The Bureau of Labor Statistics reported that the unemployment rate slipped back to 3.5% in March from 3.6% in February, but up from 3.4% in January, which was its lowest level since 1969. It has been hovering in a narrow range for many months now. Separately, the BLS also reported that nonfarm payrolls rose by 236,000 in March 2023, below the monthly pace of 334,000 over the prior six months, but still strong. Market expectations had called for a gain of 230,000 jobs. Revisions subtracted 17,000 positions to total payrolls in the previous two months.  

Today’s report shows the labor market remains relatively strong with the economy still creating jobs at a solid, albeit, slowing pace. That said, the slowing in average hourly earnings and other reports on the jobs market suggest an adjustment in the labor markets is starting to occur. The general softening in the labor force will be welcome news to the Fed which is watching for signs that inflationary pressures are dissipating. A softer labor market should help to ease wage pressures and prevent a wage/price inflationary spiral from occurring. 

Indeed, earlier this week, the Labor Department released the Job Openings and Labor Turnover report (JOLTS) that showed that the demand for labor is starting to cool down a bit. The report showed that there was a drop in job openings to 6.0% in February from 6.4% in January driven by declines in professional services, education, and leisure. The vacancy-to-unemployment ratio which the Fed cites as a measure of excess labor demand fell to its lowest level since late 2021. And the job quits rate inched higher. Job layoffs remained low, however.

Note that the March report comes too early to capture much impact from the recent banking sector woes, with the troubles at SVB not coming to a head until near the end of the survey period.

Today’s report showed that employment in health care rose by 34,000 in March, compared with the average monthly increase of 54,000 over the past six months. Employment in nursing care facilities grew by 3,400 jobs from last month and 50,100 from year-earlier levels and stood at 1,392,700 positions. Jobs increased by 4,300 positions in CCRC and assisted living facilities and were up by 59,800 from year-earlier levels to 944,000 jobs.

In the household survey conducted by the BLS, the jobless rate slipped 0.1 percentage point to 3.5%, down from 3.6% in February. Both months’ unemployment rates were well below the 14.7% peak seen in April 2020. The underemployment rate was 6.7% versus 6.8% in February. 

Average hourly earnings for all employees on private nonfarm payrolls rose by $0.09 in March to $33.18. This was a gain of 4.2% from year-earlier levels, lower than in recent months. 

The labor force participation rate inched up to 62.6% in March, up from 62.5% in February, which followed three prior monthly increases in the rate. It was below the February 2020 level of 63.3%, however.    

The number of long-term unemployed (those jobless for 27 weeks or more) was 1.1 million in March. These individuals accounted for 18.9% of all unemployed persons.  

Among the major worker groups, the March unemployment rates were 3.1% for adult women, adult men (3.4%), teenagers (9.8%), Whites (3.2%), Hispanics (4.6%), Blacks (5.0%), and Asians (2.8%).

Big industry awards ceremony draws former NIC board chairs and leaders.

Recognized as the entrepreneurial thought leader who created a forum for investors in senior housing and care, and revolutionized the use of data in the sector, Robert G. Kramer was honored with the 2023 Career Achievement Award at the inaugural McKnight’s Pinnacle Awards ceremony March 7 in Chicago. Awards went to 30 providers and long-time leaders in the senior living, skilled nursing and home care sectors.

“We have the greatest impact on our field by investing in people.”

                                                                                                    —Bob Kramer

“For more than 35 years, Bob has been a transformational figure in the senior housing and care field,” McKnight’s Vice President and Editorial Director John O’Connor said.

Kramer accepted the award to a standing ovation giving credit to those whose shoulders he stood on to achieve success, while emphasizing the importance for today’s leaders to encourage and mentor young leaders. “We have the greatest impact on our field by investing in people,” said Kramer.

The new Pinnacle awards program was launched to honor those who have had a remarkable influence over the industry, played key roles as change-makers or inspired others with their leadership approach. NIC Board Member Lynne Katzmann, founder and CEO of Juniper Communities, received the Pinnacle Thought Leader Award and NIC Operator Advisory Board member Mary Leary of Mather received the Pinnacle Agent of Change Award.

Kramer is co-founder, past president and CEO and current strategic advisor to the National Investment Center for Senior Housing & Care (NIC), as well as Founder & Fellow at Nexus Insights, a think tank advancing the well-being of older adults through innovative models of housing, community and healthcare (http: //www.nexusinsights.net/).

