NIC MAP^® Data Service clients attended a webinar in mid-October on key seniors housing data trends during the third quarter of 2020. Findings reflected the impact of COVID-19 across the seniors housing and care sector, led by NIC’s research team. Key takeaways included the following:

Takeaway #1: Seniors Housing Occupancy Fell Sharply Again in 3Q 2020

• The all occupancy rate for seniors housing fell 2.7 percentage points in the third quarter 2020 to 82.1%, the lowest level since NIC began reporting the data in 2005. This drop in occupancy was directly related to the COVID-19 pandemic as demand (as measured by net absorption) fell by more than 13,000 units. Combined with the second quarter, net absorption fell by more than 28,000 units.
• Separately, supply accelerated to 4,900 units, more than 1,000 units higher than in the second quarter.  
• Since 1Q 2020 the occupancy rate has fallen an unprecedented 5.5 percentage points. The deterioration in the third quarter was just a bit less than in the second quarter.
• Stabilized occupancy for all seniors living properties, defined by NIC as properties that have been open for at least two years or, if open for less than two years, have already reached a 95% occupancy level, fell by 2.5 percentage points to 84.4%, also a record low. The gap between all occupancy and stable occupancy was 2.3 percentage points, reaching its record high difference seen in mid-2019.

Takeaway #2: Nursing Care Occupancy Fell Most in Past Two Quarters

• By property type, the pandemic took a toll its greatest toll on nursing care occupancy in the third quarter, with a drop of 4.2 percentage points from the second quarter to 76.0% in the third quarter. Combined with the second quarter drop of 6.5 percentage points, nursing care occupancy has fallen nearly 11 percentage points since the pandemic began. This reflects the fact that the COVID-19 virus has been particularly hard for frail elders and those with multiple chronic conditions and the fact that elective surgeries had been postponed during some of the months following the pandemic.
• Assisted living was next most affected with a 2.9 percentage point decline in occupancy to 79.1%. Combined with the 3.2 percentage point drop in the second quarter, there was a total loss in occupancy of 6.1 percentage points in assisted living since the beginning of the pandemic.
• Independent living saw a 2.4 percent point decline to 84.9% in the third quarter for a total two-quarter drop of 4.9 percentage points. This pushed the occupancy rate for independent living to a new low.
• In general, residents in independent living tend to be healthier than those in assisted living and nursing care, and hence the lesser decline.

Takeaway #3: Construction Starts Slowed Further in 3Q 2020 for Assisted Living and Independent Living

• Construction starts slowed in the third quarter, with 551 units of independent living initiated in the third quarter and 788 units of assisted living. On a four-quarter aggregate basis, independent living starts totaled 5,018 units, the fewest since 2013. As a share of inventory, this amounted to 1.5%. For perspective, at its peak in late 2017, it was 3.7%.
• Like other residential and commercial real estate sectors, starts are also being affected by tighter lending conditions and shortages in lumber and other key building materials.

Takeaway #4: Not-for-Profit Occupancy Decline Less than For-Profit

• The NIC MAP^® Data Service collects data for majority assisted living and independent living property types, as well as community types such as CCRCs and stand-alone memory, and segment care types such as ADL-focused assisted living, memory care and independent living. They also track market fundamentals data by ownership structure such as for-profit and not-for-profit. These slices of data are all accessible through the NIC MAP Data Service on the NIC MAP Portal.
• Not-for-profit properties have consistently had higher occupancy rates than for-profit properties since the Data Service began reporting the data. The gap between the two ownership structures was smallest at 1.1 percentage points in the 2012/2013 period and has been widening ever since. Prior to the pandemic, the gap was a very wide 6.9 percentage points.
• In the third quarter, this gap grew to 8.8 percentage points, with the not-for-profits experiencing an average occupancy rate of 88.2% and the for-profits having an occupancy rate of 79.4%. The record wide discrepancy in the third quarter reflects the fact that occupancy for not-for-profits has held up better since the pandemic, with a 4.1 percentage point decline, while the for-profits saw a 6.0 percentage point decline to 79.4%.
• Part of the explanation is that not-for-profits typically have a larger share of independent living units which have been less impacted by the pandemic and a smaller share of assisted living units which have been more heavily impacted.  

