The Increasing Importance of Data and Analytics

NIC Co-Founder and Strategic Advisor Robert Kramer has identified “Six Key Drivers” that will shape the senior living industry over the next 10 years. Kramer is also Founder & Fellow at Nexus Insights, a think tank advancing the well-being of older adults through innovative models of housing, community and healthcare. NIC Notes is publishing a series detailing each key driver. View the first four installments of the “Six Key Drivers” blog series. What follows is an analysis of the fifth key driver: The Increasing Importance of Data and Analytics.

Data and analytics are revolutionizing senior living. These critical tools, and the technology that enables them, are vital to manage information and drive better business decisions and resident outcomes. But how?

The use of data and analytics allows us to customize our product to meet the needs and preferences of our customers and other stakeholders. It’s important to note that investments in technology are critical to the future success of both individual companies and our entire industry. Technology will be key in the challenge to stay competitive. Senior living providers need a tech platform to capture data and deploy predictive analytics to create customized solutions. It’s these customized solutions that will drive real value for investors, owners, operators and customers.

I have identified three areas of focus where data and analytics will profoundly impact our industry.

• Data and analytics will drive the delivery of customized healthcare paths for the individual.
• Data and analytics will drive customized business strategies, including the formation of essential partnerships as well as strategic growth plans by market.
• Most importantly, data and analytics will drive a customized resident experience. We will be able to provide a superior product for residents, focused on the personalized experiences that make life worth living. We can turn senior living into what I describe as an “aspirational” setting. It can be a place where people prefer to live regardless of their age, mobility or cognitive condition, instead of a place they hope to avoid.

Let’s take a more detailed look at the three areas where data and analytics will shape the future of senior living.

1. Data enables preventative, predictive and participatory healthcare. As we noted in key driver #4, healthcare is being reframed. We are slowly but surely shifting to a value-based care model that relies on data to produce better results at a lower cost. It starts with prevention and enhanced management of chronic conditions. The data we collect can be analyzed to help prevent and break the typical downward, and costly cycle of sick or injured residents who are sent to the emergency room or hospital, only to return to the community, and bounce back again to the urgent care setting. Data is required to prevent that cycle and avoid the flareup of chronic conditions that leads to acute care. But data alone is not enough. Data coupled with predictive analytics or algorithms can identify potential risks for a particular resident. In short, data and predictive analytics together can provide a healthcare roadmap customized to the individual.
   
   

   A simple example is the burgeoning category of software products that use algorithms to predict when a person is at risk of a fall. We know that falls are one of the most expensive medical events suffered by frail elders that often start a downward health spiral. The CDC estimates that more than $50 billion is spent annually on medical costs related to falls among the elderly. New technology uses algorithms to marry resident data with data from hundreds of thousands of older adults to help spot problems and intervene before a fall takes place. For example, we may determine whether the person has osteoporosis, making a fall potentially more dangerous. We can also analyze the person’s habit patterns and their gait. Are they getting up more times during the night? Is it taking them longer to return to bed? A change may indicate the need for more checks. The result is fewer fall-related visits to the hospital and a better overall experience for the resident and the family.

   
   

   Resident participation is part of the solution. Self-monitoring can provide data to help prevent and predict health problems. For example, the Lively app from Best Buy available on the Apple Watch tracks the wearer’s daily habits. It can send out an alert if the person falls. But instead of wearing a pendant that screams “elderly,” the resident has a smart watch that looks cool. Apple is in a race with other companies to provide the most sophisticated healthcare monitoring and predictive devices. These devices can check your heart rate, oxygen level, and blood pressure. Again, the data is worthless if it is simply collected. Algorithms, sophisticated machine learning, or artificial intelligence (AI) needs to process the data in real time. It doesn’t do any good if it takes four days to get an alert about the condition of a resident who by then has already fallen.

   
   

   New, game-changing data streams are also becoming available to the industry. NORC, a social research organization at the University of Chicago, in collaboration with NIC and NIC MAP Vision, has overlayed Medicare claims data with nine-digit zip code senior living property information. This allows us to pinpoint our resident populations by health status to determine chronic disease prevalence along with average healthcare spend in a building, and the average spend per resident. That provides the opportunity through NIC MAP Vision to get a complete, and anonymous, health profile of who lives in our buildings, how they compare to individuals in the wider market area as well as who are the top healthcare providers serving residents in our buildings. This kind of data is revolutionary to understand both who is in our buildings and who is providing healthcare services to them.