More than 200 aging services professionals, business partners, and supporters attended the dinner and awards ceremony. Kramer was accompanied by members of NIC’s current and past volunteer executive leadership teams and current NIC president and CEO Ray Braun.

Former NIC board chairs in attendance included John Moore, Atria Senior Living; Brad Razook, CS Capital Advisors; Kevin McMeen, MidCap Financial; Thilo Best, Bayshore Retirement Living; and Randy Richardson, former president of Vi.

Also in attendance was NIC Vice Chair Susan Barlow, Blue Moon Capital Partners; Fee Stubblefield, The Springs Living, and NIC Chair of the Operator Advisory Board; and Kari Onweller, Invesque, and Chair of the NIC Future Leaders Council.

Ceremony emcee and Long-Term Care News Executive Editor Jim Berklan said that Kramer had blazed the way and made and raised the bar for the profession. Berklan read a testimonial from Arnie Whitman, a former NIC Board Chair who was unable to attend the event. Whitman noted that Kramer was, “The inspiration that created this industry.” Vi’s Richardson welcomed Kramer to the stage to receive the award to several minutes of applause.

In his remarks, Kramer emphasized that all the award winners were there because they were encouraged and mentored by others. “We didn’t just materialize and become a leader out of nowhere,” he said. “We stood on people’s shoulders who invested in us.”

Kramer said his father taught him how to think creatively and constructively. Many others helped him along the way. As a freshman in the Maryland legislature in 1983, then House Speaker Ben Cardin took a chance on Kramer and asked him to be the house representative on the committee to rewrite CCRC regulations for the state. “I didn’t know what a CCRC was,” said Kramer. “But that was how I got my start in the industry 40 years ago.”

Kramer thanked the volunteer executive leadership that has made NIC so successful. “Each has impacted me and made me a better person,” he said. Kramer encouraged all the honorees, and those who care passionately about improving the lives of older adults and changing the expectations of and the lived experience of aging, to thank the people on whose shoulders they stand. He added that everyone in the room should make sure at least 10 people stand on their shoulders as the industry grows.

“That means mentoring,” said Kramer. “We are about people and investing in people. Be conscious of who stands on your shoulders so they will be here in future years.”

A Career of Supporting Future Leaders

Kramer himself has a long history of mentoring and supporting the development of the next generation of senior housing leaders. He has backed the growth of university and college senior living programs and scholarships.

Under Kramer’s leadership, NIC has helped to fund two college scholarships to raise the profile of the industry and to educate new leaders. The Anthony J. Mullen Scholarship and William E. Colson Scholarship—named in honor of industry trailblazers—are awarded to students at the Erickson School of Aging Studies at the University of Maryland Baltimore County (UMBC).

In a previous interview, Kramer said, “The industry needs to attract the best and the brightest. Scholarships will help meet senior living’s huge leadership and workforce demands.”

Kramer added that the professional staff at NIC and its volunteer leaders have donated many hours of their time to teach classes and speak at various schools about the senior housing and care industry. They have also helped to develop curriculums to spotlight the field’s opportunities as the older population continues to grow.

Thanks to the work of industry executives, college programs and classes in senior living are available at the Erickson School of Aging Studies and a number of other schools. These schools include the University of Wisconsin-Eau Claire; Boston University; Cornell University; the University of Southern California and Washington State University.

NIC’s board members and members of the Future Leaders Council are now targeting top graduate schools to expand senior living programming options as well as supporting broader industry initiatives like the Vision Centre. “Our goal is to raise the profile of senior living and attract more students to the sector,” said Kramer.

NIC MAP Vision released its latest Skilled Nursing Monthly Report on March 30, 2023. The report includes key monthly data points from January 2012 through January 2023.

Here are some key takeaways from the report:

Occupancy

Skilled nursing occupancy started the year with a positive trend in January 2023. It increased 49 basis points from December to end the month at 81.0%. There was positive momentum in occupancy throughout 2022 and it is up 643 basis points since the low point (74.5%) reached in January 2021. Although occupancy was relatively flat from May 2022 through September 2022, it did increase 274 basis points from January 2022 to January 2023. The staffing crisis in the sector is still a significant burden on skilled nursing operators, especially as the acuity level of patients has increased along with the demand for nurses. As staffing, wage growth, and general inflation pressures persist, operations for many operators will be under pressure but the long-term demand for skilled nursing services is expected to grow over time.

