For seniors housing and care operators, the battle to protect residents from the deadly COVID-19 global pandemic can get personal. Their experiences, particularly in the early days of the disease’s spread, shed light on the immense effort it has taken to protect America’s most vulnerable elders, and also on the toll that struggle has taken on residents – and staff – alike.  

The 2020 NIC Fall Conference presented a collection of “Operator Spotlights” designed to provide some first-person insight straight from the leaders who have been facing the pandemic, and its many challenges, every day since it first hit the U.S. Each spotlight focused on not only the challenges faced, but the solutions leaders put in place—short term and long term—to protect their staff and residents from potentially spreading or contracting the disease. 

Fee Stubblefield, CEO, The Springs Living, focused on the science of detecting COVID-19 with surface testing. Saying, “In the early days of COVID we weren’t sure what information to believe,” Stubblefield explained how surface testing led his company to understand that COVID-19 is actually airborne, and continues to be a powerful tool to help prevent infection throughout the company’s communities.  

Stubblefield pointed out that surface testing offers many advantages to operators. Response rates are quick, and it can detect the presence of COVID-19 even when residents test negative. Regular testing inspires confidence in residents and staff, at a lower cost than managing an outbreak. Looking ahead, Stubblefield said that, “COVID-19 has changed the way seniors housing providers must operate. Organizations will need to embrace the reality that you cannot deliver great care without delivering a safe environment.” 

Lynne Katzmann, President & CEO, Juniper Communities, focused on collaboration, as well as prevention and rapid, accurate, and inexpensive testing. Katzmann began by saying, “COVID-19 has challenged us all in ways that were unimaginable just six months ago.” Her top three learnings over that period are that COVID-19 is ‘invisible and insidious,” prevention is even more important than control of the disease, and testing is “our key weapon…before there’s a vaccine.”  

Katzmann relayed how she looked early on at the testing and contact tracing which had seen success overseas, and decided to employ similar tactics, even at a time when many believed testing should be conducted only on symptomatic individuals. Like Stubblefield, who worked with academic institutions to help study the virus’ spread, Katzmann partnered with the scientific community on innovation, both to help, as she said, “not only to protect Juniper, but to also positively impact our industry, and most importantly the wellbeing of older adults.”  

Working with CRISPR gene-splicing scientists from MIT, and a testing lab, Juniper helped validate a new cheek swab test, which they’ve been using since September. She believes the test, which is more comfortable, and doesn’t require a healthcare professional to administer, will enable broader and more affordable testing across the industry. 

Lori Alford, COO, Avanti Senior Living took a few minutes to focus on the importance of managing stress for her exhausted staff. Saying, “COVID fatigue is extraordinarily real,” Alford described just how difficult the COVID-19 pandemic has been, both for frontline workers and the support and leadership staff who face the threat and challenges of the pandemic on a daily basis. “They not only had to manage the fear, they had to manage their children being home all day, or dealing maybe with their spouse being home, but they continued to have to go to work,” she explained.  

Avanti launched a 6-week coaching program with staff because “What the team needed was mental wellness.” Each week, staff participated by watching a video, joining a group coaching call, and journaling throughout the week. Despite early skepticism, Alford saw real improvements in her team. “At the end of the six week journey…not only did I see a difference in transformation in the minds when they came to work for Avanti, but I would listen to them talk, and they would say, ‘I’ve shared this with my family. I’ve shared this with my friends. This has helped me grow personally, not just professionally…’ as a leader, ‘Wow!’…I would put this in the top 3 career highlights.”  

As a result of the positive results on their initial coaching program, Avanti is rolling it out for every department head in the organization, with hopes of eventually making the program available for the rest of their staff as well. 

For Dwayne J. Clark, Founder & CEO, Aegis Living, it was essential to be creative and proactive early on in the crisis. He described numerous initiatives his organization launched, in order to understand how to fight COVID-19, best serve the needs of residents and families, and how to support his staff through an extremely difficult and stressful period.  

Early on, Aegis Living formed an advisory council. “We relied heavily on these seven professionals,” he said, describing their diverse medical backgrounds, spanning gerontology, epidemiology, immunology, naturopathy, and even psychiatry. Aegis then launched numerous initiatives. These included chat suites for residents, outdoor living rooms, where residents could meet and even dine with family members and loved ones, and ‘hugging walls,’ which enable a safe means to touch, hold hands, and hold one another through a medically safe disposable barrier.  