 Takeaway #5: Seniors Housing Occupancy Declines Vary Across the Nation

• This map shows the degree of occupancy loss in seniors housing properties by metro area since the first quarter of 2020. The darker the color, the worse the occupancy rate decline. Since March, Sacramento, Denver, Boston, St. Louis have seen the most loss in occupancy, while Washington D.C., San Antonio, and Las Vegas experienced the least deterioration in occupancy.
  

Takeaway #6: More Operators with Assisted Living Report Acceleration in Move-ins

• Since March, NIC has conducted a bi-weekly survey of owners and C-suite operators and executives of seniors housing and nursing care properties across the country in our Executive Survey Insights, The goal of the survey is to gather accurate, real-time information on current conditions and share these results with the industry. The data represents responses from small, medium, and large operators from both not-for-profit and for-profit providers. The data presented here shows findings from responses collected between March 24 through the week ending October 11^th.
• Now currently in its 14^th wave, this is the longest running survey of operators since the start of the pandemic, and NIC wishes to thank survey respondents for their valuable input and continuing support. The results of our joint efforts to provide timely and informative data to the market in this challenging time have been significant and noteworthy. These near-real time insights on the effects of the pandemic on senior living are being closely watched by the media and are working to help ensure the narrative on the sector is accurate.
• In this specific chart, the pace of move-ins for the assisted living care segment is examined across respondents’ portfolios of properties in the past 30 days. Focusing on the center of the chart—Waves 4 through 7, which included surveys from late April to late May, much of the country was experiencing widespread COVID-19 restrictions in physical distancing to mitigate the spread of the virus. Respondents reported organization-imposed and government-imposed moratoriums on admitting new residents, and thus difficulty backfilling residents lost due to normal attrition, residents moving to higher levels of care, and coronavirus illness and related move-outs—and the pace of move-ins ground down.
• By the end of July as shown in Wave 10, with move-in moratoriums easing across organizations, some residents waiting on sidelines with ADL needs could not wait to move any longer, and shares of organizations with increasing move-ins in assisted living was at the highest point to date. Recently, the shares of organizations with assisted living units that reported an acceleration in move-ins in the past 30 days increased in Wave 13 to the highest levels since the survey began in March.

Operators are invited and encouraged to help provide transparency to the market by participating in the next Executive Survey. Click here to complete the survey.

Interested in Learning More?

While the full presentation of the key takeaways from this article is only available to NIC MAP clients, you can access the abridged version of the 3Q20 Data Release Webinar & Discussion featuring my  exclusive commentary below.

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Now more than ever, the actionable data provided by NIC MAP^® Data Service can help you stay informed. To learn more about NIC MAP and accessing the data featured in this article, schedule a meeting with a product expert today.

Seniors Housing and Government Can Work Together for a Bright Future. 

One of the attractions of any NIC Conference is the caliber of thought leadership and insight provided in main stage keynote sessions. Typical keynotes, held in large ballrooms, hardly feel intimate. In contrast, much of the 2020 NIC Fall Conference, hosted on a virtual platform that put every speaker and attendee on a face-to-face basis, felt close, personal, and disarmingly genuine. This dynamic was on display for one of the most anticipated keynote discussions of the nation’s most important seniors housing and care event.

Award-winning journalist Soledad O’Brien adeptly moderated a discussion with Mark Parkinson, president and CEO, American Health Care Association (AHCA) and National Center for Assisted Living (NCAL), and Andy Slavitt, senior advisor for The Bipartisan Policy Center and former Acting Administrator of the Centers for Medicare & Medicaid Services (CMS). Both leaders were frank and forthcoming regarding the impact of COVID-19 on seniors housing and care. Despite coming from the often opposing viewpoints of industry leader and policymaker, the discussion demonstrated that, for seniors housing and care, the pandemic promises to teach industry leaders a great deal – and has created opportunities to work with government to craft a bright future, while delivering better outcomes for America’s frail elders.

