The most recent analysis of nursing facility occupancy data for the facility fiscal year ending in 2017 by the Virginia Department of Health’s Division of Certificate of Public Need (DCOPN) shows that nursing home occupancy and days of care are indeed in a gradual multi-year decline. DCOPN has provided the data and related observations, including information on COPN Requests for Application (RFA), to VHCA-VCAL and other stakeholders.

DCOPN suggests that the declining occupancy trend “might be arrested to some degree as the first baby-boomers reach 75 in about two years, with millions more behind them, but Medicaid and perhaps Medicare utilization-control efforts may more than offset the arrival of the baby-boomers in ‘old age’.”

This spreadsheet is DCOPN’s calculation and presentation of occupancy of Virginia nursing homes for facility fiscal years ending in 2017. 

DCOPN observations on the data:

• This spreadsheet for 2017 provides data for 294 nursing homes, including nursing home units of continuing care retirement communities (CCRCs) and hospital long term care units that are certified for nursing home care. The spreadsheet for 2016 also covered 294 nursing homes. In both years, all nursing home units in operation during the year are represented in the spreadsheet.

• Statewide nursing home occupancy of all facilities was 85.7 percent in 2017, 85.8 percent in 2016, and 86.6 percent in 2015.

• Statewide RFA-related occupancy, i.e., excluding nursing homes with no or with very few Medicaid-certified beds and excluding nearly all CCRC-related nursing home units, was 86.5 percent in 2017, 86.6 percent in 2016, and 87.9 percent in 2015. RFA-related occupancy percentages are trending down, as are the occupancy percentages for all Virginia nursing homes as a whole.

• Total days of care provided in all Virginia nursing homes were 10,110,582 in 2017, 10,238,017 in 2016 (10,210,044 expressed as a 365-day year), and were 10,268,952 in 2015. This constitutes a decline of 1.0 percent in total nursing home days of care from 2016 to 2017 and a decline of 0.6 percent from 2015 to 2016.

• The total days of care used in the RFA-related occupancy calculations were 9,308,665 in 2017, 9,380,382 in 2016 (9,354,753 expressed as a 365-day year), and 9,441,299 in 2015. This constitutes a decline of 0.5 percent between 2016 and 2017 and a decline of 0.9 percent between 2015 and 2016 in the days of care in the RFA-related occupancy calculations.

• At the end of calendar year 2017 (technically the beginning of 2018 after 2018 licenses were issued), there were 32,680 nursing home beds in Virginia (includingthose in hospital long-term care units certified for nursing home care), whereas there were 32,615 nursing home beds at the end of 2016. This constitutes an increase in beds of 0.2 percent from the end of 2016 to the end of 2017.

• In the “Comments” column, at the end of each Planning District (PD) and each Health Planning Region (HPR), there is a notation in green font as to whether the 2017 occupancy percentage for the PD or HPR was up, was down, or was unchanged from 2016.  In nine of Virginia’s 22 PDs, the RFA-related occupancy percentage went upfrom 2016 to 2017; in 10 PDs, the RFA-related occupancy percentage went down; and in three PDs it was unchanged from 2016 to 2017.  Among the five health planning regions, Northwestern Virginia and Central Virginia had an increased occupancy percentage from 2016 to 2017, Southwest had no change, and Northern Virginia and Eastern Virginia had a decreased occupancy percentage from 2016 to 2017.

Notes about the Data

Sam Clement of the Division of COPN at the Virginia Department of Health noted the following:

• The primary source of this data is the “ALSD” spreadsheet of nursing home utilization provided to DCOPN by Virginia Health Information (VHI) with data as of March 1, 2019. DCOPN organized the data into planning districts and health planning regions and calculated the statistics shown for those areas and for the state as a whole.
• A very few facilities but none that would be included in the RFA failed to report their 2017 data to Virginia Health Information (VHI).  For these facilities, the department calculated their 2017 occupancy based on their patient-days reported for 2016, adjusted to a 365-day year. These cases are noted by an entry in the facility name column.
• DCOPN made corrections to the VHI data in those cases where a facility incorrectly reported its number of licensed beds to VHI and recalculated available days of care and occupancy percentage accordingly. DCOPN also recalculated available days of care and occupancy percentage to take into account changes in a facility’s number of licensed beds during its reporting period, as this intra-year bed-change information is not available to VHI. These changes made by DCOPN to VHI’s data are noted by entries in the “Comments” column or by Excel notes attached to the changed data cell.
• DCOPN has omitted from the RFA-relatedoccupancy calculations all nursing home units that were established as part of a CCRC, even if the CCRC nursing home unit is partly or completely Medicaid-certified, and even if it’s not restricted from admitting persons who are not existing contract-holding residents of the CCRC, which is true for some older CCRCs. The reason for this is that DCOPN believes even Medicaid-certified beds in CCRC nursing home units are used very largely by persons who are contract-holding residents of the CCRC and that in most cases CCRC nursing home beds do not provide a large amount of service to the general, non-CCRC population. 
• Furthermore, analysis of a recent year’s nursing home utilization data found that removing Medicaid-certified CCRC nursing home units from the RFA-relatedoccupancy calculations made almost no difference in any Planning District’s (PD) RFA-related occupancy calculation. In some PDs, removing the Medicaid-certified CCRC nursing home units from the PD’s occupancy calculation raised the PD’s RFA-related occupancy percentage by a tiny amount; while in some PDs, removing the CCRC nursing home units from the calculation lowered the PD’s RFA-related occupancy percentage by a tiny amount.
• A very few nursing homes that are now part of a CCRC organization were established prior to becoming part of the CCRC organization, and we believe they continue to serve the general community population in the same way as non-CCRC-related nursing homes. These nursing homes areincluded in the RFA-related occupancy calculations.