New cases of COVID-19 in skilled nursing facilities account for just a quarter of 1% of U.S. cases overall, down from over 5% of cases in June 2020. NIC’s new interactive data visualization tool shows a divergence as case counts among the general population rise in some parts of the U.S., while those in skilled nursing facilities continue to decline.

U.S. weekly COVID-19 infections are rising again across several states despite ongoing vaccination efforts. Although we are on the road to herd immunity and case count data in skilled nursing facilities (SNFs) suggest that vaccines are indeed effective, the recent uptick in U.S. cases indicates that it is still important to remain vigilant and continue to be cautious regarding enthusiasm about beating the pandemic. It is too early to let our guards down.

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

• weekly confirmed cases in SNFs vs. U.S. (sort by region, sub region, or state)
• per-resident rate of new COVID-19 infections within SNFs (all vs. specific region/state)
• weekly confirmed cases among skilled nursing residents as a share of U.S. weekly cases.

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

Choose specific regions or states from the dropdowns in the tool below to change the graphs. 

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

While skilled nursing residents make up less than 1% of the U.S. population, the analysis shows that newly confirmed cases among skilled nursing residents have shrunk dramatically. Remarkably, weekly confirmed cases within skilled nursing facilities accounted for only 0.26% of U.S. weekly cases on March 14, down 1.86 percentage points from December 20 (2.12%) and the launch of the long-term care vaccination program. This suggests that the incidence of COVID-19 has shifted to the younger adults. Recent data shows that hospitalized COVID-19 patients are getting younger across several states, including New Jersey, Pennsylvania, and Michigan.

New Cases in Skilled Nursing Facilities Fall Below 1,000

Additionally, newly confirmed cases within skilled nursing facilities continued to decline and fell below 1,000 cases for the week ending March 14 (preliminary data). The per-resident rate of new COVID-19 infections continued to decline and reached a new pandemic low of 0.09% – only 9 in 10,000 residents tested positive for COVID for the week ending March 14, 2021 compared to 303 in 10,000 twelve weeks ago on December 20, 2020.

Regional Differences

Regionally, the lowest rate of new infections among skilled nursing residents was seen in the Midwest at 0.06% – a pandemic low, where case counts are down 98% from 8,756 on December 20 to 150 on March 14. This is followed by the West (0.07% – a pandemic low), the South (0.10% – a pandemic low), and the Northeast (0.15%). Case counts within SNFs in the Northeast are down 94% since December 20 while the Northeast overall weekly cases fell only 53% over the same period. Notably, the share of newly confirmed COVID-19 diagnoses within SNFs in the Northeast decelerated from 2.44% to 0.30% for the reporting weeks from Dec 20 through Mar 14 (down 2.13 percentage points).

The positive effects of the vaccines continue to be notable across the four regions of the U.S., the rate of new COVID-19 cases among skilled nursing residents prior to vaccination rollout moved nearly in tandem with the rate of new cases within their respective regions. In recent weeks, following the vaccine rollout, new cases within SNFs have been sharply lower than the weekly cases in their respective region at any previous point.

Furthermore, SNFs weekly confirmed cases in the Middle Atlantic (New York, New Jersey, and Pennsylvania) are down 94% since the week ending December 20 and continued to diverge from the overall weekly cases within the sub region (down 47%).

State Differences

Drilling deeper into state infection rates, New Jersey weekly cases have accelerated since February 21, while weekly cases within skilled nursing facilities in New Jersey continued to decelerate and remained low. In fact, case counts within SNFs in New Jersey are down 91% from December 20 through March 14 while weekly cases among the general population there are down only 30%. Other states that saw an increase in the last few weeks include Maryland, Maine, and Texas – none of these states reported an increase in cases within their skilled nursing facilities as of March 14.

Vaccinations

As of March 14, over 40 million people in the U.S. have been fully vaccinated. Of this group, 7.6 million are in long-term care communities. The status of clinics shows that over 90% of skilled nursing facilities participating in the Walgreens and CVS vaccination programs have completed their clinics (data as of March 11). The U.S. is currently administering 2.8 million doses per day (as of March 31), and it is likely that the average vaccination rate will reach 3 million in the coming days. However, it is also important to consider vaccine hesitancy and put more efforts to promote vaccine literacy to more fully immunize those who are hesitant.