   
   

   Recent research by NORC shows that residents of senior housing settings average over 12 chronic medical conditions. More than half of all senior housing residents have a mental and behavioral health diagnosis. As NIC MAP Vision adds more data to its platform over the next year, we will be able to determine the prevalence of different chronic conditions among our residents. We can quickly find out whether the population in our building has a high or low Medicare spend, or a high rate of residents being sent to the hospital. The applications and implications for the future use of this kind of data is groundbreaking and will be transformative for the industry, which brings us to the second way that data and analytics will make a big difference in our industry.

   
   
2. Data is critical for partnering, risk bearing and strategic decision-making.Healthcare data on building residents will be essential to form effective partnerships with payers and healthcare providers. Healthcare data can also be used to make strategic business decisions.
   

   Medicare Advantage plans and other healthcare dollar risk-bearers have an incentive to reduce spending, particularly among high-cost residents in assisted living, independent living and memory care. According to NORC research, senior housing residents have annual healthcare spending of about $20,000-$30,000, with residents spending $3,000-$4,000 in out-of-pocket costs. This level of spending reveals tremendous opportunity to reduce healthcare spending and improve quality of life among these residents.

   
   

   Whether by partnership with others or deciding to take on the healthcare dollar risk directly, senior living providers must have and understand this critical data about the residents in their buildings. Without it, senior living operators are at an enormous disadvantage in negotiating potential partnerships whether with Medicare Advantage plans or healthcare providers. And without this data, senior living operators are very unlikely to be rewarded for the contribution they are making to reduce the healthcare costs of their residents.

   
   

   Risk-bearing entities want to partner with operators who can provide insights into the health conditions and the healthcare spending profile of member residents. Not only is this data essential to potential partners, but the information also gives operators insight into where improvements can be made to enhance the quality of life of residents.

   
   

   Similarly, operators need data on the healthcare needs of residents to evaluate the feasibility of potential partnerships, especially in a risk-bearing arrangement. If you are in discussions to partner with a physician practice or a healthcare system, you need to understand the healthcare spending patterns of your population. Our industry has been focused on what people spend on rent and services. But we have never before had insight into what the government, and the resident themselves are paying for their healthcare. If we don’t have this data on hand, potential partners may not recognize the value we are bringing to the table. With healthcare data in hand, you can demonstrate your value to help manage healthcare spending. Senior living providers should be recognized as a partner to lower the healthcare spend and to help keep people healthy.

   
   

   As an example of how data can be used, NIC Analytics has issued a white paper and blog post that looks at the opportunities for senior living in chronic disease care. I urge you to read them. Perhaps an operator can partner with a chronic kidney disease care provider and offer on-site service in a way that is far more consumer friendly. Bear in mind, as we’ve discussed, the customer wants to get services where they live.

   
   

   New streams of data, coupled with analytics, can also improve our business strategies. How? In senior living, we’ve traditionally used data in terms of supply and demand to create market feasibility studies. How much supply is there in a particular market and what is the demand? How many people are over age 75 and what is their income? What is the prevalence of adult children and what is their income? How many buildings and units are in the markets, and what are the rental rates? But what other data might help us improve our feasibility studies? Here’s an example. NIC MAP Vision can provide the rate of Alzheimer’s disease and other dementias in the Medicare population in the top 30 largest MSAs in the country. Miami has the highest incidence at 8.3%. Portland, Oregon, has the lowest at 2.7%. This is pretty important to know if you are deciding where to locate a memory care building.

   
   

   A 2021 white paper published by NIC Analytics provides more information on dementia and how to utilize CMS Medicare data and NIC MAP Vision supply data when evaluating local conditions. Another resource is NIC’s article “Access to Capital in the Nursing Home Industry” on utilizing dementia Medicare data for more informed underwriting.

   
   
3. Data is critically important for the purpose of engagement matchmaking. Data can be used to engage residents and match them with experiences that give them a sense of purpose, belonging and connection. If we’re going to avoid the medicalization of private pay senior living, it won’t be because we have medical history data and know how to use it. Rather, it will be because we have what I call “life data” or “life values data” and know how to use it to create an engaging environment for our new customers.
   

