Facilitating new connections is a part of NIC’s mission. For many, that means networking at NIC events, such as the upcoming 2021 NIC Fall Conference, or engaging in one of NIC’s many virtual events, such as the highly popular NIC Leadership Huddle series, for live online discussions. For NIC Co-founder & Strategic Advisor Bob Kramer, it’s bigger than that. “When I stepped down as NIC CEO a few years ago, part of my new role, in addition to advising NIC, was to become a scout and an ambassador, identifying and reaching out to potential new partners for seniors housing and care,” Kramer explained. “I was tasked with educating and inspiring prospective new partners and collaborators to understand the potential of working with seniors housing and care – and to help our traditional audiences prepare and plan for the near future.”

Since that time, Kramer has been speaking to leaders beyond the senior living sector, educating them on the industry, and sharing his insights on what opportunities and challenges the future may hold. In addition to numerous boards and business groups, he has addressed some of the most important and influential organizations in healthcare, academia, technology, and regulatory policy. In recent months, Kramer has spoken at meetings hosted by the Milken Institute’s Center for the Future of Aging, the Urban Institute, the Brookings Institution, the Milbank Memorial Fund, the AARP Public Policy Institute, the National Academies of Sciences, Engineering, Medicine, and many more.

According to Kramer–and now to many of the new audiences he’s been engaging with–senior living, in its many forms, must adapt to a series of new market realities in order to survive and prosper. That’s where the need to make new connections arises. Kramer said, “Senior living will need to interact with healthcare partners and payers, policy makers, technology providers, academics, and others, in order to adapt and provide the products and services that both consumers and payers have already begun to demand.” But to do so will require a greater level of understanding of seniors housing and care, particularly amongst those not already familiar with the industry.

Read the full-length article in this month’s NIC Insider.

You may already know Bob Kramer for his long history of thought-leadership in seniors housing and care. But did you know he attended some of the last concerts of several legendary musicians? Learn more as Beth Mace speaks with Bob in the new NIC Chats podcast.

NIC’s recent acquisition of VisionLTC and creation of NIC MAP Vision integrates the market-leading NIC MAP^® Data Service with VisionLTC’s best-in-class data for investors, owners, and operators to provide significantly deeper and broader data for industry stakeholders.

Key Takeaway: NIC MAP has long been the industry leader in facilitating data transparency in the seniors housing and care sector. NIC MAP Vision combines both supply-side time series data for 140 U.S. metropolitan markets and demand-side data for properties all across the country, significantly increasing an analyst’s ability to identify all of the comparable and competitive properties in a market area.

Some Context: A few years before I joined NIC in 2016, I had a potential client who wanted a compilation of all the seniors housing and skilled nursing properties in the state of Virginia not covered by NIC, listed by address, ownership/management, number of units, unit mix, and monthly rent rates for each type of unit because they were planning to use the information to seek underserved areas for development. In scoping the project, it was determined that to accomplish the task, a researcher would at least need a map and good internet search skills—but they would also need a tremendous amount of tenacity and patience to locate and reach the right state and local licensing/regulatory agencies (for lists of those properties with licenses), the ability to search the internet for unlicensed properties, and to reach out to the right people “in the know” at local planning and zoning boards to discover properties in the development pipeline that may or may not be announced (often easier said than done). Additionally, adding to the analyst’s effort to compile all the salient information, some states only disclose that a property provides a specific service or level of care but does not identify how many beds are licensed for each type—or only licenses the whole property. In the end, many variables from disparate places needed to be gathered and judiciously classified, and it was deemed to be a very time-consuming project that would require resources beyond which was reasonable.

This affiliation is truly a game-changer. On one hand, NIC MAP^® data, powered by NIC MAP Vision, continues to provide the same high-quality, supply-side data it has since 2005. The time series data of 140 metropolitan markets remains the gold standard for identifying historic patterns and trends and analyzing cycles in the seniors housing and care market fundamentals.

VisionLTC data, powered by NIC MAP Vision, goes beyond, and expands on the demand-side data with additional inventory including assisted living, memory care and nursing care licensed beds, and independent living units. With VisionLTC data and a few clicks of the mouse, an analyst now has the ability to go into any market area, no matter how small—or rural—and view details on local competitors to compile key property data.