Medicaid

Medicaid revenue mix was unchanged ending January at 49.8%. However, it is up 91 basis points from one year ago when it was 48.8% in January 2022. One element of the Medicaid revenue share of a property’s revenue is revenue per patient day (RPPD) and that increased 0.49% from December. It is up 2.79% since January 2022 and is now at $269, which is an all-time high.

Medicaid reimbursement has increased more than usual as many states embraced measures to increase reimbursement related to the number of COVID-19 cases throughout the pandemic, but many states have continued to increase reimbursement. Medicaid has increased 6.3% since February 2020. On the other hand, covering the cost of care for Medicaid patients is still a major concern as reimbursement does not cover the cost of care in many states. In addition, nursing home wage growth is elevated along with overall inflation, and staffing shortages are a significant challenge in many areas of the country.

Medicare

Medicare revenue per patient day (RPPD) decreased slightly from December 2022 to end January 2023 at $592. This was a decrease from $594 in December, which was its highest level since June 2020 when the federal government began implementing many initiatives to aid operators of properties for cases of COVID-19, including increases in Medicare fee-for-service reimbursements to help care for COVID-19 positive patients requiring additional care. Medicare RPPD is down slightly from one year ago in January 2022, which was when COVID-19 cases were elevated and RPPD was elevated as well. In addition, RPPD is up 3.0% since September 2022 which is likely due to the fiscal increase for 2022-2023. Meanwhile, Medicare revenue mix trended down in the month of January, decreasing 18 basis points from 23.3% to end the month at 23.1%. It is down 211 basis points compared to one year ago in January 2022. There was an elevated number of COVID-19 cases in January 2022 and the data suggests there was a significant uptick in the utilization of the 3-Day Rule waiver as COVID-19 cases increased last year. The 3-Day Rule waiver was implemented by Centers for Medicare and Medicaid Services (CMS) to eliminate the need to transfer positive COVID-19 patients back to the hospital to qualify for a Medicare paid skilled nursing stay, hence increasing the Medicare census at properties. As the cases decline, the Medicare revenue share declines, all else equal.

Managed Care

Managed Medicare revenue mix increased 85 basis points from December to end January at 11.2%. This is up 254 basis points from the pandemic low set in May 2020 of 8.7%, which was a time when elective surgeries were suspended and created fewer referrals from hospitals to skilled nursing properties. Meanwhile, Managed Medicare revenue per patient day (RPPD) increased from $467 to $468 in January. Compared to its year-earlier value of $474, it is down 1.3% and it is down $117 (20.0%) from January 2012. It continues to create pressure on operators’ revenue as managed Medicare enrollment continues to expand its reach and coverage around the country. However, some operators see an opportunity to capture patient volume with the growth of managed care. The persistent decline in managed Medicare revenue per patient day continues to result in an expanded reimbursement differential between Medicare fee-for-service and managed Medicare. Medicare fee-for-service RPPD ended January 2023 at $592, representing a $124 difference. For context, the differential one year ago was $119 and two years ago it was $101.

To get more trends from the latest data you can download the Skilled Nursing Monthly Report. There is no charge for this report.

The report provides aggregate data at the national level from a sampling of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form on our website. NIC and NIC MAP Vision maintain strict confidentiality of all data received.

The following analysis examines occupancy and year-over-year changes in inventory, and same-store asking rent growth—by care segment—within not-for-profit CCRCs and for-profit CCRCs in the 99 combined NIC MAP Primary and Secondary Markets. The analysis also explores occupancy by payment type (entrance fee CCRCs vs. rental CCRCs) as well as regional occupancy rates by profit status (not-for-profit CCRCs vs. for-profit CCRCs) during the fourth quarter of 2022.   

NIC MAP^®, powered by NIC MAP Vision, collects primary data on occupancy, asking rents, demand, inventory, and construction for more than 16,000 independent living, assisted living, memory care, skilled nursing, and continuing care retirement communities (CCRCs—also referred to as life plan communities) across 140 U.S. metropolitan markets. The dataset includes 1,160 not-for-profit and for-profit entrance fee and rental CCRCs in these 140 combined markets, including 1,084 in the 99 combined Primary and Secondary Markets.  

CCRCs Outperform Non-CCRCs in Occupancy Rates, Maintaining Consistently High Levels. 

The exhibit below shows that CCRC occupancy increased to 87.2% in the fourth quarter of 2022 for the 99 NIC MAP Primary and Secondary Markets aggregate, up 0.6 percentage points (pps) from the prior quarter. From its pandemic-record low, CCRC occupancy increased by 3.1pps but remained 4.3pps below its pre-pandemic level of 91.5% in the first quarter of 2020. 