   Senior living is very good at asking certain questions, but we overlook the most important questions. We are good at finding out the person’s need for help with the activities of daily living, or the instrumental activities of daily living such as balancing a check book. We are good at finding out how many prescriptions people take, and the over-the-counter medications they use. And we are especially good at understanding the resident’s ability to pay and for how long.

   
   

   But none of this information defines the identity of a person. In fact, every person resists being identified by those markers. We are not asking the questions that matter most to the individual and their quality of life. Most people in assisted living are moving in with us for the last two to three years of their lives. The key questions that we should be asking relate to what is most important for the person to be able to experience in the remaining time they have left. That should drive how we think about the resident, instead of coming up with a game plan based on the fact that they have 18 prescriptions, and 10 chronic conditions. What is important to the person? Maybe she wants to see her grandchild walk across the stage at college graduation. Or maybe he wants to live long enough to meet his first grandchild. We should be asking what moments in life have given you the most sense of joy? What is something new you would like to learn? What gifts, interest or talent would you like to contribute to this community? It all comes back to what matters to the residents, what’s most important to them.

   
   

   For example, Lifespark, a complete senior health company in the Twin Cities is a pioneer in whole person senior care, focused on helping people build a pathway to live their best life. Lifespark has created an Electronic Life Record (ELR) that uses artificial intelligence (AI), machine learning, and proprietary algorithms to capture not just typical medical inputs, but also thousands of additional data points that can be highly predictive for recommending not only the best care solution but also the best way to engage an older adult and enhance their experience of daily life.

   
   

   Another example: The John A. Hartford Foundation funded the Age-Friendly Health Systems initiative in partnership with the Institute for Healthcare Improvement, the American Hospital Association and the Catholic Health Association, which is now in over 2,800 care locations nationally and internationally. The goal is to help spread the reliable delivery of age-friendly care—based on the 4Ms framework (what Matters, Medication, Mentation, Mobility)—to all health care settings. The Foundation has also provided a grant to the Age-Friendly Institute, based in Boston. It operates AgeFriendly.org which features user reviews and expert advice for older adults on where to live, work and get care. The consumer reviews are akin to Yelp for care of older adults.

   
   

   So, what do we do with the life data we collect? It can be used to customize the resident experience which is how our industry will thrive in the next decade. Let’s look at several other sectors that are way ahead of us to see how they are customizing the consumer experience.

   
   

   The retail sector is a good example. My wife, Diane, was shopping online before the holiday rush for dolls for our granddaughters. But not just any dolls. Diane has very high standards for dolls and wanted unique, authentic dolls. She was checking her emails one morning and suddenly exclaimed, “How did they know?” I thought she’d been hacked until she said, “They sent me exactly what I’m looking for.” Diane had received emails from three doll manufacturers with just the kind of dolls she wanted. I said, “Diane, you have just been mass customized to have a personalized shopping experience.”

   
   

   There is a ton of data out there on us and our shopping habits. Someone put together an algorithm to find the kind of dolls that would interest Diane Kramer, who likes to holiday shop before Thanksgiving. The doll companies bought the data and knew early November was the right time to send Diane an email, so she had a super convenient shopping experience. It’s an example of how to take massive amounts of data and use it to create a customized consumer experience.

   
   

   Healthcare is another example. Heather Cox, the chief digital health and analytics officer at Humana gave a presentation at the Consumer Electronics Show (CES). She said that the next evolution of Humana would be to focus on leveraging analytics to drive new digital personalized experiences to extend care delivery to members when and how they need it. Her message: Differentiating on price isn’t the way to win on healthcare. Differentiating on experience will be.

   
   

   Humana is a huge player in the Medicare Advantage payer universe. Since Cox gave that speech Humana and United Health Group, another big payer, have been buying providers, physician practices and clinic-based settings, not expensive hospitals. Payers are seeking settings where their members can receive preventative care and assistance to manage chronic conditions to avoid the hospitals. In other words, the payer is becoming the payer and a provider, or a payvider. These big insurers are developing their own alternative care networks, and the missing piece by design is the acute care hospital.

