Long-Term Care Runs 24/7. Its Utility Bills Should Be Scrutinized with the Same Intensity.

Skilled nursing facilities and assisted living communities are operationally unique from most users: they never close. Lighting, HVAC, kitchen equipment, laundry, medical equipment, and monitoring systems all run continuously. Electricity consumption per square foot in long-term care facilities is among the highest of any commercial building type.

This creates a specific billing risk. Rate structures for 24/7 commercial customers are different from standard commercial customers. Demand charge treatment, time-of-use provisions, and load profile assumptions embedded in tariff structures were often designed for customers with daytime-heavy profiles. Applying those structures to a flat 24/7 load profile can result in systematic overcharges.

In our long-term care audit work, we consistently find rate classifications designed for general commercial customers that are suboptimal for continuous operations, demand charge methodologies that do not account for the flat load profile of care facilities, and tax exemptions — in particular medical use exemptions — that were never applied to utility accounts.

The margin profile of skilled nursing leaves no room for preventable expense. A 120-bed facility overpaying $85,000 annually on utility bills is losing the equivalent of three to four full-time CNA positions to billing errors.