Like Alford, Clark discussed the need to provide emotional support for staff. They implemented a telemedicine program, available to staff and their families for immediate access to a doctor – without having to undertake the risk of a hospital visit. $1 meals were available for staff to take home to their families. A childcare swapping program better enabled staff to manage their at-home childcare needs. “So, we really had to be creative, we really had to listen to our employees, and think about ‘what are their issues.” Said Clark. He pointed out that, at a time when many providers are struggling to get staff to come to work, Aegis has avoided that problem. “It was because we were so thoughtful about their food needs, their medical needs, their childcare needs, their mental health needs.” 

Jack Callison, CEO, Enlivant, not only faced the threat of COVID-19, but had to evacuate several properties as the result of both Hurricane Laura, which caused flooding in Lake Charles, Louisiana, and wildfires that forced evacuation from Talent, Oregon. His presentation focused on lessons learned from those experiences. “You’ve probably got your evacuation protocols, and I’m sure everybody has their COVID protocols; but you need to merge those two playbooks together,” Callison said.  

He then reviewed numerous details to consider, including doubling the number of busses that will be needed during a pandemic, in order to maintain social distancing. He suggested reaching out to local EMS and fire departments for help loading and offloading frail elders. In some cases, Enlivant found that evacuating to a hotel was the better choice, over moving residents to a sister facility. In every case, he advised to ensure to drop-ship appropriate supplies of PPE to the evacuation site.  

Callison provided tips for coordinating with a hotel. Call ahead and have the hotel remove door bars, to avoid the possibility of staff being barred from entry. Also, ask for universal key cards to access rooms. He also emphasized the need to maintain social distancing, in some cases separating numerous evacuated communities by keeping them on separate floors, and always keeping residents in their rooms. Enlivant also “opened the door” for family members and even pets, to join their residents for the evacuation. The organization arranged to take over the hotels’ commercial kitchens, in order to ensure safety protocols, and prepare three meals a day for every evacuee. They also coordinated with their food service provider to route food deliveries to the hotel. 

“The most important thing that we did, that served us well,” Callison said, was a daily call hosted by executive directors with families. The 4PM daily calls delivered consistent messaging to families and provided the efficiency of answering questions all at once, rather than in a time-consuming one-by-one approach. Callison, like all of the other operator leaders, also mentioned another core aspect of success: his staff. He said, “everything that I’ll share with you today is a function of the amazing human beings we have in the Enlivant communities, who are executing our protocols every single day. We’re so incredibly proud of the wonderful job they’re doing, keeping our elderly population safe.” 

Video replays of these Operator Spotlights remain available to registrants of the NIC 2020 Fall Conference. Click here to log in to on demand access.   

The Labor Department reported that nonfarm payrolls rose by 245,000 in November and that the unemployment rate fell to 6.7% from 6.9% in October.  This suggests that the employment recovery from the COVID-related drop in March and April continues, but at a decelerating pace.  The consensus estimates for November had been for a gain of 470,000.  In November, nonfarm employment was below its February level by 9.8 million jobs or by 6.5%.

Health care added 46,000 jobs in November, with the largest gains occurring offices of physicians and home health care services.  Health care employed 527,000 fewer workers in November than in February.  Nursing care facilities lost 12,000 jobs in November.

The 0.2 percentage point drop in the November unemployment rate to 6.7% marked the seventh consecutive month of improvement.  It is 3.2 percentage points above the pre-pandemic level of 3.5% seen in February, however, but well below the 14.7% peak seen in April.

The number of long-term unemployed (those jobless for 27 weeks or more) increased by 385,000 to 3.9 million, a figure that suggests that is continues to be a very challenging time for many Americans.  Long-term unemployed persons account for 36.9% of the total number of unemployed persons.  The number of permanent job losers rose 59,000 to 3.7 million and is 2.5 million more than in February.

The underemployment rate or the U-6 jobless rate fell to 12.0% in November from 12.1% in October.  This figure includes those who have quit looking for a job because they are discouraged about their prospects and people working part-time but desiring a full work week.

A separate report issued yesterday on unemployment insurance claims showed that more than 20.2 million workers remain on government assistance in the week ended November 14.

