You are given a text that consists of multiple sentences. Your task is to perform abstractive summarization on this text. Use your understanding of the content to express the main ideas and crucial details in a shorter, coherent, and natural sounding text. 
Text: Before we begin, let me remind you that the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 apply to this conference call.
In addition, management may also discuss non-GAAP operating performance results during today's call, including earnings before interest, taxes, depreciation and amortization or EBITDA and adjusted EBITDA.
I will begin with highlights for the quarter, and Dave and Nick will follow up with additional operating detail.
I will then open up the call to questions.
Operating two distinct business units during our global pandemic has been exceptionally challenging.
Fortunately, we have begun to return to normalcy.
The pandemic had created unique problems, logistical hurdles and forced our operations to make significant changes in field and home office procedures.
Many of these changes have been institutionalized and will become part of our normal operating procedures post-pandemic.
I could not be prouder of our management team.
Both VITAS and Roto-Rooter met these pandemic challenges head-on, produced excellent operating results that are well positioned for growth in the coming years.
In April 2020, the first full month of the pandemic, Roto-Rooter experienced an immediate and severe drop in demand for all plumbing and drain cleaning services.
This drop was short-lived.
Starting in May 2020, Roto-Rooter saw a spike in residential plumbing and drain cleaning demand.
This increase in demand was sustained throughout 2020 and has continued unabated in the first six months of 2021.
Commercial demand has also improved up pandemic lows and have now normalized close to pre-pandemic levels.
For the remainder of 2021, I anticipate Roto-Rooter's residential demand to remain at the current run rate, coupled with increased commercial demand as the country returns to normalized pre-pandemic consumer behavior.
The Great Recession, and now a global pandemic.
In each of these crises, Roto-Rooter remained operating and materially increased market share, revenue and operating margin.
Just as important, Roto-Rooter has held on to the increases in revenue market share and margins in past crisis.
Roto-Rooter is well positioned post-pandemic, and we anticipate continued expansion of market share by pressing our core competitive advantages in terms of brand awareness, customer response time and 24/7 call centers and Internet presence.
For VITAS, the most significant issue remaining from the pandemic is the disruption to senior housing occupancy and the related hospital referrals.
Recent admissions' data suggest senior housing has entered into the early stages of recovery, and our updated guidance anticipates steady improvement in the senior housing referred hospice admissions in the second half of 2021, with a further acceleration in senior housing admissions anticipated in the fourth quarter.
With that, I would like to turn this teleconference over to David.
Let's turn to VITAS.
VITAS' net revenue was $312 million in the second quarter of 2021, which is a decline of 4.7% when compared to the prior year period.
This revenue decline is comprised primarily of a 6.3% reduction in our days of care, offset by a geographically weighted Medicare reimbursement rate increase of approximately 1.8%.
Acuity mix shift did have a net impact of reducing revenues approximately $3.8 million in the quarter or 1.2%.
The combination of a lower Medicare Cap billing limitation and other contra-revenue charges offset a portion of the revenue decline by roughly 90 basis points.
VITAS did accrue $2 million in Medicare Cap billing limitations in the second quarter of 2021, and this compares to a $5.7 million Medicare Cap billing limitation in the second quarter of 2020.
Of our 30 Medicare provider numbers, right now 27 of these provider numbers have a Medicare Cap cushion of 10% or greater.
One of our provider numbers has a cap cushion between 0% and 5%, and two of our provider numbers currently have a fiscal 2021 Medicare Cap billing limitation liability.
Let's take a look at Roto-Rooter.
Roto-Rooter generated revenue of $220 million in the second quarter of 2021, which is an increase of $45.6 million or 26.1% over the prior year quarter.
Total Roto-Rooter branch commercial revenue totaled $50.3 million in the quarter, an increase of 31.8% over the prior year.
The aggregate commercial revenue growth consisted of our drain cleaning revenue increasing 39.8%, plumbing increased 32.4% and excavation expanding 25.8%.
Water restoration also increased 8.3% on the commercial side.
On the residential side, total residential revenue in the quarter totaled $149 million, an increase of 23.7% over the prior year period.
The aggregate residential growth consisted of drain cleaning increasing 20.6%, plumbing expanding 30.7% and excavation increasing 22.4%.
Water restoration also increased 23.1%.
Basically increases across the board, all segments, both commercially and residential.
Now let's look at Chemed on a consolidated basis.
During the quarter, Chemed repurchased 250,000 shares of stock for roughly $122 million, which equates to a cost per share of $487.53.
As of June 30, 2021, there was approximately $312 million of remaining share repurchase authorization under this plan.
We've also updated our 2021 earnings guidance as follows: VITAS' full year 2021 revenue prior to Medicare Cap is estimated to decline approximately 4.5% when compared to 2020.
Our average daily census in 2021 is estimated to decline approximately 5%.
This guidance anticipates senior housing occupancy will begin to normalize to pre-pandemic occupancy, starting in the second half of calendar year 2021.
VITAS' full year adjusted EBITDA margin prior to Medicare Cap is forecasted to be 18.3%, and we are currently estimating $7.5 million for Medicare Cap billing limitations in calendar year 2021.
That's an improvement from the initial $10 million of Medicare Cap we estimated at the start of this year.
Roto-Rooter is forecast to achieve full year 2021 revenue growth of 15% to 15.5%.
Roto-Rooter's adjusted EBITDA margin for 2021 is estimated to be between 28% and 29%.
So based upon this discussion, our full year 2021 adjusted earnings per diluted share, excluding noncash expense or stock options, any tax benefits we receive from stock option exercises as well as costs related to litigation and other discrete items, is estimated to be in the range of $18.20 to $18.50.
The revised guidance compares to our initial 2021 guidance of adjusted earnings per diluted share of $17 to $17.50.
In the second quarter, our average daily census was 17,995 patients, a decline of 6.3% over the prior year.
This decline in average daily census is a direct result of pandemic-related disruptions across the entire healthcare system.
This negatively impacted traditional hospice admission patterns, starting in March of 2020.
Our hospital generated admissions have largely normalized to pre-pandemic levels.
Referrals from senior housing, specifically nursing home and assisted living facilities continue to be disrupted.
During the second quarter, we have seen admission stabilization and pockets of improvements in senior housing admissions.
However, it remains too early to accurately project the pace and timeline for senior housing admissions to fully return to pre-pandemic levels.
In the second quarter of 2021, total VITAS admissions were 16,840.
This is a slight improvement when compared to the second quarter of 2020 admissions.
More importantly, admissions in the second quarter of 2021 exceeded discharges by 315 patients.
This is the first quarter since the pandemic began that our patient admissions have exceeded patient discharges.
This is the strongest indication to date that we are now beginning the process of rebuilding census to pre-pandemic levels.
In the second quarter, our hospital directed admissions expanded 7.8% and emergency room admits decreased 9%.
Total home-based preadmit admissions decreased 9.3%, nursing home admits declined 9.9%, assisted living facility admissions declined 17.5% when compared to the prior year quarter.
Our average length of stay in the quarter was 94.5 days.
This compares to 90.9 days in the second quarter of 2020 and 94.4 days in the first quarter on 2021.
Our median length of stay was 14 days in the quarter, which is equal to the second quarter of 2020 and is a 2-day improvement when compared sequentially to the first quarter of 2021.
It's now time for us to consider any questions that come before the teleconference.

user
sees fy adjusted earnings per share $18.20 to $18.50 excluding items.

assistant