In addition to the obvious concerns related to the current Public Health Emergency (PHE), the Coronavirus pandemic has created secondary challenges that numerous SNFs are facing including increased public scrutiny, changes in admission patterns, and declining census numbers.

For some facilities, struggles to maintain a census comparable to that of “the good old (pre-COVID) days” began when elective surgeries and non-essential procedures were suspended in March of this year. Even though that suspension has been largely lifted, the demand for such procedures may be slow to rise due to continued “medical-distancing” by cautious individuals. Such medical-distancing may also be the case for some prospective clients who opt for home-based services instead of receiving care in the SNF/NF.

Additionally, the ease at which coronavirus spreads in nursing homes has understandably caused concern for those families who may be seeking or would have otherwise sought, placement for a loved one. Couple this with the strict and ever-evolving visitation restrictions required at SNFs/NFs and it becomes fairly easy to see why some admissions are on the decline, at least in part. There is a general and growing need for SNFs to dispel misinformation and disclose and promote effective infection prevention and control practices to relieve public apprehension.

Let us not understate the direct impact COVID-19 has had on SNF facility admission practices. Transferring COVID-positive patients from hospitals to nursing homes continues to compound the problem. According to the Center for Disease Control and Prevention (CDC), newly admitted and readmitted residents with confirmed COVID-19 who have not met criteria for discontinuation of transmission-based precautions should go to the designated COVID-19 care unit. Furthermore, dedicated health care professionals should be assigned to work only on the COVID-19 care unit. See the full considerations here. These directives can be difficult to comply with, especially if staffing is decreased or facility layout presents challenges; not to mention the continued need for sufficient testing supplies and PPE – examples of recurring slaps in the face from Coronavirus.

In an already unprecedented and challenging time for nursing facilities, reductions in census may cause further unease related to staffing ratios, public perception, and negative impacts on revenue.


      • Communicate and collaborate with local hospitals – Is your facility able and equipped to accept COVID-positive patients?
      • Evaluate COVID-dedicated units for proper isolation protocols, dedicated staff, and adherence to moving through “zones” based on quarantine timeframes, symptoms, and testing
      • Keep current and prospective residents and their families/representatives informed of the current situation within the facility, infection control practices, availability of testing and supplies, and adaptations made to promote and ensure social distancing
      • Solidify Infection Prevention and Control programs and promote efficacy
      • Work with local and state health departments
      • Comfort current and prospective clients with effective alternatives for in-person visitation


Blog by Eleisha Wilkes, RN, RAC-CTA, Proactive Medical Review

Learn more about Eleisha and the rest of the Proactive team.