Average hourly earnings for all employees on private nonfarm payrolls rose by $0.09 in November to $29.58, a gain of 4.4% from a year earlier.  The large employment fluctuations over the past several months, especially in industries with lower-paid workers—complicate the analysis of recent trends in average hourly earnings.

The labor force participation rate, which is a measure of the share of working age people who are employed or looking for work slipped to 61.5% in November, down from 61.7% in October.  The employment-population ratio was little changed at 57.3% in November and is 3.8 percentage points lower than in February.

The change in total nonfarm payroll employment for September was revised up by 39,000 from 672,000 to 711,000 and the change for October was revised down by 28,000 from 638,000 to 610,000.   Combined, 11,000 jobs were added to the original estimates.   Monthly revisions result from additional reports received from businesses and government agencies since the last published estimates and from the recalculation of seasonal factors.

The slowdown in monthly gains in employment is troubling.  Further weakness in employment growth is likely due to the ongoing large number of newly diagnosed COVID-19 infections and its impact on business closures and job security.  Many states are re-imposing lockdowns.  Congress needs to act to implement further fiscal stimulus to keep the recovery on track.  Without a fiscal stimulus package, the recession is likely to deepen until a vaccine can be safely and widely distributed.   

“Due to growing cases of COVID-19 in many parts of the country, market conditions appear to be trending in a similar pattern to that seen earlier in the pandemic. More organizations in Wave 16 reported occupancy rate declines over the past 30 days in the segments serving residents with higher levels of care needs as the pace of move-ins has slowed. The deepest occupancy rate declines were in the nursing care segment, with about one-third of organizations with nursing care beds reporting occupancy declines of three percentage points or more. Residents moving to higher levels of care, cited by one-half of respondents, may be one of several possible factors in greater shares of organizations reporting an acceleration in move-outs for each of the care segments. As potential new residents wait on the sidelines and delay moving into properties, operators remain challenged to backfill newly available units. Recent announcements of vaccine approvals should help restore occupancy in the coming months.”

                                                                                                                                                                 –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 at a time when market conditions continue to change. This Wave 16 survey includes responses collected November 9- 22, 2020 from owners and executives of 87 seniors housing and skilled nursing operators from across the nation. Detailed reports for each “wave” of the survey, and access to the graphs included in this report, can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Wave 16 Summary of Insights and Findings