   
   

   These examples raise a question for senior living providers. What personalized experiences that are metaphors for being alive will we offer our customer? Data and analytics will enable us and our partners not only to practice true preventative healthcare but most importantly to design opportunities for our residents to have the experiences they want most in the last years of their lives. This is a completely different approach from the activities director who runs herself ragged to schedule lots of activities to appeal to everyone. Or the activities director who takes a one-size-fits all approach and hopes people show up.

   
   

   We can’t create customized experiences if its up to the staff to figure out what each individual wants and then deliver a solution. That’s where a number of new companies are focusing on how to customize the experience to engage residents.

   
   

   Sentrics has developed an integrated suite of platforms to customize the resident experience from what she watches on television to specific activities. Continual feedback from the resident helps to tailor the experience.

   
   

   Connected Living is another example. At the center of the Connected Living ecosystem is an enterprise content management system with links to programs and services.

   
   

   Again, if we are going to be a place that people are attracted to rather than one to avoid, the key will be to provide personalized or customized experiences. But to do this, we have to be able to collect data and use it quickly to personalize preventative healthcare and also to engage our residents. Rather than being a place to disappear, we will be settings that are metaphors for being alive. It’s true that our customer may have chronic conditions and may only be given three years to live by the doctor. But she wants to feel alive and have experiences that are meaningful to her.

   
   

   This will be a challenge for senior living that has grown accustomed to marketing care to meet needs. But the reality is that people want to feel alive, and we have to figure out what makes them feel alive. We must reframe the aging experience and engage our customers. The smart use of data and analytics will help us meet that challenge.

Next up: Key Driver # 6: Moving from Siloed to Seamless. We will see a shift from the current fragmented, single-point healthcare solutions and technology applications to integrated longitudinal solutions that are setting, disease, and payer agnostic.

With wage inflation and continued labor market challenges and shortages, skilled nursing operators and owners face steep competition relative to other industries (i.e., indirectly from other service industries such as hotels and restaurants) especially those operating in regions and states where broad labor availability is tight and employer demand is high. Additionally, amid generally low occupancy levels, skilled nursing owners and operators face challenges over the long term with new and proposed staffing mandates and requirements. 

The greatest shortages of healthcare staff continue to be among essential workers such as nursing staff and aides, the backbone of the skilled nursing sector. This blog post explores underlying staffing shortages data among nursing staff and aides in the skilled nursing industry from three perspectives: location (region), property-level occupancy, and the size of the property. Further, it examines how the ongoing staffing crisis affects skilled nursing properties based on these three measures and includes an interactive dashboard to explore the varying combinations of these measures on resulting levels of properties’ staff shortages.

As background, according to the latest Bureau of Labor Statistics (BLS) data, the seasonally adjusted number of employees at skilled nursing properties increased to 1,361,000 in September 2022, up 18,300 jobs from its pandemic low of 1,342,700 in March 2022. Despite these recent job gains, employment in skilled nursing is still 220,200 jobs below pre-pandemic March 2020 levels (1,581,200), equivalent to negative 13.9%, and 312,600 jobs below its peak of 1,673,600 in September 2011, equivalent to negative 18.7%

Staffing shortages likely hit their peak earlier this year in January 2022 and started to ease since. Notably, the share of skilled nursing properties reporting shortages of nursing staff dropped from 28.0% in January 2022 to 20.8% in September 2022, and the share of skilled nursing properties reporting shortages of aides dropped from 29.7% to 21.6% over the same period, according to the Nursing Home COVID-19 Public File (CMS data as of September 18, 2022, compiled by NIC Analytics).

By Region. As Exhibit 1 below shows, no region has been spared the scarcity of nursing staff and aides. However, staffing shortages in the Midwest have been acute. About 37% of skilled nursing properties in the Midwest reported shortages of nursing staff, and nearly 40% reported shortages of aides back in January 2022, the highest levels recorded since the onset of the pandemic, across all U.S. regions. 

By mid-September 2022, as staffing shortages slightly eased, about 30% of skilled nursing properties in the Midwest reported shortages of nursing staff and aides, nearly twice that of the South, Northeast, and West regions.