Trump and COVID

O’Brien’s first question was for reactions to the news which had just broken, that President Trump and the first lady had tested positive for COVID-19. Parkinson took the opportunity to express his hope that, “As bad as the news is, maybe it will be a wakeup call some people needed, that you’ve got to take this stuff seriously. You have got to wear a mask because anybody, under any circumstance, can get this virus.”

Slavitt pointed out that, in addition to the President, “43,000 other people were diagnosed with COVID yesterday.” He agreed that while we shouldn’t be politicizing the President’s health, the country might learn two lessons from the news, “One is, a thin piece of cloth would have prevented this from happening…the second lesson is simple consideration. Trump and his staff and his family entered a room, sat around Chris Wallace, were feet away from Joe Biden. None of us know whether we have COVID-19 or not…that’s why we wear masks.” He hoped that, like (UK Prime Minister) Boris Johnson, who fell seriously ill with the virus, Trump would take this more seriously, wear a mask, and encourage others to do so.

The Second Wave

Asked whether the seniors housing and care industry is prepared for a second wave, Parkinson was optimistic. “We are. We were completely unprepared for the first wave.” He explained that the virus’ ability to spread via asymptomatic carriers wasn’t understood at first. That, and the lack of masks and appropriate PPE, “really caused it to spread like wildfire in nursing homes and assisted living facilities across the country…the other thing we needed was testing, and we didn’t have that either.” He pointed to “horrendous policy mistakes made at multiple levels, that created the challenges we had.”

Parkinson continued, “For phase two we’re in better shape. The policymakers have not done great, but the scientists have. The testing we now have…as well as a little better position on PPE, I think we’re in a much better position. Clinically, we also know a heck of a lot more about how to take care of people, so the mortality rate is down.” Nevertheless, he echoed Slavitt’s frustration with America’s failure to enact simple preventive measures. He said, “We don’t have to have a second wave. What’s so damned frustrating about this is that if everyone would just wear a mask, just that simple, considerate thing, if we would just make a decision as a country that everywhere we go we wear a mask and socially distance, we wouldn’t eliminate this in two weeks – but we would grind it to very low numbers.”

Slavitt raised community spread as another key factor impacting nursing homes. He said, “It is very, very difficult, once there is community spread, to prevent that spread from getting into the nooks and crannies where everybody lives.” While agreeing that the industry today is better prepared to protect frail elders, he appealed to everyone, politics aside, to be considerate of others and help to contain the spread of the virus.

“A Business Disaster”

The discussion turned to the state of the industry, which has seen a fall in occupancy rates and a simultaneous rise in costs associated with fighting the pandemic. Parkinson said that, “My overriding message to the folks who are watching this, who are primarily investors in long term care, is that we’re going to get through this, and this is going to continue to be a good space to invest in and that’s not just hollow cheerleading. I believe there’s good data and good reason to believe that.” He went on, however, to outline how the pandemic has caused a “clinical nightmare and a business disaster.”

Parkinson offered a litany of dismal facts, including over 50,000 deaths in nursing homes, and tens of thousands in assisted living facilities. He pointed to census data that dropped from 85% to 75% in just a “month or two,” and half that in assisted living. He pointed to major increases in expenses, as operators scrambled to acquire PPE, often at “ten times the normal rate” on the black market, while paying ‘hero pay’ to staff and incurring other related expenses.

Asked how he can be optimistic in the wake of such grim realities, Parkinson said, “The good news is the government recognizes that we are an essential service, and thank god for the CARES Act funds, that have now provided nursing homes a combined, probably, almost 20 billion dollars.” He also pointed to long-term demographic advantages, saying, “people need our services. We have a growing demographic, really exploding in the age group that we take care of, and as reluctant as people will be for a while to move into our buildings, which I completely understand, people don’t move into our buildings because they want to, they move into our buildings because they have to. They just can’t be taken care of safely at home anymore. It will be bumpy, and it will take some time, but the demographics are compelling. We will win the public’s confidence back, and I think this will be a good space to be in, eventually.”