• The shares of organizations reporting month-over-month declines in occupancy rates increased for each of the care segments except for the independent living segment in Wave 16. Notably, the shares of organizations reporting declines in occupancy is the highest since Wave 8 (surveyed late-May to early-June) for the memory care and nursing care segments, and Wave 9 for the assisted living care segment (surveyed late-June to early-July). On the flip side, the shares of organizations reporting an increase in month-over-month occupancy is the lowest in since Wave 8 for the independent living and assisted living care segments, and Wave 7 for the nursing care segment (surveyed mid-May).
• The shares of organizations reporting an acceleration in the pace of move-ins in the past 30 days for independent living, assisted living and memory care were at or around their lowest levels since Wave 8 (surveyed late-May to early-June), while the shares of organizations reporting a deceleration in the pace of move-ins in the past 30 days for independent living, memory care and nursing care were at or around their highest levels since Wave 8.
• The slowdown in the pace of move-ins may be reflected in the growing share of organizations reporting residents waiting to move in. Now at the highest point in the survey, approximately one-third of respondents (34%) had a backlog of residents waiting to move in. This may suggest that once a vaccine is distributed, operators may see an increase in move-ins and occupancy rates.
• Presumably due to relaxation in resident visitation restrictions, safe visitation policies and procedures, and perhaps greater access to COVID-19 testing, resident or family member concerns cited as a reason for deceleration in the pace of move-ins and acceleration in the pace of move-outs were both down from the late summer months.
• One-half of operators with nursing care beds noted downward changes in occupancy rates, and greater shares of organizations with nursing care beds in Wave 16 noted declines in occupancy of ten percentage points or more than in the prior three waves of the survey. About one-third of organizations with nursing care beds reported occupancy declines of three percentage points or more.
• On the other end of the spectrum, the independent living segment saw a lesser degree of month-over-month occupancy change than the nursing care segment: one-quarter of organizations with independent living units in Wave 16 noted occupancy declines of up to 3 percentage points, and 15% saw increases in occupancy up to 3 percentage points. Just under a third of the occupancy declines reported for the assisted living care segment were in the 0.1 to 3 percentage point range (29%), although one-quarter (25%) reported declines of more than 3 percentage points. Only 5% reported declines of 10 percentage points or more.
• Looking at the week-over-week occupancy changes by care segment, the nursing care and memory care segments reported the largest shares of declining occupancy from one week prior (33% and 23%, respectively), suggesting the downward trend may continue.
• In Wave 16, accelerations in the pace of move-ins in the past 30 days generally matched decelerations in independent living and memory care. However, the assisted living segment and the nursing care segment saw greater shares of organizations reporting decelerations in move-ins than accelerations. While resident or family member concerns and slowdown in leads conversions/sales cited as reasons for deceleration in move-ins (61%) declined from Wave 15 (88% and 75%, respectively), about one-quarter of respondents cited an organization-imposed ban (24%).
• The shares of organizations with assisted living units reporting an acceleration in the pace of move-outs is at the highest level in the survey time series (29%) but at similar levels seen last in Waves 5 and 6, earlier in the pandemic (late-April to mid-May). About one-third of organizations with nursing care beds in Waves 15 and 16 report an acceleration in the pace of move-outs—the highest levels since Wave 5 (surveyed late-April to early-May).
• Respondents reporting ease in accessing PPE and COVID-19 test kits declined from the prior survey. Just under one-half of respondents (47%) found it easy to obtain COVID-19 testing kits, down from 59% in Wave 15. Respondents reporting easy access to PPE fell from 54% to 44% over the same time period. The Wave 17 survey, currently collecting data, will address challenges to organizations regarding access and cost of PPE.
• Similar to Wave 15, more than one-half of respondents in Wave 16 (57%), received their COVID-19 test results within 2 days, up from 13% in Wave 10, surveyed late-July to early-August. While somewhat encouraging, at this point in the pandemic, it is still taking 3 or more days to receive test results for a substantial proportion of respondents (43%).
• Although down slightly from Wave 14, most respondents (85%) were paying staff overtime hours—continuing to put strain on NOI. Organizations backfilling staffing shortages with agency or temporary staff is down from a high of 70% in Wave 15 to 62% in Wave 16.

Wave 16 Survey Demographics

• Responses were collected November 9-November 22, 2020 from owners and executives of 87 seniors housing and skilled nursing operators from across the nation. Just under half of respondents are exclusively for-profit or nonprofit providers (44%, respectively), and 12% operate both for-profit and nonprofit seniors housing and care organizations.
• Owner/operators with 1 to 10 properties comprise 69% of the sample. Operators with 11 to 25 properties make up 17% of the sample, while operators with 26 properties or more make up 14% of the sample.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 70% of the organizations operate seniors housing properties (IL, AL, MC), 30% operate nursing care properties, and 38% operate CCRCs (aka Life Plan Communities).

Key Survey Results

Pace of Move-Ins and Move-Outs

Respondents were asked: “Considering my organization’s entire portfolio of properties, overall, the pace of move-ins and move-outs by care segment in the past 30-days has…”

• Showing the most recent waves of survey data in the chart below, the shares of organizations reporting no change in the pace of move-ins in the past 30-days remained high but declined from Wave 15 for the independent living, assisted living and memory care segments—ranging from 49% to 52% in Wave 15 to 42% to 47% in Wave 16.
• In Wave 16, reports of accelerations in the pace of move-ins generally matched decelerations in independent living and memory care. However, the assisted living segment and the nursing care segment saw greater shares of organizations reporting decelerations in move-ins than accelerations.

• The shares of organizations reporting an acceleration in the pace of move-ins in the past 30-days for independent living, assisted living and memory care were at or around their lowest levels since Wave 8 (surveyed late-May to early-June). On the flip side, the shares of organizations reporting a deceleration in the pace of move-ins in the past 30-days for independent living, memory care and nursing care were at or around their highest levels since Wave 8.

Reasons for Acceleration or Deceleration in Move-Ins

Respondents were asked: “The acceleration/deceleration in move-ins is due to…”

• The shares of organizations citing increased resident demand as a reason for acceleration in move-ins in Wave 16 remained high (84%); up from a low of 66% in Wave 10 (surveyed mid-July to early-August) but down from a peak of 88% in Wave 12 (surveyed mid- to late-September).
• As shown in the chart below, resident or family member concerns and slowdown in leads conversions/sales cited as reasons for decelerations in the pace of in move-ins in the past 30-days (61%) declined from Wave 15 (88% and 75%, respectively). In Wave 16, about one-quarter of respondents cited an organization-imposed ban—an increase from the prior wave (17% to 24%), and up from 0% in Wave 14 (surveyed mid- to late-October).