By Occupancy. The pandemic stretched finances for many skilled nursing operators, and the relatively slow pace of occupancy recovery is an additional challenge. Just like the employment trends, occupancy for skilled nursing properties is recovering but remains far below pre-pandemic levels. The relationship between labor and occupancy and conversely for occupancy and labor is synergistic and a bit of a chicken and egg scenario. In some instances, if labor isn’t available, new patients cannot be admitted, but if patients cannot be admitted, occupancy cannot be improved. The key question is what are the potential solutions to break this challenging cycle and help skilled nursing properties be competitive in attracting staff, improving occupancy, and providing the best and needed care for patients?

Exhibit 2 below shows that the higher the occupancy, the lower the share of skilled nursing properties reporting shortages of nursing staff and aides. Notably, skilled nursing properties with an occupancy rate below 80% had, and continue to have, the highest proportion of properties indicating a shortage in nursing staff and aides. By comparison, skilled nursing properties within higher occupancy cohorts have been reporting relatively lower shares of properties experiencing shortages of nursing staff and aides.

By Property Size. Another way to look at this data is by property size or total units. Interestingly, the highest share of skilled nursing properties reporting staffing shortages has been among small properties (less than 50 units). Exhibit 3 below illustrates that small properties tend to have a higher share reporting shortages of nursing staff and aides, and vice versa. In general, the smaller the property, the more volatile the occupancy due to the impact of just a few moveouts. This may impact staffing as well across these smaller properties, especially if they are not part of a larger portfolio.

Taking just these three variables into account — property location, occupancy, and size — staffing shortages vary substantially. For example, finding and hiring staff can be more challenging for small properties (less than 50 units) in the Midwest, with an occupancy rate less than 80%. In fact, the interactive dashboard below tracks closely these measures and indicates that about 40% of skilled nursing properties within this group reported shortages of nursing staff and aides for the week ending September 25, 2022, the highest share of any other combination of these three measures. 

Conversely, less than 5% of relatively larger skilled nursing properties (100+ units) in the West, with an occupancy rate of 90% or more, reported shortages of nursing staff and aides, the lowest share of any other combination of these three measures. 

To monitor these staffing shortage measures at the state and county levels over time, visit NIC’s Skilled Nursing COVID-19 Tracker.

The U.S. Bureau of Labor Statistics reported that nonfarm payrolls rose by 263,000 in September 2022 and the unemployment rate fell back to its July level of 3.5%. The September increase was well below the year-to-date average of 420,000 and below the monthly average of 562,000 seen in 2021. The monthly gain paints an image of a still growing, but slowing, job market. Revisions added 11,000 positions to total payrolls in the previous two months.

Employment in health care rose by 60,000 in September and has now returned to its February 2020 level. Employment in nursing care facilities was up by 14,300 jobs from year-earlier levels and stood at 1,361,000.

In a separate survey conducted by the BLS, the jobless rate slipped back to 3.5% for September, down from 3.7% in August. The jobless rate is once again equal to its pre-pandemic level of 3.5% seen in February 2020, and well below the 14.7% peak seen in April 2020. At 3.5%, the jobless rate matches its 50-year low seen before the pandemic. Among the major worker groups, the September unemployment rates were 3.4% for adult women, adult men (3.3%), teenagers (11.0%), Whites (3.1%), Blacks (5.8%), and Asians (2.5%).

Average hourly earnings for all employees on private nonfarm payrolls rose by $0.10 in September to $32.46. This was a gain of 5.0% from year-earlier levels, still high, but lower than in August (5.2%). Notably, on a three-month annualized basis, wages rose by a slower pace of 4.4%.

The labor force participation rate slipped back to 62.3% in September from 62.4% in August and was below the February 2020 level of 63.4%.

Earlier this week, the BLS released its JOLTS report that showed the number of job openings fell 10% in August to a seasonally adjusted 10.1 million from 11.2 million in July. That left job openings at their lowest level in one year, but still well above their pre-pandemic level in 2019 when they averaged 7.2 million

These combined reports support the Federal Reserve’s intention of continuing to raise interest rates further following the 75-basis point hike in the federal funds rate in late September. Already, the Fed has increased interest rates five times this year to a current target range of 3% to 3.25%, its highest range since early 2008. Another two rate hikes are anticipated for 2022. Further, a majority of the Federal Open Market Committee (FOMC) members see the fed funds rate reaching a level of between 4.5% and 5.0% in 2023.

