Two educational sessions at NIC Fall Conference address the sales challenge.

As an effective vaccine for COVID-19 rolls out, seniors housing operators and owners are hopeful that sales will get a big boost in early 2021. But until then, they still face a challenging marketing landscape as the virus continues to spread amid renewed lockdowns and restrictions. 

“We have to win back consumer confidence,” said Traci Bild, CEO at Bild & Co., a Tampa-based sales and marketing firm.  “We have to be proactive.’ 

Bild participated in two sessions at NIC’s Fall Conference on the sales and marketing challenges presented by the COVID-19 era. Other panelists included operators and providers.  

The sessions were led by Bre Grubbs, senior vice president at Leisure Care, a Seattle-based operator with 52 communities nationwide. She asked the participants how their marketing plans have changed over the course of the pandemic.  

Sales took a back seat when the pandemic first hit. Operators were focused on saving lives and securing personal protective equipment. They also faced a changing array of rules as regulators struggled to find the best approaches to mitigate the spread of the virus. “It was a crisis,” said panelist Joe Kiernan, chief strategy officer and senior vice president at Ocean Healthcare, a New Jersey-based post-acute provider.  

As the first wave of the pandemic eased in the Northeast, Ocean Healthcare was able to admit new patients with strict precautions in place. COVID and isolation units were created. As testing ramped up, more patients were admitted. “We have learned so much,” said Kiernan. 

Transparency saved the hospital referral pipeline. Ocean Healthcare had direct conversations with all its stakeholders including resident families. Data was shared on the number and outcome of cases. A plan was developed to handle a resurgence of the virus. “We are ready to support our hospital partners,” said Kiernan. 

Salespeople Get Creative 

Flexibility has been key, according to session participants. Marketing strategies have evolved over time as the virus spread across the country as new hot spots emerged and cases surged in the fall nationwide.  

Sales efforts are being tailored to local market conditions. Contributing factors include the disease positivity rate in the wider community, and state and county regulations.  

Operators knew the pandemic would hurt move-ins, so early on they turned their attention to prevent move-outs. “One of the things we could control was our back door,” said Summer Blizzard. At the time of the panel discussion, she was vice president of sales at Independent Healthcare Properties. She now works for another provider.   

Blizzard said that the sales team quickly pivoted to working with families to deepen relationships with them. The goal was to keep current resident safe, happy and engaged. “We had to get creative,” she said. The sales team had to be educated about the virus and take a new approach.  

The session panelists said that sales representatives have faced two big objections from potential residents and their families: safety and isolation. They want to know how the threat from the virus is being handled by the community; and how the community is dealing with the isolation of residents because of the need for infection control.  

The panelists emphasized the importance for salespeople to be transparent and authentic. Sales leads must be nurtured. A soft approach works best. An occasional check in with those who have shown interest in the property has been found to be valuable.  

With restrictions on in-person meetings and tours, virtual tours and zoom conferences have helped sales teams stay in touch with referral sources and prospects.  

Successful sales reps have learned to quickly convert a phone call into a walking tour. “Virtual tours are fun,” noted Bild. “No one will move in without seeing the community.” She added that in some respects a virtual live tour makes it easier for prospects to ask questions.  

Though sales have slowed, marketing executives say that the new residents who have moved in are frailer than those of previous years. Healthier seniors are staying put. The ones who are moving can’t manage at home anymore. However, Grubbs noted an uptick of interest in recent months from seniors looking for independent living units.  

Marketing executives are revamping advertising campaigns. Video testimonials are finding some success. Property websites should be refreshed, the panelists said. Direct mail is getting another look since more people are at home. Fewer folks are out driving by properties, which can be a big source in inquiries.  

Much of the marketing focus has shifted to social media outlets such as Facebook. People at home are spending a lot of time online. A thoughtfully designed Facebook page can show a vibrant lifestyle in action despite the restrictions, according to Grubbs. Residents can be seen meeting with family outside or engaging in a fun activity.  

Marketing consultant Bild noted that the pandemic has heightened the realization that senior living is still an emotional sale. What drives a new move-in is the connection that the sales team makes with the adult child or resident. “It’s not about the building,” she said.  

Grubbs emphasized the importance of getting back to marketing basics. The goal is to stay in touch with prospects, show genuine concern and follow up on leads.   