• In Wave 16, the shares of organizations reporting an acceleration in the pace of move-outs exceeded the shares reporting a deceleration in move outs for each of the care segments. However, between roughly two-thirds and three-quarters of respondents in Wave 16 with independent living, assisted living, and/or memory care units noted no change in the pace of move-outs in the past 30-days (61% to 79%).
• While smaller shares of organizations with independent living units reported deceleration in move-outs than in the prior three waves of the survey (7%), greater shares of organizations with assisted living and memory care units than in recent waves of the survey reported acceleration in the pace of move-outs (29% and 22%, respectively).

• About one-third of organizations with nursing care beds in Waves 15 and 16 report an acceleration in the pace of move-outs—the highest levels since Wave 5 (surveyed late-April to early-May).
• The shares of organizations with assisted living units reporting an acceleration in the pace of move-outs is at the highest level in the survey time series (29%) but at similar levels last seen in Waves 5 and 6 earlier in the pandemic (late-April to mid-May).
• As shown in the chart below, resident deaths (unspecified reason) continued to be cited most frequently as a reason for acceleration in the pace of move-outs in the last 30-days (77%). This is up from 61% in Wave 13 but below the peak of 85% reached in Wave 6 (surveyed in early-May). Residents moving to higher levels of care was cited by one-half of respondents (51%)—the highest since Wave 7 (surveyed mid-May). Resident or family member concerns cited as a reason for acceleration in the pace of move-outs was 40% in Wave 16—down from 63% in Wave 10 (surveyed late-July to early-August).

Change in Occupancy by Care Segment

Respondents were asked: “Considering the entire portfolio of properties, overall, my organization’s occupancy rates by care segment are… (Most Recent Occupancy, Occupancy One Month Ago, Occupancy One Week Ago, Percent 0-100)”

• In Wave 16, the shares of organizations reporting month-over-month declines in occupancy rates increased for each of the care segments except for the independent living segment. Between 42% and 54% of organizations with assisted living units, memory care units and nursing care beds reported downward changes in occupancy in the past 30-days.
• The shares of organizations reporting declines in occupancy is the highest since Wave 8 (surveyed late-May to early-June) for the memory care and nursing care segments, and Wave 9 for the assisted living care segment (surveyed late-June to early-July).
• The shares of organizations reporting an increase in month-over-month occupancy is the lowest in since Wave 8 for the independent living and assisted living care segments, and Wave 7 for the nursing care segment (surveyed mid-May).

• The chart below breaks out the rates of change in occupancy by care segment with greater granularity. The blue and orange-hued stacked bars correspond to the solid bars in the chart above indicating the degree of change by the saturation of color.
• The chart above illustrates that In Wave 16, 50% of operators with nursing care beds noted downward changes in occupancy rates. The chart below describes the degree of those occupancy rate changes: greater shares of organizations with nursing care beds in Wave 16 noted declines in occupancy of ten percentage points or more than in the prior three waves of the survey (greater shares of organizations also reported increases of ten percentage points or more). Additionally, the chart shows that about one-third of organizations with nursing care beds reported occupancy declines of three percentage points or more.

• On the other end of the spectrum, the independent living segment saw a lesser degree of occupancy change than the nursing care segment: one-quarter of organizations with independent living units in Wave 16 noted occupancy declines of up to three percentage points, and 15% saw increases in occupancy up to three percentage points.
• Just under a third of the occupancy declines reported for the assisted living care segment were in the 0.1 to three percentage points range (29%), although one-quarter (25%) reported declines of more than three percentage points. Only 5% reported declines of ten percentage points or more.
• Regarding the change in occupancy from one week ago, between 62% and 87% of organizations with independent living, assisted living and memory care, and 50% of organizations with nursing care beds reported no change. Organizations with independent living units saw the smallest changes in week-over-week occupancy rates (7%, decreased and 7% increased). However, the nursing care and memory care segments reported the largest shares of declining occupancy from one week prior (33% and 23%, respectively).