The Opportunity to Improve

In agreement with Parkinson, Slavitt said, “industries through time emerge stronger from crises, often, if they do some self-examination, like Mark’s talking about, if they really, genuinely look at what they’re doing and say, ‘here are four or five things that can help us.’” He added, “This is an industry that everybody cares about, every Congress person, every senator, every presidential candidate needs this community to be successful. It’s not too big to fail, it’s too important to fail.” He said, “I love the fact that the industry is opening dialogue, that the industry is talking to the White House and HHS every day, that we’re figuring this out together.”

Parkinson warned industry decision makers not to miss this opportunity to improve. “The knee-jerk reaction for some might be, ‘Hey, let’s just get this behind us and try to move on with business as usual.’ That would be a huge mistake. You cannot ignore the fact that close to 100,000 people have died in long term care facilities. If we don’t use that as a moment of reflection, to not just look at what caused this, outside of our control, but look in the mirror and figure out those things that were within our control that could have slowed some of this down, and what could we do to be better in the future, then we’re missing an enormous opportunity.”

Regulatory Reform

Both panelists agreed in other areas, as well. On the burden of regulations, Parkinson pointed out that skilled nursing is more heavily regulated than “virtually all other healthcare providers,” and stated the “amazing statistic” that “80% of the enforcement budget at CMS is spent on nursing facilities.” He suggested that CMS focus regulations on “things that really matter,” such as infection control, person-centered planning and activities, and other areas where nursing homes can improve care for their residents.

“Mark’s right. You can’t regulate culture,” Slavitt responded, then advocated for “what works best,” which he described as an industry that recognizes what it needs to improve and asks for investment from the taxpayer to get there, as well as the accompanying regulations, which, “would make everybody comfortable, and provide assurances.” He added, “If the industry is able to move itself to that point, I think the industry will find a very ready and willing partner in the government, no matter which government…”

Workforce

On workforce issues, Parkinson said, “We don’t pay our healthcare workers enough, particularly the frontline workers in long term care.” He asked the question, “What do we do to make sure that we not only have enough people to work in our facilities, but that they can do so and take care of their own lives?” He linked the answer to the need for funding, as well as immigration reform. In response, Slavitt again offered some agreement, saying, “Right now, people who spend their day caring for the rest of us, if they somehow don’t have enough money to make ends meet, that is a litmus test that we should address…there’s plenty of resources in this country to do that.”

On immigration, Parkinson advocated for resolving the “dreamer problem,” as well as reviving programs that bring nurses in from foreign countries. “The challenge that economies will face in the 21^st century, is where they will get the workers that are needed. The demographics of a declining workforce are very bad across all of the developed world.”

Addressing the politics of immigration, and acknowledging the need for workers, Slavitt said that “there actually is a center point of agreement on a number of these topics.” He explained that while they may not make everyone happy, they offer solutions to “add fairness” and move the country forward. “Sometimes it takes an event, sometimes it takes a new Congress, sometimes it takes a new way of looking at things, but one day, hopefully soon, we can resolve some of these issues.”

Medicare and Medicaid

Another issue that both experts addressed was Medicare and Medicaid. On Medicare, Parkinson acknowledged that the new payment plan, PDPM, initiated under Slavitt’s administration and recently put in place, is working well. He views Medicaid, on the other hand, as a politicized program that is now underfunding care in many states. “We’re going to have to figure out what our priorities are. Instead of just talking about these workers, these heroes, and the greatest generation, are we really willing to put some resources behind that, to give them the kind of care, and the kind of jobs, that they deserve.”

Slavitt responded, “In some point of time, whether it’s before or after the election, we’re going to have to do that [fund Medicaid], or many people who are on Medicaid today are going to face challenges, and payments are going to get even lower.” He pointed to a recent actuarial report that indicated, “Over the last year, Medicare lost two years of the life of its trust fund, and is now projected to turn insolvent in 2024.” What worries him, he said, is that during the next presidential term, the program will become underfunded. He explained that the next President may be in a position either to fund the program or cut benefits and payments under the program.