According to quarterly NIC MAP^® data, released by NIC MAP Vision, demand, as measured by the change in occupied units, largely outpaced new supply while marking its sixth consecutive quarter of positive increases, with a net absorption gain from the prior quarter of more than 8,700 units, or 1.6% for the NIC MAP Primary Markets. This advance pushed the share of senior housing units vacated during the pandemic that have been re-occupied to near-full recovery (95%). If this pace of demand growth continues into the next quarter, senior housing may soon start filling new inventory added during the pandemic, on a net basis.

As a result of supply/demand trends, the exhibit below shows that the all-occupancy rate for senior housing for the NIC MAP Primary Markets increased for the fifth consecutive quarter to 82.2% in the September 2022 reporting period, up 1.0 full percentage point (pps) from the June 2022 reporting period on a three-month rolling basis, with a small gain of 0.1pps from August 2022. From its time series low of 77.9% in June 2021, occupancy increased by 4.3pps but remained 5.0pps below pre-pandemic March 2020 levels of 87.2%.

By Majority Property Type. At 84.7%, the all-occupancy rate for majority independent living (IL) properties for the NIC MAP Primary Markets increased 0.9pps from June 2022, with a gain of 0.2pps from August 2022. For majority assisted living properties (AL), the all-occupancy rate for the NIC MAP Primary Markets remained unchanged from August 2022 but was up 1.1pps to 79.7% from June 2022. Occupancy for both independent living properties and assisted living properties remained 4.9pps below March 2020 levels.

All-occupancy increased or remained stable in 27 of the 31 Primary Markets for IL in the September 2022 reporting period compared with June 2022. At 82.2%, Miami saw the largest quarterly improvement in September 2022, up 2.4pps from June 2022. Orlando IL occupancy fell 1.6pps in September 2022 to 84.5%. Orlando had the largest quarterly decline among the 31 NIC MAP Primary Markets.

All-occupancy rose or remained stable in 29 of the 31 Primary Markets for AL in September 2022 compared with June 2022. At 78.4%, Phoenix occupancy saw the largest increase since June 2022 and gained 2.8pps quarter-to-quarter. Seattle’s occupancy remained unchanged from August 2022 but fell by 1.4pps from June 2022 to 77.5%. Seattle had the largest quarterly decline among the 31 NIC MAP Primary Markets.

Keep track of the most timely comprehensive review of the sector’s market fundamentals and trends. The NIC Intra-Quarterly Snapshot monthly publication, available for complimentary download on our website, continues to provide a powerful and closely watched means to stay ahead of industry trends, even as senior housing markets sustain a fast pace of evolution and adaptation, amidst an apparent recovery. 

The October 2022 IQ Snapshot report will be released on nic.org on Thursday, November 10, 2022, at 5:00pm.

Interested in learning more about NIC MAP Intra-Quarterly data? To learn more about NIC MAP Vision data, schedule a meeting with a product expert today.

Senior housing and care’s premier event delivered on three days of connections, learning, and engagement.

Bringing together more than 2,800 industry participants, the 2022 NIC Fall Conference surpassed turnout expectations as attendees explored the near-term challenges of the senior housing and care sector, and the long-term opportunities as a demographic wave of older adults begins to arrive. The Conference was held September 14-16 at the Marriott Marquis in Washington, D.C. Highlights included:

• • A detailed economic and industry specific outlook.
  • The inaugural Women’s Networking Meetup.
  • Insightful educational sessions.
  • A NIC white paper defining the emerging active adult segment.
  • New research underscoring the integration of healthcare and housing.
  • Multiple daily, formal and informal, networking opportunities.

More than 70% of all those at the event were executives at the C-suite or managing director levels. Attendees also represented a good balance of both senior living operators and capital providers. Notably, the Conference drew 637 first-time attendees.

In opening remarks, NIC Board Chair Kurt Read, managing director at RSF Partners, noted that NIC is much more than a conference. Rather, he said, “NIC is the collective expression of the passionate commitment to create better environments now and in the future for our nation’s elders and those who serve them.”

The Fall Conference theme— “Forward Together”—highlighted the resilience and perseverance of the industry and the importance of building effective partnerships among operators, healthcare providers, investors, and other capital sources.

“The pace of change is frantic,” said NIC President and CEO Brian Jurutka, who listed the big industry challenges of rising expenses, a workforce shortage, ongoing pandemic-related issues, and the needs of a growing elderly population. “NIC is a platform and resource to help the industry move forward together,” he said.