In comparison to CCRCs, occupancy for non-CCRCs stood at 80.9% in the fourth quarter of 2022, 6.3pps below that of CCRCs. Notably, during the height of the pandemic, non-CCRCs experienced a larger decline in occupancy rates. Specifically, the decline in occupancy rates for non-CCRCs (11.3pps) was nearly 4.0pps more than that of CCRCs (7.4pps). 

The recently released COVID-19 study conducted by NORC at the University of Chicago, through a grant from NIC, found that CCRC residents were significantly safer from dying of COVID-19 than older adults living in skilled nursing properties and both non-CCRCs and non-congregate residential housing in the community at large. 

By Profit Status – Occupancy for Not-For-Profit CCRCs Continued to Outpace That of For-Profit CCRCs.  

Among the 1,084 CCRCs spread across the 99 Primary and Secondary Markets tracked by NIC MAP Vision, approximately 75% are operated as not-for-profit, and 25% are operated as for-profit.   

In the fourth quarter of 2022, not-for-profit CCRC occupancy (88.2%) was 3.9pps higher than for-profit CCRCs (84.3%). Compared with the first quarter of 2020, not-for-profit CCRCs were 4.4pps lower, while for-profit CCRCs remained 4.1pps below pre-pandemic occupancy levels.   

Notably, for-profit CCRCs are recovering relatively quickly from their pandemic record low but experienced the largest occupancy drop at the peak of the pandemic. On the other hand, not-for-profit CCRCs had relatively smaller occupancy declines and maintained higher occupancy rates. 

By Payment Type – Occupancy for Entrance Fee CCRCs Continued to Outpace That of Rental CCRCs.  

Among the 1,084 CCRCs spread across the 99 Primary and Secondary Markets tracked by NIC MAP Vision, 64% are operated as entrance fee, and 36% are operated as rentals.   

In the fourth quarter 2022, entrance fee CCRC occupancy (89.2%) was 5.4 percentage points higher than rental CCRCs (83.8%). Rental CCRCs are currently 5.2 percentage points below their pre-pandemic occupancy levels, while entrance fee CCRCs are 3.8 percentage points lower. Similar to the pattern based on profit status, rental CCRCs saw steeper drops in occupancy rates, but are rebounding more quickly – compared with entrance fee CCRCs. 

A consistent pattern emerges from all these comparisons – CCRCs vs. non-CCRCs, not-for-profit CCRCs vs. for-profit CCRCs, and entrance fee CCRCs vs. rental CCRCs – properties where demand and occupancy contracted more severely during the height of the pandemic are rebounding more quickly. Interestingly, one of the findings from recently released research by NIC Analytics, exploring the interplay between inflation, in-place rate growth, demand, and occupancy in senior housing, was that the lowest occupied properties/segments were able to generate new demand and grow occupancy faster, but this occurred largely because of lower in-place rates and minimal or even negative rate growth. The fact that these properties/segments had minimal/negative rate growth also suggests that their demand and occupancy may have contracted more severely during the height of the pandemic, and to accelerate the recovery of occupancy, one potential option was likely to lower rates in an attempt to buy occupancy.  

By Region – Not-for-Profit and Entrance Fee CCRCs Outperform For-Profit and Rental CCRCs Across All Regions 

Regional Occupancy Rates – By Profit Status 

The exhibit below shows that in the fourth quarter of 2022, not-for-profit CCRCs had higher occupancy rates than for-profit CCRCs across all regions except in the Pacific. The largest differences in fourth quarter occupancy between not-for-profit CCRCs and for-profit CCRCs were in the Southwest (6.4pps), followed by the West North Central (5.8pps), then the Mid-Atlantic and Northeast (4.8pps and 4.7pps, respectively).  

Not-For-Profit CCRCs. The Mid-Atlantic (91.1%), Northeast (90.6%), and Pacific (88.2%) regions had the strongest occupancy rates in the fourth quarter of 2022. The Southeast region had the lowest occupancy at 85.3%.   

For-Profit CCRCs. The Pacific (90.8%), Mid-Atlantic (86.3%), and Northeast (85.9%) regions had the strongest occupancy rates in the fourth quarter of 2022. The Southwest and West North Central regions had the lowest occupancy at 80.2%.  