Apples or oranges? It is of chief import when analyzing a market for senior living housing and services to designate properties as comparable or competitive. Doing so increases the accuracy of demand analyses. In most market studies, before an analyst drills down into a competitive set of properties, they need to have broad knowledge of all of the comparable seniors housing and care properties in a market area that could capture any prospective resident from the total demand pool.

• Properties that are designated “comparable” offer similar levels of care (e.g., independent living, assisted living, memory care, nursing care), and similar levels of programming and services included in the monthly fee (e.g., one meal a day, housekeeping twice a month, basic utilities, etc.).
• Once a listing of all seniors housing and care properties is created for a specific market area of interest, the analyst then categorizes them into one or more competitive sets. Communities that are designated “competitive” are further defined as offering similar levels of care, programming and services included in the monthly fee—and have comparable unit size; pricing; amenities; quality of design, fit and finish; age of physical plant; and they target the same age- and income-qualified consumer.

Comparable and competitive properties (and their respective units within) are important to differentiate, especially when conducting a study of market depth for a particular property or development project. Comparable properties must be included in the mix because they are possible selections based on care level and services offered. Competitive properties, however, may require more thoughtful consideration from the analyst to identify features that appeal to households with a particular income, affinity group, or expectations for attractiveness and features.

NIC MAP Vision powers up the process. It’s a science…and an art. In developing a competitive set for a seniors housing market study, regardless of whether it entails review of an entire county or a small neighborhood, it requires objective data (the science part) and subjective observations (the art part). Through the VisionLTC client portal, a vast variety of objective seniors housing data can be accessed and compared to put a fine point on the big picture including, but not limited to:

• • PMA (site data): target market household demographics and associated growth rates, net worth, home values, home ownership rates, total and projected supply competitive supply
  • Competition data: owner/operator, property type, payment type, unit mix, assessed property value, property sale price, mortgage amount, lot acreage and total building square footage, average online consumer review star ratings, origin of resident data
  • Assisted living rate data: minimum and maximum rent data by unit type
  • Medicare data: total Medicare spend per beneficiary, 30 and 90-day readmission rates, percent attributed to a Medicare ACO
  • Development pipeline data: address, new or renovation, stage in development, hard costs, number of units, owner contact information and detailed notes about the project
  • Labor data: position, total employment, percent labor availability by position type, FTE per licensed bed, hourly wages
  • Survey performance data: number of surveys, total citations, quality of care ratings, complaints, fines
  • Construction cost data: various building components and total cost per square foot
• Many additional factors can be considered to build the objective picture in a market study through the  VisionLTC client portal. The analyst can drill down in a marketplace to age of units, competitive and comparable care segment 5-year supply growth rates, senior disability rates including activities of daily living (ADLs), instrumental activities of daily living (IADLs), and cognitive impairment rates.

About NIC MAP Vision:

NIC MAP Vision, an affiliate of NIC, is a leading provider of comprehensive market data for the seniors housing and care sector. NIC MAP Vision brings together two strong, well-respected, and complementary teams and platforms – the market-leading NIC MAP^® Data Service (NIC MAP) and VisionLTC’s best-in-class market research analysis platform. For more information, visit www.nicmapvision.com.

Learn More About VisionLTC Data

Schedule a meeting with a Product Expert to learn more about how our product offerings can help support your business and save you time in an increasingly competitive market.

On March 28, new cases of COVID-19 among skilled nursing facility staff were 2.4 times higher than among residents for the first time since CMS started reporting data in late May.

COVID-19 Cases – U.S. vs. Skilled Nursing Facilities (Week ending March 28 vs. February 21)

More than three months after the launch of the long-term care vaccination program, case counts continued to fall within U.S. skilled nursing facilities (SNFs) and remained relatively low even as cases among the general population roared back in recent weeks across half of U.S. states.

Overall, twenty-five states and geographies reported higher weekly COVID-19 infections among the general population. However, new COVID-19 infections within skilled nursing facilities declined and/or held steady across all U.S. states. The resurgence among the general population is occurring largely in the Midwest and Northeast.

In the Midwest, Michigan reported the highest increase in COVID-19 cases among the general population of all 50 states; cases there jumped 346% from February 21 to March 28, highs not seen since December 2020, while cases within skilled nursing facilities declined 36% over the same period. Virus trends continued to decrease and flatten in skilled nursing facilities in the entire Midwest.