Valuable Connections

As the premiere industry event, the 2022 NIC Fall Conference engaged attendees in three days of results-oriented networking, information sharing, and timely educational sessions. Industry leaders shared their perspectives and insights on a wide range of topics including the emerging active adult segment, the new consumer, capital market trends, and how to successfully scale operations, among other issues.

NIC Chief Economist Beth Mace was the featured speaker at the inaugural Women’s Networking Meetup, where nearly two hundred women executives exchanged ideas and made connections. Mace offered her insights and advice on the changing role of women in the industry. One tip: Be open to change.

Actionable Content

The Conference offered 10 stand-alone educational sessions. (High quality videos of all educational sessions are available to attendees in the Conference mobile app.)

Attendees packed the Marriott Marquis ballroom for the keynote session, “Economic and Financial Market Outlook.” Financial forecaster Jason Schenker delivered a lively, data-rich analysis of the economy’s bright spots and current risks.

“More people are working than ever before,” said Schenker, president of Prestige Economics and chairman of The Futurist Institute. But wages are rising, and inflation is up 8.3% annually, the highest rate since 1981.

Demographics are a big plus for senior living. “We will have a steady stream of residents,” he said. The healthcare needs of an aging population will greatly impact the workforce. In fact, he noted that 5 of the top 10 areas for job growth are in health-related occupations.

“The next 2-3 years will be tough,” predicted Schenker, citing expense pressures, rising interest rates, and worker shortages. But he was generally optimistic about conditions 24-36 months from now. His advice to attendees: “Plan for long-term upside opportunities.”

Several sessions addressed the new consumer and the growing active adult segment. NIC presented a white paper defining the property type. Key components include age-eligibility, majority market rate, rental, and lifestyle focused.

A panel of experts discussed the investment case for active adult in the aptly titled session: “Rational Exuberance.” Investors like the demographic profile of residents and their extended length of stay.

The panelists parsed the differences between active adult, senior housing, and multifamily properties. The operation of active adult properties is more like that of multifamily projects. But the sales cycle is more akin to that of senior living. “We’re very bullish on the sector,” said panelist Joseph Fox, co-founder and co-CEO, Livingston Street Capital.

Separately, a panel of industry leaders analyzed the new customer—a group much different from the population the industry has been serving. Baby boomers are harder to please than their predecessors. The panelists agreed that baby boomers are seeking an experience, not just a place to live.

“We are too wrapped up in the real estate,” said William Swearingen, senior vice president, marketing and sales, Spectrum Retirement Communities. It’s important to showcase the active lifestyle and the cultural reference points that baby boomers understand, he advised, “Take a chance.”

A CEO roundtable provided a big picture perspective on operations, the new customer, and workforce issues. In a separate panel discussion on repositioning, Tana Gall, president, Merrill Gardens, detailed how the company refashioned a portfolio for the middle market, now named Truewood by Merrill. Other speakers shared strategies on unit mix, tapping untapped workers, and how to reconfigure floor plans to boost staff efficiency.

The session, “Stay Focused and Keep Working: Effectively Scaling Your Operations,” mapped out successful approaches. Experts explored the pluses and minuses of acquisitions, new developments, and management assignments. “You need a plan to scale and grow,” noted panel moderator Bryan Starnes, CFO, ALG Senior.

New research, funded by NIC, was introduced at the Conference. It shows that senior housing residents average more than a dozen chronic conditions. The research was conducted by NORC at the University of Chicago. The study also highlights the opportunities to integrate healthcare and housing to improve health and cut costs.

A number of speakers at the Conference emphasized that the pandemic has secured a place for senior living in the healthcare continuum. Partnerships, in various forms, are growing quickly between senior living providers and healthcare systems.

The investment-focused sessions were well-attended. A panel discussion on environmental, social, and governance (ESG) strategies highlighted its growing role among institutional investors. Speakers also discussed the push for diversity, equity, and inclusion (DEI) initiatives.

Other popular sessions detailed the state of the capital markets and deal-making as operators rebuild occupancy. The consensus was that capital is available for the right product in the right place. Echoing much of the buzz at the Conference, speaker Julie Ferguson, executive vice president at Ryan Co. said, “We believe in the long-term value of senior living.”