As we start 2026, you must choose between hundreds of priorities, goals, and programs.  There are lots of projects you could take on, but you can’t do them all. There isn’t a single right list for every operator. But if I still owned buildings here are four things that I’d be doing in every one of them.

1.      First, I would make sure our nurse turnover rate is below the national average. The all-nurse turnover rate is 46.4 percent a year and the RN turnover rate is 43.6. If you’re above those numbers, then you have a problem. Hundreds of thousands of nurses will retire over the next 10 years and there aren’t close to enough new ones to replace them. The operators who crush it going forward will be crushing these metrics. More importantly, low turnover is directly related to resident outcomes. And the good news is you can control your turnover rate. If you are above the national average, there are multiple strategies to fix that. They include:

a)      Robust mentorship programs for new hires.

b)     Outsized employee engagement and satisfaction programs including frequent measurement of both.

c)      Linking leadership pay to keeping turnover low.

d)     Making it a company goal to achieve great numbers and enact policies to reach the targets.

2.      The second task I would take on would be to have a defined population health plan. For years it was just the managed care companies that benefited from lowering the cost of care for our residents. Those days are over. Whether it’s an accountable care organization (ACO) or an Institutional-Special Needs Plan (I-SNP), or both, we can now get paid for keeping our residents healthy. Despite that the overwhelming percentage of our long-stay residents are still not in either program. According to Eric Palm, the chief growth officer at Provider Partners Connect Care, there are only an estimated 250,000 long-stay residents in these programs. That means there are almost an estimated 900,000 who are not. There are times where that makes sense. But, for most providers, having an I-SNP and/or an ACO, and getting a piece of the upside financial reward, does make sense. Patient outcomes are often exceptional. And it’s not uncommon for a provider’s share of the gain to approach $100,000 per year in a single building. I would make 2026 the year that I had a defined plan. 

3.      The third task I would take on is to make sure my long-term debt was at interest rates that are as low as possible. You may be sick of me talking about this, but it really matters. We had a 30-year window where providers could lock in low, long-term rates with HUD and yet many missed the opportunity. The window is back open. HUD loans are now closing in the 5’s (percent). That’s obviously not as good as in the high 2’s or 3’s that we experienced a few years ago. But it’s much better than the 7 percent-plus rates we’ve seen lately. If you are waiting for rates to drop even further, you may be waiting a long time. Rates are still low compared to historical levels, so, I would lock them in right now and if they go lower, then refinance.

4.      Finally, I would make sure my clinical team is ready for the changes coming from the Centers for Medicare and Medicaid Services (CMS) for the SNF Valued-Based Payment program. For a decade, the only metric that mattered on this payment was our rehospitalization rate. We could lose up to 2 percent of our Medicare reimbursement payment for a high rehospitalization rate or get up to a 2 percent bonus for a low rate. We just had one measure. That changes big time with the 2027 and 2028 rule. CMS will soon factor in eight measures. Those are:

• SNF 30-Day All-Cause Readmission Measure (SNFRM)

• Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalization (SNF HAI)

• Total Nursing Staff Turnover (Nursing Staff Turnover)

• Total Nurse Staffing Hours per Resident Day (Total Nurse Staffing)

• Discharge to Community—Post-Acute Care Measure for SNFs (DTC PAC SNF)

• Percent of Residents Experiencing One or More Falls with Major Injury (Long-Stay) (Falls with Major Injury)

• Discharge Function Score for SNFs (Discharge Function Score)

• Number of Hospitalizations per 1,000 Long Stay Resident Days (Long-Stay Hospitalizations)

It’s true that these measures only impact a few percent of our Medicare Part A payment. But they matter more than that. They are a good representation of what you need to focus on to get great patient outcomes. If you achieve great outcomes with these eight measures, you will be in very good shape clinically and financially for many years to come.

I realize there are lots of other worthwhile projects to take on. I’ll focus on some of them in the future. But, if you can accomplish these four, you will have a very good 2026.