In the Northeast, 8 out of 9 states reported higher cases of COVID-19 among the general population compared to February 21 levels. Only Maine reported a higher but relatively low case load among skilled nursing residents. The highest case count within SNFs was reported in New York – 157 new cases for the week ending March 28, but still down 58% from February 21 levels (376), whereas cases within the general population in New York increased by 23% over that same period.

In summary, case counts within SNFs are down 98% since December 20 and the launch of the long-term care vaccination program and accounted for less than a fifth of 1% of U.S. cases on March 28 (0.18%). As for per-resident rate of new COVID-19 infections, only 7 in 10,000 residents tested positive for COVID for the week ending March 28 compared to over 300 in 10,000 back on December 20, 2020. Additionally, forty-one states and geographies reported a total of 20 cases or less within their SNFs on March 28 (See NIC’s interactive tool at the end of this blog for more details).

COVID-19 Cases – Residents vs. Staff (Skilled Nursing Facilities)

As COVID-19 infections picked up speed in recent weeks in some parts of the country, new cases among staff have been relatively higher than among residents. On March 28, reported new cases among staff were 2.4 times higher than among residents for the first time since CMS started reporting data in late May.

At the height of the pandemic and prior to the launch of the long-term care vaccination program, new cases among skilled nursing residents were 20% higher than among staff. However, the trend has reversed in recent weeks: newly confirmed cases among residents were 58% lower than among staff on March 28.

Additionally, about 97% of skilled nursing facilities across the U.S. reported no new COVID-19 cases among residents for the week ending March 28, these same facilities reported 83% of total virus cases among staff.

These numbers speak to the high vaccination rates among residents and lower acceptance of COVID-19 vaccine among staff. At this point in this 13-month pandemic, older Americans may indeed be safer in skilled nursing facilities than in the general population.

The success story of the long-term care vaccination program for skilled nursing facilities should continue to encourage not only skilled nursing staff but also the broader population to get vaccinated and help bring an end to the pandemic.

Interactive Tool – Weekly COVID-19 Confirmed Cases | Skilled Nursing Facilities vs. U.S.

Choose specific regions or states from the dropdowns in the tool below to change the graphs, or any two weeks comparison in the (View All States tab) to compute the percent change.

NIC’s new interactive tool tracks the incidence of COVID-19 and provides a way to compare weekly infections of COVID-19 in skilled nursing facilities and in the U.S. and across regions, sub regions, and states. Data show

• weekly confirmed cases in SNFs vs. U.S. (sort by region, sub region, or state)
• per-resident rate of new COVID-19 infections within SNFs (all vs. specific region/state)
• weekly confirmed cases among skilled nursing residents as a share of U.S. weekly cases.
• States summary table (choose any two weeks comparison to compute the percent change).

The data is displayed in an easy-to-use interactive dashboard that allows sorts down to state level, with data updated weekly. Check back each week to see and compare current data. 

“On one hand, the market fundamentals continue to show signals of progress due to the availability and widespread distribution of the COVID-19 vaccine among America’s seniors—on the other hand, staffing challenges and wage pressures are continuing to put strain on NOI for many operators. These data from the Wave 25 survey support trending improvement in the pace of move-ins and in occupancy rates across each of the care segments. However, staffing shortages that were experienced by many operators prior to and exacerbated by the pandemic persist. Currently, two-thirds of organizations report staffing shortages within their portfolio of properties. Adding to the challenge, nearly all respondents to the Wave 25 survey were paying staff overtime hours, and four out of five organizations were tapping agency/temp staff. The Wave 26 survey currently collecting data will explore strategies operators are implementing to attract staff.”

–Lana Peck, Senior Principal, NIC

NIC’s Executive Survey of operators in seniors housing and skilled nursing is designed to deliver transparency into market fundamentals in the seniors housing and care space as market conditions continue to change. This Wave 25 survey includes responses collected March 22 to April 4, 2021 from owners and executives of 64 small, medium, and large seniors housing and skilled nursing operators from across the nation, representing hundreds of buildings and thousands of units across respondents’ portfolios of properties.