Organizations Currently Offering Rent Concessions to Attract New Residents and Organizations Experiencing a Backlog of Residents Waiting to Move-In

Respondents were asked: “My organization is currently offering rent concessions to attract new residents,” and “My organization is experiencing a backlog of residents waiting to move-in”

• Fewer organizations in the Wave 16 survey sample were offering rent concessions to attract new residents than in the prior three waves of the survey. Organizations offering rent concessions (51%) is down from a high of 61% reached Wave 14 (surveyed in the latter half of October). It should be noted that the concept of “rent concessions” is broad and may include non-monetary benefits.
• Approximately one-third of respondents (34%) indicated that their organizations had a backlog of residents waiting to move in. This has increased to the highest point in the survey.

Improvement in Access to PPE and COVID-19 Testing Kits

Respondents were asked: “Considering access to PPE (personal protective equipment) and COVID-19 testing kits, my organization has experienced that access has improved… Very little, it is still difficult to obtain enough PPE/testing kits in most markets/Somewhat, in some markets it is easier to obtain PPE/testing kits than in others/Considerably, we typically have no difficulty obtaining PPE/testing kits, regardless of market”

• Respondents reporting ease in accessing PPE and COVID-19 test kits declined from the prior survey. Just under one-half of respondents (47%) found it easy to obtain COVID-19 testing kits, down from 59% in Wave 15. Respondents reporting easy access to PPE fell from 54% to 44% over the same period.

• The next survey, Wave 17, will address challenges to organizations about access to and cost of PPE.

Time Frames for Receiving Back COVID-19 Test Results

Respondents were asked: “Regarding COVID-19 test results (either for staff, residents or prospective residents) results typically come back within…”

• Like Wave 15, more than one-half of respondents in Wave 16 (57%), received their COVID-19 test results within 2-days, up from 13% in Wave 10, surveyed late-July to early-August. At this point in the pandemic, it is still taking 3 or more days to receive test results for a substantial proportion of respondents (43%).

Labor and Staffing

Respondents were asked: “My organization is backfilling property staffing shortages by utilizing … (Choose all that apply).” Note: this question was asked in Wave 3, and then again in Waves 10-16.

• Although down slightly from Wave 14, most respondents in Wave 16 (85%) were continuing to offer staff overtime hours. Just under two-thirds of respondents were using agency or temp staff to fill staffing vacancies—62% up from 36% in Wave 3 but down from 70% in Wave 15.

Owners and C-suite executives of seniors housing and care properties, we’re asking for your input! By providing real-time insights to the longest running pulse of the industry survey you can help ensure the narrative on the seniors housing and care sector is accurate. By demonstrating transparency, you can help build trust.

“…a closely watched Covid-19-related weekly survey of [ ] operators
conducted by the National Investment Center for Seniors Housing & Care…”
Wall Street Journal | June 30, 2020

The Wave 17 survey is available until Sunday, December 13, and takes just 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.

In “Dramatic Moments in History: Another Period of Disruption,” Kurt Read, Chair of the Board of Directors, NIC; and Principal, RSF Partners; provided attendees of the 2020 NIC Fall Conference with a review of the seniors housing and care industry’s performance characteristics since NIC was founded in 1991. This is the third and final post in our blogging series that provide the key takeaways from that session which reviewed the past 30 years of investment in seniors housing and care. In this post, we touch upon NIC’s role through those years, and look to the years ahead, with thoughts from a new generation of leaders sitting on NIC’s Future Leaders Council. 

The Current Disruption 

Heading into the current period of disruption, Read looked at a number of factors impacting the market. The first factor Read looked at was the cost of capital. Looking at cap rates, he showed that the cost of capital has been going down, through the second quarter of 2020. In seniors housing, compared to apartments, the risk premium on seniors housing has been dropping, particularly since the last recession, indicating that investors, prior to the COVID-19 pandemic, were viewing the sector as less risky. “I’m not sure investors are going to agree with that premise in a post-pandemic environment,” Read opined. 

Looking at NCREIF annualized total investment returns, ten-year and five-year returns are still close to 10%. However, Read points out, the one- and three-year returns are now more in line with other real estate asset types. “We’ve gone from being the darling to one of the team,” he said. Transaction volumes, which for the past eight or nine years have been strong, have now stalled. Comparing 2020 with 2008 and 2009, and referring to his discussion on distress cycles, Read pointed out that, “We’re in that time period where there’s very little price discovery.” 

