Frank Romano, president of Essex Group, a family-owned provider of skilled nursing, assisted living, and home care services in Massachusetts, tells Provider his company expects to end the year with around an 89 percent occupancy rate for its buildings, which is slightly better than the state average of nearly 87 percent.

Across the various offerings Essex holds, that same occupancy rate was 91 percent in 2017, and a decade ago it was hovering at 96 percent.

So, to combat the effects of this lower trend in occupancy, Romano has not only shifted into more and varied business lines—like a new focus on adult day care, hospice, and even operating a seniors’ transportation company—but also leads the charge for policy changes to aid providers.

First off, he says, the SNF occupancy problem is an issue of private-pay patients going to assisted living instead of SNFs, and the second factor is that ACOs are “squeezing the days we have in the building.” This leaves a lot of empty space, with some 7,000 beds in Massachusetts without a resident.

Romano backs a plan to have the state buy back 3,000 of those empty beds at a cost of $25 million, with the federal government paying half and the state half. Progress is being made as he and others lead the advocacy charge, but no agreement has been struck, yet.

“There would be more demand to help fill beds and get occupancy up. We clearly need that, and we also just passed new licensure regulations in Massachusetts,” Romano says. “That will allow us to have other services inside a SNF in a nonlicensed area, such as in the past we would get adult day care in a SNF, but you needed a waiver.”

Now, a provider does not need that waiver and can move other services into the SNF setting like a home care office or housing options. “You can put in an assisted living unit in a SNF, for example” he says.

Campus Setting Is Appealing
Essex Group has SNFs and assisted living on its campuses, so it has not looked at using the new regulations for its SNFs. “We don’t have freestanding nursing homes,” Romano says. “We have all of our services on our campuses, and that has helped keep occupancy up.”

The strategy is that if someone comes in with a broken hip and Essex Group does a good job, the company then hopes to transfer that person to an assisted living unit or offer day care. “We have that vertical integration, and the reason we transfer to one of those two options is to make sure we are not doing a readmission in 30 days and getting penalized,” he says.

Another new service for the company to offer is hospice programs. “We have gone from 1 percent 10 years ago to 10 percent of the population in our buildings being in hospice, and my goal next year is to get that to 15 percent,” Romano says.