Detailed reports for each “wave” of the survey and a PDF of the report charts can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Wave 25 Summary of Insights and Findings

• According to Wave 25 seniors housing and care survey respondents, on average, nine out of ten residents (92%) of their respective properties—including all care segments across their portfolios—have been fully vaccinated. From late January to the present, resident uptake of the vaccine has steadily increased. Staff uptake of the vaccine, however, leveled off between Waves 22 and 24 and has just recently increased slightly from over half (55%) to nearly two-thirds (63%) of staff.

• As a result of the vaccination rates, one-half of organizations are currently testing staff at least once a week for COVID-19, and one-half are testing residents only if symptomatic. Notwithstanding the need to test staff more frequently, and the costs associated with testing, one-half of respondent organizations indicate they probably will not or definitely will not make the COVID-19 vaccine mandatory for staff (53%); however, one-quarter probably will or definitely will (27%). The share of organizations considering making the vaccine mandatory for staff has increased since Wave 22 (11%).
• Staffing shortages that were experienced by many operators prior to and exacerbated by the pandemic persist in Wave 25. Currently, two-thirds of organizations report staffing shortages within their portfolio of properties (68%). And NOI continues to be pressured. Nearly all respondents to the Wave 25 survey are paying staff overtime hours (97%), up from a prior peak of 92% in the Wave 19 survey conducted December 28 to January 10. Furthermore, four out of five organizations are currently tapping agency/temp staff (82%). Both factors are at a time series high.

• The Wave 25 survey revisited the ways organizations are supporting property staff and their families to see what changes, if any, have occurred since early in the pandemic. As shown in the chart below, substantially fewer organizations are still offering additional paid sick leave and remote work. However, flexibility in work schedules is enduring: three-quarters of respondents (75%) are still offering staff flexible work hours.

• The shares of organizations reporting acceleration in the pace of move-ins has increased for independent living, assisted living and memory care since Wave 23, and reports of acceleration in move-ins in independent living is at the highest point in the time series. It is encouraging to see the pace of move-ins increasing in independent living, now, after lagging the higher levels of care that presumably saw earlier penetration of the vaccine due to the generally higher age and more acute health care needs of residents in assisted living, memory care and nursing care.

• Many operators have been eagerly anticipating a boost in occupancy due to the COVID-19 vaccine availability, and these survey data from Wave 25 support continued trends in improvement in the pace of move-ins and upward changes in occupancy rates across each of the care segments. More than one-half of organizations responding to the Wave 25 survey noted an increase in prospect interest specifically related to the vaccine (56%)—up from 25% in Wave 21. A similar proportion of survey respondents (57%) expect their organizations’ occupancy rates to recover to pre-pandemic levels sometime in 2022.
• Increased resident demand was cited by nine out of ten respondents (90%) as a reason for acceleration in move-ins in the past 30-days (the highest point in the survey time series), and about one-quarter of respondents in the Wave 25 survey reported that their organizations had a backlog of residents waiting to move-in (23%). The share of organizations currently offering rent concessions remains around 50% since the Wave 12 survey, conducted mid- to late-September.
• The Wave 25 survey data continue to show a trend in the shares of organizations noting an increase in occupancy across all four care segments, and each of the care segments are at or near the respective time series high points in terms of reports of occupancy increases.

• However, the degrees of occupancy increases vary. As shown in the chart below, the largest degrees of upward changes in occupancy rates were reported in the nursing care segment with 32% reporting upward changes of 5 to 10 percentage points. Reports of occupancy increases in organizations with independent living residents is at the time series peak, but the degree of change is weaker than the other care segments with one-quarter reporting increases of 0.1 to 3.0 percentage points.

Wave 25 Survey Demographics

• Responses were collected between March 22 and April 4, 2021 from owners and executives of 64 seniors housing and skilled nursing operators from across the nation. Owner/operators with 1 to 10 properties comprise one-half of the sample (52%). Operators with 11 to 25 and 26 properties or more make up about one-quarter of the sample (25% and 23%, respectively).
• One-half of respondents are exclusively for-profit providers (54%), just over one-quarter (28%) are nonprofit providers, and 18% operate both for-profit and nonprofit seniors housing and care organizations.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 79% of the organizations operate seniors housing properties (IL, AL, MC), 33% operate nursing care properties, and 39% operate CCRCs (aka Life Plan Communities).