In summary, weekly COVID-19 cases within skilled nursing facilities continue to decline or flatten with relatively small increases across few states. Data suggest that vaccines are indeed effective, but it is important to keep track of the incidence of COVID-19 in skilled nursing facilities vs. U.S. since most of skilled nursing patients have been vaccinated.

To gain in-depth insights and track the week-over-week change rate for new resident cases and fatalities of COVID-19 within skilled nursing facilities at the state and county levels, visit NIC.org. You can also access the Skilled Nursing COVID-19 Tracker along with a rich trove of analysis and insight on the NIC COVID-19 Resource Center.

NIC is committed to provide timely data, analyses and insights that increase transparency and understanding of the sector, especially in this difficult time of COVID-19. We strongly support all actions and efforts that prioritize distribution of COVID-19 vaccines, testing, and availability of PPE to protect frontline workers and residents.

A lot of attention has been paid to the occupancy challenges that seniors housing operators have faced since the COVID-19 pandemic began in early 2020. This blog focuses on the impact of the pandemic on occupancy by operator size. We conclude that single-property operators generally saw smaller occupancy declines during 2020 than very large operators. New supply, as well as pandemic-related changes in the rates of move-ins and move-outs, contributed to this disparity.

Methodology. NIC Analytics utilized NIC MAP® Data, powered by NIC MAP Vision, for this analysis. We examined occupancy patterns among single-property operators, small-sized operators (2–4 properties), medium-sized operators (5–9 properties), large operators (10–24 properties), and very large operators (25 and more properties).

This analysis uses majority property type. Majority property type is the industry’s traditional categorization where each property is classified by its plurality care segment (referenced as majority) and where memory care is considered a subset of assisted living. Seniors housing is defined as the aggregate of majority independent living and majority assisted living. Properties are categorized by their operator’s size in each quarter. Some properties in this analysis have had a change of operator during 2020, so each operator size group per metropolitan market may not be entirely “same store.”

NIC MAP Primary Markets. While deaths, move-outs, and a slowdown in move-ins contributed to decreases in occupancy, new inventory continued to come online during the pandemic, which put further pressure on occupancy rates. For the NIC MAP Primary Markets, net absorption for 2Q20, 3Q20, and 4Q20 was negative for each quarter, with a staggering -33,500 units having been vacated on a net basis and again available. However, net inventory grew by 13,000 units for the same period. The combination of new inventory growth and negative net absorption put enormous pressure on seniors housing occupancy rates, which fell from 87.5% during 1Q20 to 80.7% during 4Q20 for the NIC MAP Primary Markets. The 6.8 percentage point drop in the occupancy rate may not have been as steep, however, had the number of new and unleased units not increased as much.

Findings. Over the course of the pandemic in 2020, single property operators saw the smallest declines in occupancy of the five operator size groups examined for the NIC MAP Primary Markets. Conversely, very large operators saw the greatest declines in occupancy from 1Q20 to 4Q20. Occupancy dropped 5.8 percentage points for single-property operators and 8.2 percentage points for the very large operators within the Primary Markets.

Between 1Q20 and 4Q20, single-property operators experienced negative inventory growth, while very large operators had the largest inventory growth of the five operator categories for the NIC MAP Primary Markets. The inventory decline for single-property operators could be due to a few factors, including that some properties may have been purchased from single-property owner/operators to become owned and operated by larger chains, or there may have been property closures or closures of units or wings at properties that remained open. The additional units coming online during this period put added pressure on occupancy for very large operators in a way that the single property operators did not experience.

Conclusion. This analysis has shown that generally, the very large operators experienced the greatest drops in occupancy during the pandemic of the five selected operator groups. Some of the explanation for this is the inventory growth that occurred for the largest operators.

Additional explanations for the larger drop in occupancy observed for very large operators include that some larger operators may focus more broadly on REVPOR or revenue per occupied unit and, therefore, managing more to asking and actual rates than occupancy levels. It may also be that properties that were operated by single-property operators in 2020 had more flexibility to allow move-ins based on local coronavirus positivity rates, whereas properties operated by larger chains may have had more uniform, organization-wide policies and procedures in place either controlling or restricting move-ins regardless of the level of coronavirus positivity rate by region or locale.