Regional Occupancy Rates – By Payment Type

In the fourth quarter of 2022, entrance fee CCRCs had higher occupancy rates than rental CCRCs across all regions. The most significant difference between entrance fee and rental occupancy was reported for the Southeast region, where entrance fee CCRC occupancy was 7.6pps higher than rental, followed by the West North Central (6.2pps), and the Mountain (5.3pps). 

Entrance Fee CCRCs. The Northeast, Pacific, and Mid-Atlantic regions had the strongest entrance fee CCRC occupancy rates – all above 90%. The smallest CCRC occupancy was in the Southwest region at 86.1%.  

Rental CCRCs. The Mid-Atlantic, Northeast, and Pacific regions had the highest occupancy rates, ranging from 86.1% to 87.8%, whereas the Southeast region had the lowest occupancy rate of 79.8%, the only region with an average occupancy rate below 80%. 

4Q 2022 Not-For-Profit vs. For-Profit CCRCs – Market Fundamentals by Care Segment 

The exhibit below illustrates the relative market performance of not-for-profit CCRCs compared with for-profit CCRCs by care segment in the fourth quarter of 2022 and includes year-over-year changes in occupancy, inventory, and asking rent growth.  

Occupancy. Overall, the occupancy rate for not-for-profit CCRCs continued to outpace that of for-profit CCRCs across all care segments. The difference in fourth quarter occupancy rates between not-for-profit CCRCs and for profit CCRCs was largest for the assisted living segment (4.5pps), and smallest for the nursing care segment (1.7pps).   

The not-for-profit CCRC independent living care segment had the highest occupancy (90.8%) in the fourth quarter of 2022, followed by not-for-profit CCRC assisted living and memory care segments (87.5% and 86.5%, respectively). Although in terms of occupancy improvements from one year ago, the independent living segment had the smallest gain across all care segments for both not-for-profit CCRCs and for-profit CCRCs. The largest occupancy gains from one year ago were seen across all care segments within for-profit CCRCs. 

Asking Rent. The monthly average asking rent for not-for-profit CCRCs across all care segments remained higher than for-profit CCRCs except in the independent living care segment. The highest year-over-year asking rent growth for both not-for-profit and for-profit CCRCs was noted in the independent living segment (4.2% and 4.5%, respectively). 

Note, these figures are for asking rates and do not consider any discounting that may be occurring. Learn more about actual in-place rates, i.e., the effective rates or the rates that are “actually being paid” to live in senior housing.

Inventory. From year-earlier levels, inventory across for-profit CCRCs decreased (or shifted) across all care segments, while not-for-profit CCRCs saw increased/relatively stable inventory in all but nursing care. Nursing care inventory for both for-profit and not-for-profit CCRCs experienced the largest declines from year-earlier levels (negative 5.2% and 2.6%, respectively). The highest year-over-year inventory growth was reported for the not-for-profit CCRC memory care segments and independent living segments (1.4% and 0.4%, respectively).  

Negative inventory growth can occur when units/beds are temporarily or permanently taken offline or converted to another care segment, outweighing added inventory.   

In conclusion, the senior housing industry can benefit from the occupancy success lessons of CCRCs. Collaboration and shared knowledge can be the key to achieving this goal. By learning from each other’s best practices, the industry can better serve its residents and prepare for any future challenges that may arise. 

Look for future blog posts from NIC to delve deep into the performance of CCRCs.  

Are you interested in learning more?  

To learn more about NIC MAP Vision data, and about accessing the data featured in this article, schedule a meeting with a product expert today.  

This article originally appeared in Ziegler’s Senior Living Finance Z-News. 

This article is the first in NIC’s Industry Thought Leaders Series, bringing insights from leaders in the field to NIC Notes readers.  

When I walk the halls of the NIC Conference, I see ghosts. Memories of big personalities of past large company operators are still clear in my mind. Most of those fast growth companies are gone now, but do we have clarity about the lessons they provide?

One particular memory is of one CEO standing in the bar at the Sheraton Chicago with a line of people ten deep all waiting to sell him a building. At its peak, his company was buying on average one building per day. Maybe they simply outgrew their quality, which is a way of saying they added more buildings than they were operationally able to manage well? Likewise, gone are the days of Lyle Lovett, Jim Belushi, and KC and the Sunshine band private concerts. Gone are the themed receptions that felt more like Vegas than a financial meeting with shows of dancers moving provocatively behind a backlit curtain. Mild compared to most financial sector conferences of the 1990s and early 2000s, the NIC has smartly and thoughtfully responded to changing times. Leaders like Lynne Katzmann, Judy Marczewski, and Kelsey Mellard have nudged and sometimes shoved us in a new direction. DEI and ESG are now flags flown declaring new understanding, awareness of our responsibility, and commitment to all represented in our profession. And, of course, Bob Kramer is always poised to sound the charge of advancement by being the industry’s agent provocateur. Capital providers and operators have evolved in their awareness of changes in society, but have we evolved in our understanding of the cultural differences between each other? Do we really understand how to fulfill our promises to our customers — older adults? 