Towards the close of the discussion, addressing national priorities, Slavitt said, ”What we need is some radical introspection, as a country, into what kind of country we want to be. Part and parcel of this is the question of how we take care of people who need our help; they’re no longer at the stage where they can care for themselves, whether it’s because they have a disability, whether it’s because they’re aged, whether it’s because they’re low income, whether it’s because they’re sick. I think that is an enormous part of our national debate.”

For the past two weeks, over a thousand seniors housing and care leaders from across the U.S. have logged on, often from their own home offices, to participate in their industry’s most important event. Of course, ‘the NIC’, in response to the COVID-19 pandemic, is now a virtual experience. But industry professionals have embraced what it has to offer. Many have discovered that ‘the NIC’ is as rich in thought-leadership and opportunities to connect with other decision-makers as ever – and that in some ways, the ‘essential virtual’ experience offers surprising advantages over traditional events.

In the runup to the conference, NIC Founder & Strategic Advisor, Bob Kramer, pointed out that the new platform offers real value for attendees. He said, “The 2020 NIC Fall Conference is not only a uniquely affordable educational opportunity, it also provides an unprecedented new dealmaking platform, the NIC Community Connector™.” The vast majority of attendees are now registered on the NIC Community Connector, ensuring that there are, indeed, plenty of opportunities to connect directly with people in a position to make a deal.

In practice, attending companies were able to extend opportunities to connect and learn to more of their staff than they would otherwise send in person. “We are taking advantage of the virtual format by including more of our team to build on essential relationships and gain invaluable insights from the educational sessions,” said Marilynn Duker, CEO of Brightview Senior Living. Without the cost, both in dollars and time, of travel and booking accommodations, and with a lower price for registration, the conference attracted numerous attendees who might otherwise not have made the trip.

By Popular Demand

In many ways, the conference adhered to traditional educational and thought-leadership programming. In total, more than 50 sessions offered insights, opportunities to participate in substantive discussions, presented the latest data and analysis, and featured some of the nation’s foremost experts and industry leaders. As in any in-person NIC conference, keynote general sessions featured panels of experts who needed no introductions.

Award-winning journalist Soledad O’Brien moderated a discussion with Mark Parkinson, President & CEO, American Health Care Association (AHCA) and National Center for Assisted Living (NCAL), and Andy Slavitt, senior advisor for The Bipartisan Policy Center and former Acting Administrator of the Centers for Medicare & Medicaid Services. Both leaders were frank and forthcoming regarding the impact of COVID-19 on seniors housing and care.

Parkinson, on whether the seniors housing and care industry is prepared for a second wave, said, “We don’t have to have a second wave. What’s so damned frustrating about this is that if everyone would just wear a mask, just that simple, considerate thing, if we would just make a decision as a country that everywhere we go we wear a mask and socially distance, we wouldn’t eliminate this in two weeks – but we would grind it to very low numbers.”

On funding Medicaid, Slavitt said, “In some point of time, whether it’s before or after the election, we’re going to have to do that [fund Medicaid], or many people who are on Medicaid today are going to face challenges, and payments are going to get even lower.” Towards the close of the discussion, Slavitt had this to say about national priorities, ”What we need is some radical introspection, as a country, into what kind of country we want to be. Part and parcel of this is the question of how we take care of people who need our help, they’re no longer at the stage where they can care for themselves, whether it’s because they have a disability, whether it’s because they’re aged, whether it’s because they’re low income, whether it’s because they’re sick. I think that is an enormous part of our national debate.”

Another highly anticipated general session featured an O’Brien-moderated discussion with seasoned political commentators, David Brooks and David Gergen. It felt like an honest, forthright assessment of the impact of the coming election on the sector. David Brooks offered a mea culpa on his 2016 predictions of a Clinton victory, and described his efforts since then to reconnect with the segments of the American populace with whom he’d grown out of touch. Both men offered their insights and predictions for the election – as well as their assessment on the impact it will have on American life and business interests.