Bild agreed. She advised operators to stay on top of leads. “The pandemic has hurt traffic,” she said. “But the traffic that is coming in is legitimate.” She expects demand to resume with the introduction of the vaccine, advising operators to redouble their sales efforts. “Prepare now,” she said.  

Senior living providers eagerly await FDA approval of a COVID-19 vaccine and are preparing the logistical plans needed to ensure a fast and efficient process to vaccinate residents. In the meantime, robust testing remains the most effective strategy for protecting residents and staff from widespread infection. To better understand current testing strategies and how they have adapted over time, I spoke with Ed Ward, Vice President of Operations, Kisco Senior Living to learn more about their innovative testing program.

Kisco Senior Living, a Carlsbad, California-based provider, has embarked on a strategy of pool testing. Pool testing, also known as batch testing, combines saliva samples from a large group and tests the combined sample for evidence of the coronavirus all at one time. This process can be cost effective and easier to implement than repeated, individual testing. It can also instill confidence among staff, residents, and their families. Further, pool testing cuts down on both time and supplies required and, as discussed in a NIC Leadership Huddle, is a strategy that is being utilized by other high-profile organizations, such as the National Basketball Association. If a sampled pool generates positive test results, then everyone in that group receives an individual PCR test as follow-up. Contact tracing to identify other residents or staff who may have been exposed can then begin as well.

In our conversation, Ward described reluctance by some residents to undergo the sometimes uncomfortable nasopharyngeal PCR testing process, and as a result, he said that a portion of residents were foregoing routine medical appointments to avoid having to isolate themselves for the subsequent two weeks. Ward said, “We thought it was unacceptable to do invasive testing if we were going to do regular and routine testing of our residents.” Kisco implemented rapid, antigen testing residents for a time, but found that for asymptomatic individuals, the rapid test wasn’t as accurate as they needed it to be. “We wanted something as accurate for asymptomatic individuals as it was for those who are symptomatic.”

Residents are grouped into pools based on their risk profile. All residents are tested at least once per week. Any resident who leaves the community, to go to a medical appointment for example, is considered at higher-risk, and tested twice per week. Associates are also tested twice per week.

At Kisco, two pool sample sizes are utilized, depending on factors such as building census and location of where people work or reside. For smaller properties, a pool of up to 50 residents is typically used. For larger properties, a pool size of up to 100 can be tested. It is more expensive to test the larger pool size, but on a per-resident basis, the cost is less than the smaller pool size. The program’s cost amounted to approximately $100,000 per month, and Kisco has included testing expenses in their 2021 budget.

Ward told me that he is in regular contact with the labs that process their pooled samples to understand their turnaround times. Samples are overnighted and are turned around within at least 24 hours, often only taking 12 hours. Because Kisco can identify COVID-19 positive cases so early, “This has allowed us to open up dining and activities and have a lot more confidence about our operation,” Ward explained.

In addition to testing staff and residents, Kisco includes anyone coming into their property – whether for hospice, home health, or salon services – in their higher-risk pools. “Agencies might have their own testing protocols, but by controlling it ourselves and including them in our pools in order to provide services in our buildings, this gives us another degree of confidence,” Ward said.

Kisco is also working with their lab partners to facilitate safer and more confident visitation of residents. This includes a program – now available in all Kisco communities – where visitors can consent to providing PCR test results directly from the lab to Kisco. Upon a negative test, visitors are cleared to visit the community within a 24-hour period. Moving forward, Ward explains, “If vaccines, therapeutics, or other advances to control this virus emerge, we will monitor the science and data and make adjustments based on the facts at the time.”

It seems clear that pool testing may in fact be one of the most appropriate ways to test residents in a large, congregate setting, and in this case, has increased the likelihood of residents keeping up with their routine medical appointments, allowed for safer and more confident visitation of residents, and a return to more ‘normal’ conditions for Kisco residents.

2020 has been a challenging year. The seniors housing and care sector was thrust into an adrenaline-fueled, 24/7 pitched battle to protect millions of America’s most vulnerable citizens from the deadly COVID-19 global pandemic. Leaders across the sector have been challenged by regulatory inconsistencies, sweeping changes in public policy, an intense media spotlight, evolving consumer attitudes, changes in healthcare delivery, the implementation of new technology, mental and physical health concerns of staff and residents, and uncertainty in capital markets – just to name a few.

NIC has responded to these challenges by doing what we do best: provide data, analysis, and a platform for connections. Since mid-March, we have launched a number of initiatives designed to improve our understanding of the impact of the pandemic on the seniors housing and care industry. Much of this information can be found on the COVID-19 Resource Center on NIC.org.