NIC MAP Vision Clients with a NIC MAP Data subscription can access the full version of this analysis in the latest Insights Newsletter by logging into their Client Portal.

About NIC MAP Vision:

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

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The pandemic has thrust healthcare for seniors into the spotlight. The latest NIC Leadership Huddle event, titled, “Value-Based Care: What’s in It for Me?” explored how operators and their partners are navigating what is likely to become a new normal: bringing healthcare to seniors where they live. The webinar and discussion explored the argument that–with or without COVID-19–every seniors housing organization must understand how providing access to healthcare services is now a part of their value proposition for both residents and investors.

Two operators and a broker shared their approach to providing healthcare and participating in value-based care models. Each vignette was followed by live commentary from Jim Lydiard, vice president, Strive Health, and Amy Kaszak, president of Special Needs Plans, AllyAlign.

Kaszak, pointing to exploding healthcare costs and the expansion of value-based models, said, “As hospitals, therapy, primary care, home health, and skilled providers adapt to new payment models and incentives, senior housing communities–even those who do not bill for Medicare services–will have opportunities to engage in value-based relationships.”

Jonathan R. Cook, president and CEO, LifeSpire of Virginia, an operator of four CCRCs (or life plan communities), with 1,450 residents across the Commonwealth, walked through several key advantages of a recent partnership with AllyAlign. He pointed out that every hospital readmission takes up about five hours of a staff nurse’s time, filling out paperwork as residents are admitted and then returned. The new partnership has significantly decreased readmissions. Cook said, “Being able to take that five hours, over 30% of readmissions, and put those nurses and those team members back on the floor to provide more direct care – huge win for our clinical teams.”

Another advantage for Cook has been the implementation of advanced telehealth tech. Residents, particularly during the COVID-19 pandemic, fear making trips to the doctor, and this innovation allows them to receive the same level of care, while staying safe at home. Cook said, “By having one provider unite the care coordination on our campuses, it’s going to create better outcomes, better care management, and better care transitions for our residents. We believe that’s going to reduce costs, it’s going to reduce heartache, it’s going to reduce the anxiety that those residents and families have as they age and need more care programs and services.”

Kaszak, who is very familiar with the LifeSpire model, summarized, “The primary care team, in partnership with the community team, delivers the value, and the Medicare Advantage plan pays for the value and value-added services. Value-based payments go both to the primary care team and to the community.”

Tim Nelson, executive director, Mountain View Retirement, a senior living community in Tucson, Arizona, has seen significant benefits in a partnership with CareMore Health. “We’ve been able to retain our residents longer, give them a happier, healthier life while they’ve been with us, and we’ve also been able to build even stronger community partnerships, with our skilled nursing facilities, and even with the hospitals and different local physicians’ groups.” His community has seen a decrease in hospital readmissions, dropping from 16 percent down to 6.2 percent.

Nelson said, “We’ve been able to do direct admits from our assisted living and memory care, and sometimes even our independent living, straight to the skilled nursing facility and back to us.” CareMore staff are also always available to help facility staff, even when they’re not onsite. “We can call our providers and their support staff 24 hours a day, seven days a week,” said Nelson. Being able to showcase those abilities has been “a huge asset” when touring prospective new residents and their families.

Shane Connor, vice president-Senior Housing Group, Bull Realty offered an investor’s perspective on the integration of value-based care in senior housing. He sees multiple benefits. On recruitment and occupancy rates, he said, “The prospective resident, and certainly their family are ever-more aware of healthcare now than they have been, with COVID.” He said that being able to show integration of value-based care – or third-party partnerships – is now a competitive differentiator.

Healthcare integration also promises to significantly improve length of stay, which will boost occupancy rates. Connor also sees an advantage on staffing, as onsite or visiting clinical staff reduce burdens on facility staff, particularly with higher acuity residents. That can reduce costs. On valuations, Connor explained, “If you’re evaluating a group that implements value-based care, or is embracing value-based care, you’re going to be more confident that they’re going to keep people healthy and be able to keep those beds full. From a valuation standpoint, if I’ve maybe held this facility for five or six years, and we can show the impact that the value-based integration had, on the occupancy, on the bottom-line financials, then when I go to take that out to market for another prospective buyer, you may be able to command a higher dollar, a higher valuation.”