The popular NIC Talks series, now a highly anticipated staple of the traditional event, returned —featuring another group of uniquely qualified, passionate thought-leaders, including JoAnn Jenkins, CEO of AARP, addressing the question, “How will COVID-19 impact the future of aging and aging services?” In the style of “TED-Talks,” these often emotionally powerful presentations added some punch to the analysis and data on offer in week one. A week two peer-to-peer discussion offered an opportunity to further discuss the NIC Talks presentations, with moderator Bob Kramer and NIC Talks presenter, Dan Cinelli.

In addition to one of the richest educational programs ever offered at a NIC conference, the event extended a variety of means for attendees to build and grow their business and social networks. Echoing in-person events, the virtual platform reveals to its users who else is in the lobby, or in a breakout session, and allows them to message one another, either in text or via video chat. Anyone who misses running into old friends in hallways should be heartened by this means to interact in such an organic, impromptu manner.

New Ways to Network

The unique, new NIC Community Connector launched in parallel to the event, and is currently only available to its attendees, who may continue to use it free of charge through the end of 2020. The innovative online platform provides a means to search for potential new contacts, and to communicate directly with the deal-makers they need to meet with. NIC is continuing to develop the platform, with new features scheduled to launch this year.

Attendees were also able to set up ‘braindates’ with each other, either one-on-one or in small groups. These intimate, focused exchanges provided not only a means to share thinking, but to connect with fellow attendees, and potentially to begin to build and grow new relationships with peers, based on those interactions. Through braindate™, attendees set up their own focused discussion groups, joined groups set up by fellow attendees, or arranged one-on-one meetings of their own.

In week two, called ‘connections week,’ NIC hosted numerous peer-to-peer discussions, on carefully curated topics of immediate relevance in today’s world. These moderated events offered participants expert thought-leadership, as well as frank discussion, and often eye-opening insights and ideas, offered up by attendees sharing their own real-world experiences and perspectives in more intimate small group breakout discussions.

Beyond educational sessions, the event offered attendees a variety of opportunities to spend time with each other, network, engage in self-care, and even share some cocktails or world-class entertainment together.

A series of ‘Brand, Brain, and Being’ sessions offered attendees a chance to focus on themselves and gain expert tips on improving personal brand, productivity, creativity, and overall wellness. Just as in traditional events, there was a LinkedIn expert on hand to help improve social profiles.

Meanwhile, for NIC MAP® Data Service power users and novices alike, there were opportunities to learn from NIC MAP experts, discuss how they use the NIC MAP Data Service platform, and meet (virtually, of course) with NIC MAP staff to discuss how the industry’s leading data service might benefit their businesses. Discussion groups for NIC MAP users delved into how they use the platform to analyze market feasibility, inform underwriting, and effectively target markets.

As with traditional NIC events, the attendee experience also included world-class entertainment. As week one drew to a close, the Young@Heart chorus, introduced by an impressive collection of A-list celebrity admirers, charmed and entertained with their talented, and infectiously fun, performances. Perhaps the most anticipated session of week two was a behind-the-scenes experience with Broadway and film cast members from “Hamilton!”, who also delighted fans of Broadway’s most popular show with exclusive performances that were simply not to be missed.

Although the conference has ended, attendees will retain access to a library of its many educational sessions and will also be able to use the powerful NIC Community Connector through the end of 2020. As expressed by NIC CEO Brian Jurutka in a press briefing, “I believe this conference – and the NIC Community Connector – will be valuable to thousands of leaders and their businesses, as they begin to craft a new normal and build towards a successful future, both for their businesses and for the millions of America’s elders seeking access and choice in seniors housing and care.”

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—providing both capital providers and capital seekers with data as to how COVID-19 is impacting the sector.