As the situation evolves, it is essential that industry leaders be able to share lessons learned, discuss strategies, hear the latest insights and continue to connect with one another, even as travel restrictions and risk of infection continues to make in-person gatherings and networking nearly impossible. NIC is therefore temporarily shifting from its traditional emphasis on a major in-person spring conference event.

For the first half of 2021, NIC is pivoting to provide a program of online opportunities for seniors housing and care leaders both to stay informed and connected across the industry.

To that end, NIC is extending the extremely popular “Leadership Huddle” webinar series and enhancing it with the addition of post-webinar ‘peer-to-peer’ breakout sessions designed to facilitate further discussion, moderated by webinar hosts and experts. Made possible by our generous partners and sponsors, the entire series of Leadership Huddle webinars will be complimentary and open to attendees across the industry.

The series of enhanced Leadership Huddle webinars will kick off on Wednesday, January 27, and then will continue, with additional events to be held on the 2nd and 4th weeks of each month, through the first half of 2021. Attendees of NIC conferences can expect the same high level of expertise, analysis, insight, and thought-leadership typically found in our conference programming. The program will enable NIC to be able to provide the most relevant, timely, and impactful subject-matter, keeping pace with change as it occurs.

2021 will likely bring further change, hopefully bringing America, and the seniors housing and care industry, beyond this crisis and into a new normal, in which in-person events are again possible. Until then, NIC will continue to take a nimble, adaptive approach, in order to continue to offer industry leaders and stakeholders the most efficient, effective means to stay informed, share information, and connect with one another.

Partners and sponsors, who typically enjoy opportunities for recognition and visibility at the NIC Spring Conference, can, instead, now choose to gain visibility and associate their brands with NIC’s via Leadership Huddle webinar presentations, as well as a variety of other opportunities, some of which are unique this coming year. Interested parties can sign up to receive up-to-date information on all upcoming sponsorship opportunities here.

In the absence of large, in-person events, NIC’s pivot to develop the industry’s premier digital properties, with the support of partners and sponsors, is a major opportunity to gain visibility and recognition with industry leaders, where they will safely and efficiently convene online, throughout the entire year.

NIC MAP^® Data Service released its latest Skilled Nursing Monthly Report on December 2, 2020, which includes key monthly data points from January 2012 through September 2020.   

Here are some key takeaways from the report: 

1. Occupancy challenges continue for skilled nursing properties as the occupancy rate stood at 74.0% in September 2020, the most updated figure from this survey. While up 12 basis points from 73.9% in August, the September level was 10.9 percentage points below the recent February peak of 84.9%. Since February, the COVID-19 pandemic has significantly impacted skilled nursing operations across the country. Occupancy is down 10.2 percentage points from the September 2019 level of 84.2%. 
   
2. The decline has been more severe in urban areas as occupancy fell 11.8 percentage points since February versus the 8.0 percentage point decline in rural areas in that same period. As the country and the skilled nursing sector navigate through the coming fall/winter months, COVID-19 cases are likely to continue to grow and could further pressure occupancy lower. The funds from the CARES Act and other implemented policies, such as the 3-Day waiver, have helped to support skilled nursing properties thus far and into the first nine months of the pandemic, but additional stimulus is most likely needed for many operators to make it through to the other side of the pandemic.  
   
3. Managed Medicare patient day mix increased 33 basis points to 6.3% in September 2020 after hitting a 7-year low during the pandemic of 5.4% in May.  However, it is down 29 basis points since March and has decreased 78 basis points since its record high point in February of 7.1%. The increase since May suggests managed Medicare admissions have increased since the lows of the pandemic, but they are likely significantly below levels prior to the pandemic. As cases of COVID-19 continue to grow and some states implement restrictions once again, it is possible that managed care patient days are further pressured if elective surgeries are suspended again. In addition, managed Medicare revenue mix increased 61 basis points from August to September to 8.8%. However, it is has declined 110 basis points since March and 188 basis points since February, when it was 10.7% before the pandemic started. At its peak in March 2019, it was 11.8%.
   