You can register to attend upcoming NIC Leadership Huddles, including both the live webinars as well as the optional, first come, first served participation in peer-to-peer discussions, within the Events tab on www.nic.org. Registrants are provided with a recording of the event, compliments of NIC, and our generous sponsors and partners.

“The respondents of the Wave 24 Executive Survey Insights appear to be cautiously optimistic, with hope that the shadow of the pandemic weathered over the past year is fading. The share of organizations reporting deceleration in the pace of move-ins and declines in occupancy rates is at the time series low for all care segments. In looking back over the past year and the 24 iterations of the Executive Survey Insights results, it’s apparent how closely the survey’s results have mirrored the reality experienced by many operators as they faced daily struggles to keep their residents and staffs safe from contagion—and to save lives.”

–Lana Peck, Senior Principal, NIC

Launched one-year ago in mid-March 2020 as part of a broader effort by NIC to provide timely understanding of the impact of the COVID-19 pandemic across the seniors housing and nursing care sectors—the single biggest challenge ever faced by operators—this continuously running, bi-weekly, Executive Survey Insights analysis has been widely viewed and closely monitored by many industry stakeholders, operators, developers, investors, lenders, and analysts.

Yielding data on properties of every size, type, ownership structure, and across each care segment, every completed questionnaire delivers information from the perspective of an owner/operator’s entire portfolio of seniors housing and nursing care properties. Typically garnering around 80 responses on average, the survey has provided real-time insights on hundreds of buildings and thousands of units across the country every two weeks since near the beginning of the pandemic.

Detailed reports for each “wave” of the survey and a PDF of the report charts can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights. Additionally, the full range of time series data for each wave of the survey by care segment for move-ins, move-outs and occupancy rate changes can be found here.

The survey has provided a flexible medium for owners and operators of seniors housing and nursing care properties to deliver transparency to the industry as market conditions have rapidly changed. Early in the time series, in March and April 2020, the survey tracked operators’ mitigation strategies for labor shortages that were aggravated during the pandemic, availability of PPE, and the many ways operators were supporting property staff and their families during the crisis. Later in the series, the survey tracked the needs of operators in keeping residents and staff safe. Answers to questions pertaining to improvement in access to PPE and COVID-19 testing kits, time frames for receiving test results, and, more recently in the 2021 surveys, the availability, administration, and distribution of COVID-19 vaccines—demonstrates how the full continuum of this survey has kept the industry and the media informed about daily challenges and successes on the front lines and in the properties themselves.

With a year’s worth of time-series data documenting the impact of the pandemic on senior living, the survey has and will continue to track a number of standard topics focused on the market fundamentals including the pace of move-ins and move-outs, changes in occupancy rates by care segments, utilization of rent concessions to support occupancy, and factors pressuring NOI.

The result is a cross-section of America’s seniors housing and nursing care industries, a consistent indicator of trends, updated almost in real-time. Each of the 24 “waves” of the survey data has provided directional insights while preceding sources of other data by weeks and months, working to help ensure the wider narrative on the sector is accurate.

Timeline of Executive Survey Insights and the Coronavirus Pandemic in the U.S.

Across the time series from March 2020 to March 2021, the Executive Survey Insights results have shown clear trends that have corresponded with the broad incidence of COVID-19 infection cases in the United States. The chart below illustrates the drastic slowdown in seniors housing and care move-ins by care segment early in the pandemic, followed by somewhat of a stabilization over the summer, and another tapering off as conditions worsened in the fall. By Wave 18, the COVID-19 vaccine had begun to be distributed across the country through the Long-Term Care Vaccination Program (in the latter half of December) and the pace of move-ins accelerated as reflected in operators’ subsequent experiences in Waves 19 through 24. Currently, in Wave 24, the shares of organizations reporting deceleration in the pace of move-ins has fallen to time series lows across each of the care segments.

The following narrative is an examination of the past 12 months of survey data from near the beginning of the pandemic through to current conditions. For context, the chart below, which details 24 waves of survey data regarding the pace of move-ins (for assisted living as an example), shows how closely the survey’s results have mirrored the reality experienced by many seniors housing and care operators during the various waves of the pandemic, and lays out a framework for the time intervals to be discussed. How far has the industry come and how much further does it need to go in order to resume pre-pandemic operations in what will be considered the “new normal” going forward?