This Wave 13 survey sample includes responses collected from September 28-October 11, 2020 from owners and executives of 73 seniors housing and skilled nursing operators from across the nation. Detailed reports for each “wave” of the survey can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Wave 13 Summary of Insights and Findings

The shares of organizations with assisted living units and/or nursing care beds reporting an acceleration in the pace of move-ins in the past 30-days rose to the highest levels since the survey began in March (43% and 46%, respectively). Coupled with fewer organizations reporting an acceleration in the pace of move-outs, more organizations reported upward changes in occupancy for these care segments. Acceleration in move-ins was most frequently attributed to increased resident demand, with one-quarter of respondents indicating that their organizations had a backlog of residents to move into their communities. Organizations citing resident or family member concerns as a reason for deceleration in move-ins (presumably due to the uncertainty of the prevalence of COVID-19 in the fall months and potential for restrictions on visitation) declined from three-quarters to two-thirds but remains higher than in prior surveys. While accurate and timely testing (within 48-hours) is crucial to operators’ ability to settle new residents into communities and keep them safe from outside contagion which could be brought in by visitors or staff, nearly two-thirds of respondents were waiting three days or more for test results, and still only about one-half of respondents find it easy to obtain PPE and COVID-19 test kits.

• • In Wave 13, approximately 40% of organizations with independent living, assisted living, and/or memory care segments and nearly one-half of organizations with nursing care beds (46%) reported that the pace of move-ins had accelerated in the past 30 days.
  • The share of organizations citing increased resident demand as a reason for the acceleration in move-ins in Wave 13 remained high (85%). Some respondents noted greater urgency among new residents regarding move-ins in geographies where restrictions have been lifted; others cited new buildings leasing up, and resident transfers to higher levels of care.
  • Regarding reasons for a deceleration in move-ins, more organizations in Wave 13 than in Wave 12 cited a slowdown in leads conversions/sales (82% vs. 55%). Resident or family member concerns also remained high in Wave 13 (68%) but declined slightly since Waves 12 and 11 (73% and 74%, respectively).
  • In Wave 13, organizations with nursing care beds reported both the highest proportion of month-over-month occupancy increases (44%) and decreases (44%). Greater shares of organizations across all care segments in Wave 13 reported upward changes in occupancy than in Wave 12 (to varying degrees). However, more organizations with assisted living and independent living report occupancy decreases than occupancy increases.
  • Looking forward, between 21% and 26% of organizations with independent living, assisted living, and/or memory care units, and 28% of organizations with nursing care beds reported an increase in week-over-week occupancy. Organizations with nursing care beds and/or independent living units reported the highest shares of week-over-week occupancy increases. However, the majority of respondents cited no changes in occupancy from the prior week.
  • The strain on operating costs persist as three-quarters of organizations continued to provide staff overtime hours, and one-half continued to offer rent concessions to attract new residents—up from one-third in Wave 10. Of the organizations that operate any independent living units (including a combination of other seniors housing and care segments), two-thirds (65%) were currently offering rent concessions, followed by roughly one-half of organizations with any memory care and/or assisted living units (58% and 55%, respectively). About two in five organizations with any nursing care beds (41%) reported offering rent concessions.

Wave 13 Survey Demographics

• • Responses were collected from September 28-October 11, 2020 from owners and executives of 73 seniors housing and skilled nursing operators from across the nation. More than half of respondents are exclusively for-profit providers (61%), about one-third (31%) are exclusively nonprofit providers, and 8% operate both for-profit and nonprofit seniors housing and care organizations.
  • Owner/operators with 1 to 10 properties comprise 63% of the sample. Operators with 11 to 25 properties make up 18% of the sample, while operators with 26 properties or more make up 19% of the sample.
  • 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), 21% operate nursing care properties, and 34% 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…”

• • The shares of organizations with assisted living units and/or nursing care beds that reported an acceleration in move-ins in the past 30-days increased in Wave 13 to the highest levels since the survey began in March (43% and 46%, respectively). For both of these care segments, the shares of organizations reporting deceleration in the pace of move-ins were the lowest in the time series (23% and 20%, respectively).

