As COVID-19 continues to threaten millions of frail elders, the seniors housing and care communities in which many of them live face immense challenges. Despite shortages of PPE, testing, and support, operators have had to find ways to care for residents, many of whom require intimate personal contact to assist in activities of daily living, while fending off a highly contagious, invisible, lethal disease that can be spread by asymptomatic or presymptomatic carriers.
A national spotlight is on the sector. As policy makers plan to reopen society, and frontline care workers continue the fight to protect vulnerable residents, it is time for industry leaders to address what may become a significant additional challenge to come out of this crisis: a narrative based on a lack of context, lack of understanding, and lack of comparable data.
While many news reports are balanced, and report facts as well as they can, some lack clear, consistent definitions and complete and accurate data, simply because it is not available. While the difference between independent living, assisted living, memory care, and skilled nursing is apparent to those who work in the industry, the general population lumps these different care settings and their different populations into one category.
Additionally, data, where it is available, varies from state to state, and even from county to county. States vary on how they count COVID-19 infections and deaths. Some have mandated available data be made public; others have not. Coverage often focuses on the “numerator” – the total number of COVID-19 positive cases and deaths – but rarely is the “denominator” – the total number of residents in the care setting – included in the story. Furthermore, reports often do not take into account the fact that the very reason residents of high acuity settings are there is because they are frail with multiple comorbidities, a known risk factor for COVID-19 mortality, and many need help with ADLs. Context requires understanding how populations of similar acuity and need for help with ADLs in traditional private housing fared during the pandemic.
Of course, owners, operators, and capital providers understand that different property types serve very different acuity levels, but the media – and the public – often do not. According to the recently released “Seniors Housing Data Book” from ATI Advisory, in skilled nursing settings, the average resident is 83.5 years of age, requires assistance with 5.1 activities of daily living (ADL), such as feeding, bathing, and toileting, suffers from multiple comorbidities, and has a 76% likelihood of cognitive impairment. In Independent Living, however, the average resident is 82.2 years of age, requires help with 0.3 ADLs, and has a 21% likelihood of cognitive impairment. Without COVID-19–relevant data that distinguishes between these populations, how can we expect the media to provide context? And how can we expect anxious families, both now and in the future, to understand how a single data point from a headline – such as their state’s “long term care facilities” COVID-19 mortality rate, is relevant to their particular situation?
NIC was founded nearly 30 years ago to help improve transparency to capital providers for an industry that was, at the time, deeply opaque, compared to other types of commercial real estate. Small and large operators then, as now, were understandably resistant to the idea of sharing some of their most sensitive data, particularly given potential short-term risks. But over time the effort has proven highly effective at improving liquidity, lowering the costs of capital, and making it possible to improve the options available to America’s seniors.
The industry now has an unprecedented opportunity to improve trust in the public eye, while simultaneously helping efforts to control the spread of this deadly virus. Accurate, consistent, and timely data with broad reach can help families, policymakers, health officials, and senior living operators understand and combat the virus – and be better prepared in the future. With the nation looking on, it is time to demonstrate a willingness to be transparent, and to share data that will help track and combat COVID-19 across each property type and care segment.
NIC has launched a number of data initiatives in response to the COVID-19 pandemic. They rely on the continued participation of owners and operators, many of whom are overwhelmed and beset with other pressing issues. Yet, we encourage participation as an essential means to help shed light and provide context across an industry that can only benefit from greater transparency and clarity.
As evidenced over several decades of improved access to capital by seniors housing and care, increased transparency leads to increased trust. NIC is a trusted, respected third party source of industry data with national scope across all sector property types. We understand what defines each property, and why these differences matter, and we can be relied upon to educate those outside the industry as we provide the industry data to them.
We encourage operators to take a few minutes each week to share data with NIC, which will help to improve transparency, and build trust, while the spotlight is shining. During a time of intense national scrutiny, this is a rare opportunity to build a foundation of understanding and greater clarity, which may yield dividends for many years to come.