Survey Waves 1-10 (March 24 – August 2, 2020)

Early in the pandemic, the most common reason cited by operators for deceleration in move-ins was a slowdown in leads conversions/sales due to moratoriums of moving residents into communities to mitigate COVID-19 contagion within seniors housing and care buildings. Ultimately, these bans on move-ins resulted in challenges backfilling vacancies. Respondents also noted at the time that they were seeing fewer hospital referrals or elective surgeries that had reliably served to bring in residents for therapy and rehabilitation stays prior to the pandemic.

By Wave 9, in addition to bans on move-ins abating, survey respondents commented that resumption of pre-COVID-19 planned resident move-ins, improving availability of COVID-19 testing prior to entry, and lessons learned regarding sanitation measures and enhanced safety protocols for visiting with social distancing were implemented to provide reassurance about moving into seniors housing.

Survey Waves 11-15 (August 17 – November 8, 2020)

Presumably due to new spikes of COVID-19 cases in many areas of the country or possibly due to restrictions on family member visitation rules imposed by some states, more organizations in Wave 11 than in all of the prior waves of the survey cited resident or family member concerns with moving a loved one into senior living.

While accurate and timely COVID-19 testing (within 48-hours) was considered crucial to operators’ ability to settle new residents into communities and keep them safe from outside contagion—which could be brought into community by visitors and staff—nearly two-thirds of organizations were waiting three to five days for test results to come back, and still only about one-half of respondents found it easy to obtain PPE and COVID-19 test kits. Frustration with testing turnaround times was expressed in the survey comments with some respondents fearing that the impact of the testing delays could result in difficulty mitigating infection control, further slowing the pace of move-ins, and hampering their ability to replace census.

By Waves 12 and 13, battling the pandemic was putting a strain on operating costs. Although the pace of move-ins had picked up somewhat in the summer months, more organizations were using agency or temp staff to fill staffing vacancies, adding to increasing operating costs since the pandemic began. Further, the share of survey respondents offering rent concessions to attract new residents in Wave 12 had grown to approximately one-half—a level that remained consistent going forward.

The use of rent concessions appeared to provide some support to occupancy rates as month-over-month seniors housing care segment occupancy changes (from 30-days prior) in Waves 14 and 15 trended higher than in recent waves of the survey. The loss of revenue associated with a decline in occupancy rates across care segments in conjunction with rising expenses associated with staffing, PPE, and testing protocols was putting acute pressure on NOI for many operators and their capital partners. Beginning early in the pandemic, the majority of organizations had been bolstering staffing deficiencies with additional overtime hours. 

Survey Waves 16-20 (November 9, 2020 – January 24, 2021)

The fall surge of the coronavirus resulted in another slowdown in the pace of move-ins, and an increase in the share of organizations reporting residents waiting to move in. Presumably as a result of better and safer visitation protocols and more acceptance, resident or family member concerns cited as a reason for acceleration in the pace of move-outs was then at the lowest level in the survey time series.

By Wave 19, NOI continued to be pressured as nine out of ten organizations were still paying staff overtime hours and two out of three were using agency or temp staff to backfill staffing shortages. The higher levels of care segments (assisted living, memory care, and nursing care) reported increases in PPE budgets commensurate with growing levels of care. Additionally, organizations with the largest portfolios of properties were more likely to report significantly higher PPE budget increases than single-site operators.

The drag on occupancy rates continued to be observed in the Wave 19 survey results, likely reflecting a combination of challenges in backfilling COVID-related vacancies as well as the effects of typical seasonality during the holidays and winter months. Despite reports of record-high COVID-19 cases across the country occurring daily, roughly two-thirds of respondent organizations were not increasing move-in restrictions presumably in part due to operator innovations in infection mitigation and creative visitation protocols which have gained acceptance from many residents and families.

Long-anticipated as a game-changer with regard to improving occupancy, many operators were starting to receive the COVID-19 vaccine. In December, the CDC prioritized skilled nursing and assisted living residents and staff members in phase 1a of the COVID-19 vaccine distribution. In Wave 20, ending January 24, 2021, four out of five organizations had finished their first clinic.