Looking at occupancy decline, Read emphasized the importance of context. He explained how occupancy decline is partly a function of length-of-stay averages, which vary depending on property type. A CCRC, with a ten-year length-of-stay average, will see occupancy drop far more slowly than an assisted living property with a one-year average length-of-stay. Current data reflects this relationship in today’s occupancy decline numbers, by property type. 

NIC’s Role 

Read concluded his review of the seniors housing and care sector by reflecting on the role of NIC during the past 30 years. “All along that time, a small sector, trying to get capital, needed to grow up. How do you grow up when you’re a sector? You get data, and you get together great leaders who challenge each other to get better. That’s what NIC has been about all of these years.” For the remainder of the session, Read introduced NIC leaders, past, present, and future, to share, in their own words, why NIC was founded, what it is working towards today, and where it will lead in coming years.  

The first to speak was NIC Founder & Strategic Advisor; and President, Nexus Insights; Bob Kramer, who said, of the founding of NIC, “The goal was to provide investors with insights and transparency comparable to that which was available for the major commercial real estate property types.” Looking to the future, Kramer said, “NIC has an extraordinary opportunity to provide leadership, both within and outside our industry, on the resetting of the relationship between ‘where I live’ (housing), ‘what keeps me healthy,’ (health), the where and how of healthcare services delivery, and personal care.” 

Data and Transparency 

In his introduction of Kathryn A. Sweeney, Co-founder and Managing Partner, Blue Moon Capital Partners, Read explained that, as NIC got started in the 1990s it became clear to investors that seniors housing and care lacked the data available to investors in other asset types. Sweeney explained why she and others at NIC piloted and launched what is known today as the NIC MAP^® Data Service. “The seniors housing industry suffered a high cost of capital due to the lack of transparency. Institutional investors saw more risk until the industry could be compared to all commercial real estate types,” Sweeney explained.  

NIC launched a NIC MAP pilot, looking at the Charlotte, NC market. NIC convened a task force of operators and investors and also hired ProMatura Group to collect and tabulate the data. Task force members also worked their relationships with operators in the space to get their participation. The result “wasn’t pretty,” said Sweeney, “but we worked out the bugs and launched in the top 31 markets.” Sweeney concluded with the statement, “Today, NIC MAP is recognized as the most trusted data source for a wide range of metrics, information, and insights. Importantly, the lower cost of capital objective was met.” 

Next to speak was NIC Chief Economist, Beth Mace, who discussed not only the NIC MAP Data Service’s offering of data and analysis, but also the many current initiatives, publications, research, and outreach conducted by NIC. “All of these efforts have resulted in making the seniors housing and care sector more accessible, transparent, and easy to understand. It has allowed more institutional capital to come into our sector, which has helped drive down the price of capital and help create more housing options for seniors.”  

Thought-Leadership 

The final two speakers were introduced by Read as, “innovative thought leaders that are pushing all of us, and pushing our industry to push ahead.” First to speak was Dana Scheppmann, Senior Vice President, Capital One Healthcare Real Estate, and leader of NIC’s Future Leaders Council. She pointed out that, as healthcare providers move from fee-for-service to a more “outcomes-based model”, they are challenged both to control patient behavior outside of their care, and to track and quantify outcomes.  

Scheppmann relayed a vision in which the seniors housing and care sector could help resolve both issues. “What NIC can do, to help push this initiative along, is to connect these healthcare providers with these owners, with these operators, to make sure we are pitching to them. We can help them with this initiative.” In partnership with healthcare providers, the sector could help ensure better outcomes for healthcare patients, while potentially also attracting more residents coming from the healthcare system. 

On the potential for facilitating such partnerships, the final word belonged to Kelsey Mellard, CEO, Sitka: “NIC’s greatest success in the future will be their ability to continue to convene and drive a data-informed conversation about the intersection of seniors housing and healthcare delivery.” In thanking both young leaders for their contributions, Read reflected on the future of NIC, saying, “As always, it’s incredibly inspiring to me to see the passionate talent that is attracted to NIC and to our industry.” 

Toward the beginning of the COVID-19 public health crisis, I authored a blog post highlighting some of the strategies that seniors housing and care operators were implementing to maintain resident wellness and engagement. Subsequently, I had the opportunity to present on this topic at the 2020 NIC Fall Conference. While preparing, it struck me how much these strategies have evolved over the course of just a few months as operators stepped up to the challenge of delivering an ever-greater sense of connectedness to their residents in this time of a global pandemic.