The NIC has offered capital providers and operators the venue for our industry to evolve for the next generation. In my 26 years in attendance, I have seen our industry grapple with the question of organizational size. What is the right size of a quality operator? Twenty buildings, 40 buildings or 100? Since most of the “ghosts” I mentioned above were large national providers who prioritized scale over quality, have we generally come to think that quality cannot be achieved by these whales? All of these ghost organizations started out with a quality mission and were run by good folks, even friends of ours. So why, as they grew, did their quality decrease and, is it absolutely true that size determines quality? 

I started The Springs Living in 1996, and by 2010, our company had outgrown our seed capital partner and was looking for institutional capital that could align with our new, bigger building concept of building rental CCRCs. We turned to a fairly new capital provider at the time called Harrison Street. Flying from Portland to Chicago to meet with one of Harrison Street’s founders, former Motorola CEO, Chris Galvin, I had all the numbers memorized expecting to get grilled about financials. After pleasantries, in a conference room at their headquarters on Wacker Drive, Mr. Galvin volleyed the first question. “Tell me about your culture.” I was confused, why didn’t he ask me about my NOI margin? Fortunately, the answer came naturally for me, and I explained my “why.” Obviously satisfied with the answer, he transitioned to the next question. “How big do you want to grow?” 

I had seen some large senior housing companies fail and did not think most were capable of producing a place where I would want my family to live, or myself for that matter. I answered, “Not very big because senior housing is not a big company business.” Mr. Galvin grinned a little bit before challenging my statement. “It’s not about the size of the organization,” he said, “it’s simply that your industry has not yet figured out its limiters.” That statement stuck and has driven my ongoing obsession to figure out our industry’s limiters. 

One of those limiters may be our understanding of the differences between organizational cultures. Not just our individual organization’s culture, but the underlying industry cultures of the stakeholders needed to meet the customer demand. I am talking about the culture of capital and the culture of operators, who each see the world through different lenses…I am proposing we may be limited by lack of clarity between the culture of capital and the culture of operators. Not sure what I just said? That is exactly my point. 

Senior housing operators and senior housing capital providers may be like sugar is to salt. Both need each other to meet the needs of the customer, but their composition is vastly different. The Schneider Cultural Model may offer some insight to the differences. This model proposes that operators are cultures of “cultivation,” and capital are cultures of “control.” Operators are all about purpose, belief, and value to name a few clarifying characteristics. Capital is about predictability, order, capacity and, of course, returns. Try justifying a pro forma to a capital provider based on a “belief” if you can’t hit their target IRR. If you’re an asset manager, try telling an operator they need to stick to the “policy” instead of care for their residents. Schneider’s cultural model just may offer some clarity, and, as an industry, we must get better at understanding how to deliver quality. After all, if an organization grows, shouldn’t it have more resources? If it has more resources, it should be able to make life better for residents as well as the employees, and that should produce better risk adjusted returns for capital. The ability to deploy capital faster than organizations can grow quality plagues our industry, and, if we don’t learn the lessons from the organizational ghosts of the past, we are destined to repeat history. It seems it’s easier to talk investment committees into committing funds to real estate than it is to fund operational infrastructure that will help us give our customers the care they want as well as the returns investors need. 

Emerging out of COVID is our industry’s chance to reinvent ourselves, to change our paradigm, and be the organizations that our customers need. Seventy million baby boomers are counting on us to get this right. To do that, we need to work together to meet the needs of our customers and employees. As a profession, the public perceives us as only as good as the lowest quality operation in our market. More than enough demand exists to fill all of our buildings if we offer the quality that folks want and need. It is time to change the recipe and have a conversation around our limiters and our differences so we can invest in quality and grow together. The foodies of the world have shown us how amazing the combination of a little salt with a little sugar can be. Different ingredients when blended wisely can yield satisfying and sustainable results. Likewise, a clear cultural understanding between capital and operations can help us fulfill our promise to our customers, and those customers will be us someday. I believe the best days of senior housing and care are ahead; 70,000,000 people are counting on it.