Survey Waves 21-23 (January 25 – March 7, 2021)

Amid growing optimism among operators, in late January when the survey data had yet to show an upward trend in occupancy, respondents were starting to notice an increase in prospect interest specifically related to the availability of the vaccine. Positive signals became palpable in the Wave 22 survey results, which revealed upward shifts in organizations reporting acceleration in move-ins and occupancy increases across each of the care segments. Data compiled in NIC’s Skilled Nursing COVID-19 Tracker clearly showed that COVID-19 cases in skilled nursing communities were falling at a faster pace compared to the U.S. since the launch dates of the Pfizer and Moderna vaccines in long-term care settings, and more organizations with memory care units and/or nursing care beds reported increases in occupancy than decreases since prior to the fall surge of the coronavirus.

Roughly nine out of ten respondents in the Wave 22 survey indicated that educating and motivating staff to take the vaccine was a challenge, and operators applied a variety of strategies to encourage and improve vaccine acceptance. In addition to education/communication campaigns, community and corporate leadership stepped up and publicly took the vaccine themselves and the majority have been personally available with one-on-one support for concerned staff. Few respondent organizations have incentivized staff to take the vaccine with financial benefits.

Nearly one year into the coronavirus crisis, the pandemic has necessitated many changes in the way seniors housing and care operators do business. In the NIC Executive Survey Insights Wave 23 results, respondents were asked to list one of the things that their organization plans to keep doing, stop doing, bring back and further develop. In addition to maintaining COVID-19 and infection mitigation protocols, organizations will continue leveraging virtual technologies for a variety of uses including digital marketing campaigns, entertainment, remote visits, and some activities. With most of survey respondents’ residents being fully vaccinated, seniors housing and care operators have begun to look forward to bringing back communal dining, group activities, resident/employee gatherings, and discontinuing visitation restrictions, meal delivery, pandemic staff benefits, and frequent COVID-19 testing.

Survey Wave 24 (March 8 – March 21, 2021)

Currently, with about nine out of ten organizations reporting their residents are fully vaccinated, operator optimism about occupancy recovery continues to grow. More than one-third (38%) think their organizations’ occupancy rates will return to pre-pandemic levels this year. To boost occupancy, approximately 60% of organizations are now offering rent concessions, approaching the peak reached in Wave 17.

In Wave 24, increased resident demand was cited by 85% of respondents as a reason for acceleration in move-ins in the past 30-days, and the shares of organizations reporting deceleration in the pace of move-ins and occupancy decreases is at time series low for all care segments.

Organizations that have seen a notable increase in prospect interest specifically due to the availability of the COVID-19 vaccine has grown from 25% in Wave 21 to 46% in Wave 24. However, staffing shortages experienced by operators prior to and exacerbated by the pandemic persist in Wave 24: three-quarters (77%) of organizations report staffing shortages in their portfolios of properties.

According to the Wave 24 survey respondents, the average percentage of staff who have been fully vaccinated remains at a stagnant 55%. Between Waves 21 and 24, staff uptake of the vaccine to fully vaccinated levels remained flat. Given these results, one in five respondents (20%) say they definitely or probably will make the COVID-19 vaccine mandatory for staff members—similar to the Wave 23 survey (25%) and higher than in Wave 22 when 11% said they planned to make the vaccine mandatory for staff at that time.

Interestingly, although respondents in Wave 23 indicated they were looking forward to less COVID-19 testing, the lack of staff vaccination growth continues to put strain on operating costs for COVID-19 testing. Where one-half of organizations (52%) are testing staff at least once a week, one-half (54%) are testing residents only if symptomatic.

Going forward as vaccine optimism replaces uncertainty, the NIC Executive Insights Survey will track changes in the seniors housing and care sector with continued focus on the market fundamentals, labor and staffing, and factors that affect NOI. From time to time, new questions will be asked as conditions necessitate. NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to advance clarity and transparency during the course of the pandemic.