The most common strategies implemented early in the pandemic frequently involved a simple barrier of sorts, whether that was the window of a building or a plastic “cuddle curtain” for receiving a hug. These tactics gave residents the opportunity to see family and friends and to approximate the physical contact that residents and family members crave. In select communities, essential caregivers can have regular contact and visitation with residents, but when that isn’t possible, adoption of virtual reality, robotic technology, and other creative ways to facilitate companionship are becoming more common. Below, I comment on some of these.

Virtual Reality Technologies

Ten months into the pandemic, virtual reality (VR) companies have established a foothold in the seniors housing and care sector. Virtual reality creates opportunities for socialization that are both digital and physical at the same time. These experiences can provide a 360° video inside a headset, delivering a panoramic view that moves with the viewer. In some instances, virtual reality cameras can be provided to family members so they can film weddings, reunions, vacations, and other family gatherings. These are then stored as part of a content package residents can immerse in, allowing them to feel like a participant, as opposed to simply a viewer.

Facilitated Companionship

Socialization and interaction are key value propositions of senior living. Achieving these value propositions has been made that much more difficult during the pandemic when mask-wearing and physical distancing are known steps for disease prevention or slowdown. In the age of COVID-19, facilitating companionship in any way possible is key for residents.

Pre-pandemic, some forward-thinking Medicare Advantage operators were using a “two birds, one stone” tactic to address both food insecurity and loneliness. Partnerships with organizations like Hunger Action Alliance and Meals on Wheels rely on meal deliverers to do more than simply drop food off. They engage with members, report back to care teams on home conditions, medication adherence, and other potential concerns identified during their visit.

Senior housing operators also use this strategy, recognizing that every touch point is an opportunity for socialization. While the necessary safety measures must still be implemented, each medication distribution, meal delivery, and clinical check-in can be viewed as a chance to engage with residents.

Outside of a property itself, other opportunities exist to facilitate companionship. One such opportunity and organization is Papa which, in the pre-pandemic era, paired motivated college students with older adults and families who needed companionship and assistance with everyday tasks. Papa partnered with health plans to not only address loneliness, but to also provide transportation to appointments, medication pickup, and church or gym attendance. Times are different now, and in the pandemic era, Papa has focused on offering virtual companionship. Interested parties can still sign up for free and request a “papa pal,” to provide company virtually and share an uplifting conversation.

Robotic Animal Companion Pets and Social Robots

Robotic animal companion pets are also used to address issues of social isolation and can be a creative fit to brighten up the days of a resident. These robotic pets respond to both touch and motion and provide a realistic animal experience. The genuine feel and sound of a cat purring and soft fur mimics a live animal, without the need for trips outside or refilling the water bowl. The realism and interactive play provided by these robotic pets combats the feelings of loneliness amongst older adults.

For those looking to go even deeper into the realm of robotics, there is Pepper, the first social humanoid robot. Originated in Japan by SoftBank Robotics, Pepper can recognize faces and basic human emotions and engages with people through conversation and a touch screen. This robot can offer proactive engagement by calling residents by name, initiating interaction, and proactively moving toward residents to start conversations. Another major benefit is Pepper’s ability to speak multiple languages, which can help with residents who are forgetting native languages due to lack of use.

Creatively Utilize Existing Resources

With all the challenges posed by the pandemic and its impact on resources, it is more important than ever to utilize existing resources to their fullest capacity. This could mean taking advantage of creative chefs and kitchen staff. For example, operators may consider implementing a virtual teaching kitchen with the ability to televise a chef cooking a favorite recipe. It would be even better if the chef can tie that recipe to wellness and use the experience as an opportunity to educate residents about nutrition. This could be something as simple as a mocktail that touts the health benefits of ginger. Mocktail kits can be created in advance and distributed to residents for their enjoyment.

The challenges created by the COVID-19 pandemic have been many. Among them is the need to maintain interaction and socialization opportunities for residents. Seniors housing and care operators have embraced the opportunity to tackle this issue by continuously evolving their strategies to mitigate the side effects of social distancing and isolation. Time, creativity and imagination will no doubt spawn further ideas to combat this very important pandemic-related challenge.