief on the reimbursement side.” (S6N2rep.2) Southeast, 5 star, for profit, 100–150 beds
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Inability to pay more than what is received in unemployment |
“Staff is an issue, because you can't keep staff…. My employees got between $7000 and $10,000 on this last stimulus. That's more than they make in a while, so they're not going to work. They can draw an extra $300 in unemployment to stay home.” (S4N3.2) Midwest, 1 star, for profit, 50–100 beds
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Testing expenses |
“…if they [the Department of Health] find free testing for employees and residents, I would love to have that information. These labs are charging us up the wazoo.” (S3N1.3) Mid‐south, 1 star, for profit, 150–200 beds
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PPE expenses |
“I mean, the amount of PPE that we burned through every day, I can't even begin to convey that to you. I mean, multiple dumpsters full of gowns and gloves and face shields and masks…every single day thousands and thousands and thousands of dollars of PPE exiting the building.” (S5N5.1) Northwest, 4 star, for profit, 50–100 beds
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Fines resulting from survey deficiencies |
“Because the financial recourse if you get fined is significant. So it's a nearly impossible…even if you're late getting your information in, you're subject to a huge fine, up to $20,000. That's a lot of money.” (S1N4.3) Northeast, 3 star, for profit, 50–100 beds
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Value of CARES act funding |
Using CARES Act funds to retain staff |
“HHS [U.S. Department of Health and Human Services] funds did help, with some of the additional funds we received…We have not let anyone go. We still have all of our full staff, and we're able to keep everybody on.” (S7N5.1) Mid‐south, 5 star, nonprofit, 50–100 beds
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Value of CARES Act funding |
“Without the CARES Act and the extra supplemental…funds that was given by the US government, we would have had a very difficult time…When you don't have enough patients, we still have to pay our bills and…we shrink our staff because we don't have enough patients.” (S8N3.1) Southwest, 4 star, for profit, 150–200 beds
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Strategies to cut costs |
“As the census goes down, of course, so do the opportunities to make any kind of revenue…What the organization that I worked for did was as they looked back, and they realized, 'Wow, we haven't even made this budget or that budget' I think they lost like 3.4 million in a three month period. And so what they opted to do was to offer early retirement…for quite a few of their employees, including the employees in my facility. I had a total of nine people accept those early retirement packages. So now, I'm also then short nine people.” (S6N1.2) Southeast, 4 star, nonprofit, 100–150 beds
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Hopes and recommendations |
Need for regulation regarding agency salary |
“I think there needs to be, because of COVID, some regulatory engagement in what agencies can target for staff. Because we're all going to go bankrupt soon enough if the government doesn't get involved.” (S6N3.2) Southeast, 4 star, nonprofit, 100–150 beds
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Hope for additional funding |
“Even though we've received quite a bit of stimulus money, I can tell you, with what I've been spending this past fall, and what I've spent over the last month, and what I've lost in revenue over the last month, every single penny of stimulus funds that I have received is spent, is gone. I'm hoping…there'll be more stimulus funds available, because there's no end in sight right now for COVID.” (S1N5.2) Northeast, 4 star, for profit, 50–100 beds
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Expectations for when support stops, staff cuts |
“I don't know how many nursing homes will survive 2021. When the stimulus money stops, I don't know how many nursing homes will actually survive…We are going through a little staff cut…From a financial standpoint, I see exactly what's going on and what they're doing and why, because we're not going to get the stimulus money forever and we've got to learn to start standing on our own two feet and know that COVID is just part of the new norm.” (S3N5.1) Mid‐south, 5 star, for profit, 50–100 beds
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Need for further support |
“If we had another massive crisis like COVID, I think nursing homes would go out of business…Nursing homes already kind of get a bad rap even though really good things are happening in them, and I think everybody still feels very defeated. We feel like we don't have any partners, we don't have people lobbying for us…And so I don't know that long term care could [continue], 1) with staffing shortages that are still out there and, 2) people can't work under these conditions.” (S6N1.4admin 2) Southeast, 4 star, nonprofit, 100–150 beds
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