• • In Wave 13, approximately 40% of organizations with independent living, assisted living, and/or memory care segments compared to nearly half (46%) of organizations with nursing care beds reported that the pace of move-ins had accelerated in the past 30-days.
  • The shares of organizations experiencing an acceleration of move-ins in independent living in Waves 12 and 13 were higher than in previous waves of the survey, and near the time series peak reached in Wave 9 surveyed at the end of June.

Reasons for Acceleration/Deceleration in Move-Ins

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

• • The share of organizations citing increased resident demand as a reason for the acceleration in move-ins in Wave 13 remained high (85%) after peaking in Wave 12 (88%). Organizations citing hospital placement in Wave 13 (30%) is lower since the peak reached in Wave 10 surveyed in the latter half of July (41%).
  • Regarding reasons for a deceleration in move-ins, more organizations in Wave 13 than in Wave 12 cited a slowdown in leads conversions/sales (82% vs. 55%). Resident or family member concerns also remained high (68%) but declined slightly since Waves 12 and 11 (73% and 74%, respectively). Very few organizations cited a moratorium on move-ins as a reason for deceleration in the pace of move-ins (5%). This is down from 61% at its peak in Wave 4 surveyed in the latter half of April.

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”

• • Half of the organizations in both Waves 12 and 13 were offering rent concessions to attract new residents (51% and 53%, respectively)—up from one-third in Wave 10 (34%).
  • Of the organizations that operate any independent living units (including a combination of other seniors housing and care segments), two-thirds (65%) indicated they were currently offering rent concessions, followed by roughly one-half of organizations with any memory care and/or assisted living units (58% and 55%, respectively). About two in five organizations with any nursing care beds (41%) reported offering rent concessions.
    • Digging deeper, organizations with CCRCs in their portfolios were less likely to be currently offering rent concessions than organizations without CCRCs (48% vs. 56%). Additionally, the majority of organizations with declining occupancy in assisted living and/or memory care were currently offering discounts.
  • Approximately one-quarter of respondents in Waves 12 and 13 indicate that their organizations have a backlog of residents waiting to move in (25% and 26%, respectively).

Move-Outs

• • The shares of organizations reporting an acceleration in the pace of move-outs decreased in Wave 13 for the assisted living and nursing care segments. The majority of organizations in Wave 13 continue to note no change in the pace of move-outs in the past 30 days. This has been consistent since the survey began in late March.

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 13, organizations with nursing care beds reported both the highest proportion of month-over-month occupancy increases and decreases (44%). The share of organizations reporting nursing care occupancy decreases is the highest since Wave 8 surveyed in late May to early June.

• • Greater shares of organizations across all care segments in Wave 13 than in Wave 12 reported increasing occupancy. However, more organizations with assisted living and independent living report occupancy decreases than occupancy increases.

• • Regarding the change in occupancy from one week ago, between 21% and 26% of organizations with independent living, assisted living, and/or memory care units and 28% of organizations with memory care beds reported an increase in week-over-week occupancy. The majority of respondents cited no changes in occupancy from the prior week. Organizations with nursing care beds and/or independent living units reported the highest shares of week-over-week occupancy increases.

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”

• • While there’s been some improvement in recent waves of the survey, still only about half of the respondents find it easy to obtain PPE and COVID-19 test kits. Slightly fewer respondents reported no difficulty getting PPE in Wave 13 than in Wave 12 (51% vs. 59%), however, slightly more in Wave 13 noted no difficulty getting COVID-19 test kits (52% vs. 45%).

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…”

• • The time frames for receiving back COVID-19 test results did not continue to trend as positively in Wave 13 as Wave 12. Just over one-third of respondents (38%) received their COVID-19 test results within 2 days, down from 43%.
  • Importantly, the majority (62%) note that it still takes more than 3 days to receive test results—however, this is down from 87% in Wave 10.

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 10-13.

• • Three-quarters of organizations (76%) are continuing to offer staff overtime hours in Waves 12 and 13 (down from 85% in Wave 3), and roughly half are still using agency or temp staff to fill staffing vacancies—up from 36% in Wave 3.

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…”
The Wall Street Journal | June 30, 2020

The Wave 14 survey is available until Sunday, October 25, 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.