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If there was ever a time when skilled nursing centers should pay attention to what is taking place in their local markets and where they can provide the most value, it is now. This period of time is a transition for health care in general, eldercare, and the care provided in nursing centers.

While some national trends are apparent, local realities and expectations vary, and dominant providers and payers are driving priorities. Nursing centers will succeed by competing on quality as it is perceived in their markets to optimize their payer mix.

Generally, nursing centers are caring for an older and frailer population, often in the later course of their disease. Shorter Medicare or managed care stays are increasing as a share of total days, often requiring more acute and intensive services. These shorter stays are more of a challenge as there is less time to implement a care plan that meets resident limitations, preferences, and available supports.

Maintaining a diverse mix of residents and payers—even if the center has a successful niche specialty like hip repair rehabilitation—will enhance overall quality of care, as well as the center’s reputation. Despite recent indications that occupancy rates are decreasing on average across nursing centers, successful centers can still maintain a favorable payer mix and high occupancy rates.

Although home health care continues to become more widely used for post-acute care (PAC) by less frail elders, a home health stay is frequently preceded by a short PAC skilled nursing facility (SNF) stay. With multiple transitions required in these PAC episodes, quality-of-care transitions from hospital to home are a high priority for many SNFs.

Caring for frail elders often requires changing or rebalancing priorities on an ongoing basis. As reflected in the new regulations, residents of nursing centers are less stable medically, and their attitudes and care preferences are evolving as their health changes.

The person-centered care movement that has influenced all of health care is particularly relevant to the care of these frail individuals who face greater risks from treatment, and often have clearer preferences related to services they want to receive.

One can expect that during this time of relative uncertainty in health care, some nursing centers will struggle and others will thrive. Competent staff and an effective QAPI program to continuously identify and provide specialized services for residents who require them will be essential to an organization’s ability to adapt to the evolving demands.

The local health care environment, which changes much faster than national regulations or payment policies, will influence the mix of residents that are admitted and the services a center will have to provide or have available. Proactively assessing and attending to the quality priorities of the center’s local health care provider network and the communities it serves, by establishing a comprehensive QAPI program, will be critical to success.