Top Trends in Long Term Care 2023

Top trends in long term care for 2023 include: enormous concerns over increased censuses paired with staffing shortages, Medicare reimbursement changes paired with potential government mandates, the possibility of a recession and the ongoing vulnerability LTC organizations face with COVID-19.

Successful LTC facilities will be those that continue to provide superior care despite economic and operational challenges. They will also be adaptable in a constantly changing climate.

As we look ahead these are some things you can anticipate:

Census Levels

As we’re all acutely aware, during the COVID pandemic, census levels skyrocketed in all long-term care (skilled nursing & assisted living) facilities. It is predicted that by the end of 2023, the industry will return to pre-pandemic levels.

Beginning in 2024 it’s predicted that occupancy gains will start to show as well, as we see improved population growth in the 75-80+ age range. 


During the COVID pandemic long term care facilities lost 210,000 jobs, according to a report by the American Health Care Association and National Center for Assisted Living. This report was also backed by data from the Bureau of Labor Statistics (BLS).  The BLS reported a drop in staffing from 1.5 to 1.3 million, levels that have not been seen since 1994.

While most healthcare sectors saw significant drops in staffing during the pandemic, they have since recovered. Long term care facilities, however, have not recovered and staffing shortages remain.

In addition, the Biden Administration has proposed a federal staffing minimum ratio mandate to meet growing census levels. There is, however, no monetary backing. And of course, this proposal is receiving a lot of push back. It is unclear if it will go through. 

There is some good news, however, for LTCs. While the use of travel nurses and temporary labor increased over the last several years, LTCs can expect to see labor markets tighten up in 2023.

With the possibility of a recession, job security is becoming important once again, making this a favorable market for LTC employers.

Many successful LTCs are actively seeking to improve their staffing ratios. They are doing this by offering flexible schedules, increased salaries, improved benefits (mental health benefits, 4-day work weeks, childcare offerings), innovated technology, and clear guidance and support on how clinicians can grow in their careers.

Bequest Staffing is ready and available to help you secure elite talent in your area. Reach out to us today!


Anyone who’s worked in healthcare for more than 5 minutes is extremely aware of the growing importance of technology in providing effective patient care. 2023 will be no exception.

From creating better workflow strategies to improving patient data security to automating record keeping to virtual communication to utilizing cloud based tools, all successful LTCs will need to keep up with the rapidly changing and technology-focused landscape of healthcare.

Process Changes

Much like we saw at the beginning of the COVID pandemic, it’s predicted that in 2023 we’ll see an aggregate of process changes that might feel overwhelming. 

The industry will continue to face the spread of multi-drug resistant organisms (including COVID-19). It will need to maintain infection control practices.

To improve patient outcomes, there will be a drive for more education focused on fall prevention and caring for patients with dementia. Long term care facilities will also see a growth in the need for specialty services such as dialysis & mental health support.

Demand for New Services/Options

With an increasingly health-conscious culture and population, long term care facilities will see an increased demand for wellness programs and services. This will include such things as offerings for nutrition, meditation, yoga, and acupuncture.

In addition, it is predicted that over the course of the next 5 years there will be an increased demand for ‘a la carte’ options for residents who desire a higher level of independence when it comes to their own care. These options can range from the simple (laundry services, assistance with bathing) to the more complex (physical therapy, medication management).


When it comes to Medicare payments, skilled nursing facilities will see a 4.6% reduction in payments over the next 2-years. This is a result of SNFs earning 5% more than expected after the implementation of the Patient Driven Payment Model (PDPM).

As of today’s writing, in New York State, there is a bipartisan push for a 20% increase in Medicaid reimbursement rates. 70% of nursing home residents in New York State are Medicaid recipients.

In the current market – these types of proposals are quite common at the state level.

The End of an Era?

Late last month the Biden Administration announced it will be ending the national emergency and public health emergency (PHE) declarations on May 11, 2023. 

LTCs have had plenty of time to prepare for the end of PHE. But the reality of those lost benefits – may be the end of line for those facilities that remain in highly vulnerable positions. These can include those that are suffering from staffing shortages, rising acuity, and/or depressed censuses.

One of the larger facilities in the nation, Sava Senior Care, has already announced it will likely cease operations in 2023.

Did we miss any?

What new challenges do you see for long term care in 2023?

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