Owners and C-suite executives of seniors housing and care properties, we’re asking for your input! By demonstrating transparency, you can help build trust. The survey results and analysis are frequently referenced in media reports on the sector including in McKnight’s publications, Mortgage Professional America Magazine, Senior Housing News, Multi-Housing News, Provider Magazine,, and other industry-watching media outlets. The surveys’ findings have also been mentioned in stories by Kaiser Health News, CNN, the Wall Street Journal, and other major news outlets across the U.S.

The Wave 26 survey is available and takes 5 minutes to complete. If you are an owner or C-suite executive of seniors housing and care and have not received an email invitation to take the survey, please click this link or send a message to insight@nic.org to be added to the email distribution list.

NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and transparency into market fundamentals in the seniors housing and care space at a time where trends are continuing to change.

As the U.S. enters the fourth week of rising COVID-19 cases, nineteen states have reported increasing COVID-19 cases among the general population for the week ending March 21. According to the CDC, Michigan reported the highest increase in COVID-19 cases among the general population at 187%, up from 7,313 cases during the week ending Feb 21 to 20,982 on March 21. Interesting and in contrast, skilled nursing facilities in Michigan reported a 55% decline in newly confirmed cases among residents over the same week-over-week period.

Other states that saw significant increases in cases between the reporting weeks of February 21 and March 21 are Maine (57%), New Jersey (36%), Alabama (32%), Idaho (31%), Maryland (26%), while at the same time, all of these states reported falling COVID-19 cases within their skilled nursing facilities. This may suggest that at this point in this 13-month pandemic, older Americans may indeed be safer in skilled nursing properties than in the general population.

CMS data as of March 21 compiled by NIC’s Skilled Nursing COVID-19 Tracker show that six states reported no new COVID-19 cases within their skilled nursing facilities for the week ending March 21 – down 100% from February 21 levels. These states include Wyoming, Montana, South Dakota, Nebraska, Utah, and Delaware.

Furthermore, more than twenty states reported fewer than 10 newly confirmed cases among residents across all their skilled nursing facilities. However, two states (Minnesota and Connecticut) reported a very small uptick in newly confirmed cases among skilled nursing residents, but the increases remain relatively low. (See interactive tool below for more details).

NIC’s Skilled Nursing COVID-19 Tracker shows that more counties are “turning grey” on the Tracker map, i.e., they report no new COVID-19 cases for the week ending March 21 compared to three months earlier on December 20 and prior to vaccine rollout. The difference between the two maps above corroborates the success story of the long-term care vaccination program for skilled nursing facilities and the effectiveness of the vaccines against new variants. The level of concern across skilled nursing facilities is most likely lower now than three months ago. This can only suggest a positive near-term outlook and more confidence in the post-pandemic picture and the safety of skilled nursing properties.

NIC’s new analysis below shows that new cases of COVID-19 in skilled nursing facilities account for just a fifth of 1% of U.S. cases overall on March 21, down from over 5% of cases in June 2020 and from over 2% in December 2020 and the launch of the long-term care vaccination program.

Per-resident rate of new COVID-19 infections continued to decline and reached a new pandemic low of 0.08% —only 8 in 10,000 residents of skilled nursing facilities tested positive for COVID for the week ending March 21, 2021 compared to 303 in 10,000 twelve weeks ago on December 20, 2020.

New Jersey weekly cases continue to accelerate since February 21, while weekly cases within skilled nursing facilities in New Jersey continued to decelerate and remained low. In fact, case counts within SNFs in New Jersey are down 92% from December 20 and 53% from February 21 through March 21 while weekly cases among the general population there are down 23% from December 20 but up 30% from February 21 levels. Choose specific regions or states from the dropdowns in the tool below to change the graphs. 

NIC’s new interactive tool tracks the incidence of COVID-19 and provides a way to compare weekly infections of COVID-19 in skilled nursing facilities and in the U.S. and across regions, sub regions, and states. Data show

• weekly confirmed cases in SNFs vs. U.S. (sort by region, sub region, or state)
• per-resident rate of new COVID-19 infections within SNFs (all vs. specific region/state)
• weekly confirmed cases among skilled nursing residents as a share of U.S. weekly cases.
• Summary states table (choose any two weeks comparison to compute the percent change).

The data is displayed in an easy-to-use interactive dashboard that allows sorts down to state level, with data updated weekly. Check back each week to see and compare current data.