Wave 24 Survey Demographics

• Responses were collected between March 8 and March 21, 2021 from owners and executives of 64 seniors housing and skilled nursing operators from across the nation. Owner/operators with 1 to 10 properties comprise more than one-half of the sample (61%). Operators with 11 to 25 properties make up under one-quarter of the sample (20%), while operators with 26 properties or more make up 19% of the sample.
• One-half of respondents are exclusively for-profit providers (51%), one-third (34%) are nonprofit providers, and 15% operate both for-profit and nonprofit seniors housing and care organizations.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 75% of the organizations operate seniors housing properties (IL, AL, MC), 33% operate nursing care properties, and 33% operate CCRCs (aka Life Plan Communities).

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

The Wave 25 survey is available and takes 5 minutes to complete. If you are an owner or C-suite executive of seniors housing and care and have not received an email invitation to take the survey, please click this link or send a message to insight@nic.org to be added to the email distribution list.

Nestled among the many pain points of 2020 were a smattering of bright spots for the seniors housing and care industry. For one, the year ushered in a wave of innovative strategies to combat loneliness in the face of social distancing. Among the top strategies was the use of virtual reality – an area which saw a lot of growth and adoption among operators during the public health emergency. As I delved deeper into researching the topic, I learned that virtual reality – in addition to creating opportunities for socialization and stimulation – has been gaining traction as a staff training tool as well.

Embodied Labs’ person-centered caregiver training, for example, provides immersive learning experiences that mimic many of the common conditions and life transitions that impact people as they age. These lab experiences cover vision and hearing loss, Alzheimer’s Disease, end-of-life conversations, cognitive decline, and LGBT and transgender health and aging. In each of these experiences, the trainee becomes the viewer, and assumes a first-person perspective of how older adults experience different aging challenges.

In Embodied Labs’ virtual reality platform, proprietary software is combined with a virtual reality-ready gaming laptop and a tethered head-mounted display. The labs have found their place not only for existing caregiver staff to hone their skills, but also for caregivers-to-be. Georgetown University, for example, is now in its third year using the experiences with third-year medical students who choose to participate in a geriatric clerkship. For these medical students, this is a powerful  opportunity that really embodies the experience of older patients and is essential practice in being a doctor.

I spoke with Pamela Saunders, PhD, Associate Professor and Director of the Geriatrics Clerkship as well as Georgetown University’s Aging & Health Master’s program on how the Embodied Labs’ experiences are used to improve care for older adults. Dr. Saunders noted, “The idea really is to promote an understanding of the patient’s perspective for students. Students can read about macular degeneration, but to really experience how difficult it is to see with this disease is what we want them to walk away with.” Along with each experience, medical students do a pre- and post-assessment and share their reflections with their professors. “If I had my way, I’d have every medical student do it,” she continued. “It would be an inexpensive and easy way to provide training to students in geriatric medicine and embody the patients’ perspective.”

The virtual reality experiences aren’t just limited to students. Benedictine Living Community-Winona is an assisted living, memory care, and skilled nursing community serving approximately 200 residents in Winona, Minnesota. On the Winona campus is a CNA Training Center, used not just by Benedictine Living staff, but also nursing students from the three nearby colleges. In 2018, a Bremmer Trust Fund grant provided the training center with eight virtual reality headsets to be used with “The Beatriz Lab”, Embodied Lab’s Alzheimer’s module.

I spoke with Jenna Barkeim, RN/CNA Training Instructor at Benedictine Living about the impact of the CNA Training Center and the new Embodied Lab’s training modules. Jenna recalled working as a CNA on the Memory Care Unit and thinking how hard it is to prepare someone for working in an environment like that. “While staff reactions to the training module varies,” Jenna says, “I feel the experiences are really impactful for everyone, especially those that had or have loved ones with Alzheimer’s. I believe our staff is more understanding and sympathetic after viewing these modules.”

Currently, the CNA Training Center at Benedictine Living Community of Winona utilizes all the modules from Embodied Labs and is currently working to incorporate “The Frank Lab,” which is the recently released training program on social isolation and loneliness. As has been highlighted during the COVID-19 public health emergency of the last year, loneliness and isolation is a national public health problem with a very real impact to an individual’s health and well-being.

When it comes to training the caregivers of America’s older adults, there needs to be more than just reading and listening. Virtual reality training experiences, which are now more portable and affordable than ever, give students and trainees an incredibly immersive experience, allowing them to understand various conditions more fully from a first-person perspective. This ultimately produces a more empathetic and compassionate caregiver, which benefits everyone involved.