Surviving the Post-COVID Long-Term Facility “Great Recession”

Date October 29, 2021

The pandemic has dealt a blow to many industries and businesses, but few could say they have been as negatively impacted as long-term care. Occupancy rates are at all-time lows and operating costs at all-time highs, and everyone is relying on stimulus money to survive. What are you doing to ensure your facilities survive this “great recession”?

It is time to take a deep dive into your operations and relationships to ensure your facilities remain open in 2022 and beyond. Some basic data analytics—for example, a simple analysis comparing your per diem rate to your competitors, state or county—can be used to identify areas you need to address, not only to stay in business, but to make a profit.

Grow your bottom line

Following are five ideas for increasing your revenues:

1. How is your relationship with your pharmacy and therapy providers? Do you own these services, or partner in one of them? Small to medium-size institutional pharmacies are willing to give price breaks or minority ownership for long-term contracts with facilities. Therapy companies are willing to do joint ventures or enter into management agreements to provide their services to a facility. Managing PDPM and pharmacy is vital to operating an efficient and profitable facility. Getting in bed with your providers is a sure way to increase your bottom line.

2. Labor shortages are common, and the cost of agency is through the roof. Consider buying or starting your own hiring agency or setting up a training center to feed labor to your facilities. Maintaining your current workforce is just as important as recruiting new talent. Use analytics to identify your best and worst employees. For example, analytics allow you to identify the employees who are documenting encounters properly and those who are not. You can identify which employees create risk. Develop programs to keep the best and let the worst go.

3. Have you identified the highest paying residents in your state? Setting up specialty wings to take care of vent and dialysis patients can multiply revenues. A typical Medicare patient might pay $350 a day; a vent patient could generate $1,000. Dialysis can be done via mobile units and set up in virtually any available space in the facility, saving on transportation costs and allowing you to keep vent patients that need dialysis in your facility.

4. Keep your residents out of the hospital and in their rooms. Offer wound care services and other care options to identify and address problems before they lead to hospital visits. Offering alternative care in the facility can generate ancillary revenue and maintain your occupancy levels. Consider setting up your own ambulate service to transport disabled individuals.

5. Take advantage of the Employee Retention Credit (ERC). It is not too late, and you probably qualify. The requirements of the 2021 version of the ERC have opened the door for almost any group of facilities. Don’t fall victim to the 20 percent fee that so-called ERC specialty companies are charging. The credit can be calculated and documented for a reasonable fee.

Get the right kind of financial support

Does you accountant know your industry? Working with an industry-savvy accountant is important to any business, but it is vital to healthcare organizations. We can, for example, help you set up more complex, more productive facility-specific analytics than most LTC facility providers can do on their own.

HBK Healthcare Solutions is a dedicated team of physician practice and living assistance facility subject matter experts within HBK CPAs & Consultants, an Accounting Today Top 100 CPA firm. We have worked with healthcare providers since our founding in 1949, and our current clients include assisted living, long-term care, skilled nursing and rehabilitation single-facility and multi-facility, multi-jurisdictional enterprises. For more information or to schedule a free consultation, call me at 330-758-8613 or email me at

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