4. Medicare revenue mix increased slightly from August to September, ending at 21.8%. Medicare revenue mix has held up relatively well since the pandemic began in March, compared with other payors. It is up 46 basis points since March compared to managed Medicare (down 110 basis points) and private (down 134 basis points). In addition, skilled mix has increased 47 basis points since March driven by the increase in Medicare patient day mix. Medicare patient day mix decreased slightly from August to end September at 12.4%. However, it has increased 97 basis points since March.  As overall occupancy has declined dramatically during the pandemic creating significant pressure on skilled nursing operators, Medicare patient days likely did not decrease as much as it would have given that the Centers for Medicare and Medicaid Services (CMS) waived the 3-Day Rule, which waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered skilled nursing stay.  

To get more trends from the latest data you can download the Skilled Nursing Monthly Report here. 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 in order to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form here. NIC maintains strict confidentiality of all data it receives. 

The NIC MAP^® Data Service recently released national monthly data through September 2020 for actual rates and leasing velocity. In this release, NIC also provided data on three metropolitan areas for which there is enough data to report:  Atlanta, Philadelphia, and Phoenix.  

U.S. National Trends—Memory Care Segment—3Q20 

A few of the key takeaways from the 3Q2020 Seniors Housing Actual Rates Report are listed below. Full access to the reports and other takeaways is available to NIC MAP® Data Service clients.  

• • Average initial rates for residents moving into independent living, assisted living and memory care segments were below average asking rates, with monthly spreads generally largest for memory care. Care segments refer to the levels of care and services provided to a resident living in an assisted living, memory care or independent living unit.   
  • The average discount for the memory care segment was the largest of the three care segments in September 2020 and averaged 8.4% below average asking rates. This equates to an average initial rate discount of 1.0 month on an annualized basis, more than in June, July, or August, but less than in September 2019 (1.2 months).  
  • For the assisted living segment, average in-place rates were consistently below average asking rates since reporting began in January 2017. However, the monthly gap between these two rates is shrinking and was only 0.4% or $18 in September 2020. One year ago, it was 3.4% or $170.   

• • The rate of move-outs has exceeded or equaled the rate of move-ins for each of the prior twelve months for both the independent living and assisted living segments, and for seven of the last twelve months for the memory care segment as of September 2020. The difference between the pace of move-outs and move-ins was widest in the immediate aftermath of the pandemic in the March, April, and May period. 
  • There was monthly variation in initial rate discounts by geography and care segment during the third quarter of 2020. Of the three metropolitan markets currently being reported by the NIC MAP® Data Service (Atlanta, Philadelphia, and Phoenix), Philadelphia’s independent living  segment had the largest discount in initial rates relative to asking rates, with a discount equivalent to 2.4 months at an annualized basis in September 2020.  
  • Atlanta’s assisted living segment had a large initial rates discount relative to asking rates at 1.9 months (annualized) in September 2020. In contrast, Phoenix had no discount and Philadelphia offered 0.5-month discount. This compares with 0.7 month for the assisted living segment at the national level.   

The NIC Actual Rates Initiative is driven by the need to continually increase transparency in the seniors housing sector and achieve greater parity to data that is available in other real estate asset types. Now, more than ever, in the world of the COVID-19 pandemic, having access to accurate data on the actual monthly rates that a seniors housing resident pays as compared to property level asking rates helps NIC achieve this goal. 

The Seniors Housing Actual Rates Report available in NIC MAP provides aggregate national data from approximately 300,000 units within more than 2,500 properties across the U.S. operated by 25 to 30 seniors housing providers. The operators included in the current sample tend to be larger, professionally managed, and investment-grade operators as we currently require participating operators to manage 5 or more properties. Note that this monthly time series is comprised of end-of-month data for each respective month. 

Note that the data reported here is on care segment, where care segment type refers to each part or section of a property that provides a specific level of service, i.e., independent living, assisted living or memory care. NIC also has this data for majority property type, where majority property type refers to which care segment comprises the largest share of inventory. In addition, care segment actual rates data is also available for the Atlanta, Phoenix and Philadelphia CBSAs. 

While these trends are certainly interesting aggregated across the states, actual rate data is even more useful at the CBSA level. As NIC continues to work toward growing the sample size to be large enough to release more data at the CBSA level, partnering with leading software providers like Yardi, PointClickCare, Alis, and MatrixCare makes it easier for operators to contribute data to the Actual Rates Initiative. NIC appreciates our partnerships with software providers and our data contributors and their work in achieving standardized data reporting. 

If you are an operator or a software provider interested in how you can contribute to the Actual Rates Initiative, please visit nic.org/actual-rates.