COVID-19 Pandemic Impact on Nursing Homes Financial Performance




Orewa, Gregory N.
Weech-Maldonado, Robert
Lord, Justin
Davlyatov, Ganisher
Becker, David
Feldman, Sue S.

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SAGE Publications


Nursing homes expressed concern about potential severe adverse financial outcomes of COVID-19, with worries extending to the possibility of some facilities facing closure. Maintaining a strong financial well-being is crucial, and there were concerns that the pandemic might have significantly impacted both expenses and income. This longitudinal study aimed to analyze the financial performance of nursing homes during COVID-19 pandemic. Specifically, we examined the impact of the pandemic on nursing home operating margins, operating revenue per resident day, and operating cost per resident day. The study utilized secondary data from various sources, including CMS Medicare cost reports, Brown University’s Long Term Care Focus (LTCFocus), CMS Payroll-Based Journal, CMS Care Compare, Area Health Resource File, Provider Relief Fund distribution data, and CDC’s NH COVID-19 public file. The sample consisted of 45 833 nursing home-year observations from 2018 to 2021. Fixed-effects regression analysis was employed to assess the impact of the pandemic on financial performance while controlling for various organizational and market characteristics. The study found that nursing homes’ financial performance deteriorated during the COVID-19 pandemic. Operating margins decreased by approximately 4.3%, while operating costs per resident day increased by $26.51, outweighing the increase in operating revenue per resident day by about $17. Occupancy rates, payer mix, and staffing intensity were found to impact financial performance. The study highlights the significant financial impact of the COVID-19 pandemic on nursing homes. While nursing homes faced substantial financial strains, the findings offered lessons for the future, underscoring the need for nursing homes to improve the accuracy of their cost reports and enhance financial transparency and accountability.



long-term care, nursing homes, COVID-19, financial performance, operating margin, operating revenue, operating cost


Orewa, G. N., Weech-Maldonado, R., Lord, J., Davlyatov, G., Becker, D., & Feldman, S. S. (2024). COVID-19 Pandemic Impact on Nursing Homes Financial Performance. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61. doi:10.1177/00469580241240698


Public Health