Just two days ahead of the NBA season’s restart in Orlando, Florida, NIC hosted it’s ninth “Leadership Huddle” webinar to discuss the professional sports league’s efforts to contain the virus, and gain insight on the latest developments in testing, wearables, and protocols. Titled “From Pro Sports to Senior Care: Innovations in Testing, Tech, and Protection,” the event was intended to share lessons and experiences earned fighting COVID-19 in other industries with seniors housing and care providers and investors.

While very different in terms of scope, demographics, access to resources, and scale, the NBA has been faced with some of the same challenges that senior living operators face today. Working with experts across the country, including Testing for America, a “nonprofit established by leading scientists, academics, and entrepreneurs,” the NBA is showing significant improvements in curtailing the spread of the virus amongst its players and staff, despite putting them in close proximity to train and play together in a ‘bubble’ located in Orlando, Florida.

As NIC CEO Brian Jurutka explained in his opening remarks, “We are now approaching the fifth month since the coronavirus was declared a pandemic. The country has moved from the crisis response phase, where we pulled back from business as usual, to trying to resume activities that were shut down as we await developments in vaccines and treatments for the virus.” As different sectors approach reopening, there is the potential to share critical lessons, innovations, and experiences across industries.

Sri Kosaraju, Governing Council, Testing for America, expressed the importance of testing, saying, “all of you are obviously dealing with this every single day, and it’s critically important to what you do, and the intent of this, from our perspective, is for it to be a resource, and to be helpful to you in this hour.” Testing for America is a nonprofit “established by leading academics, engineers, and entrepreneurs to solve the COVID-19 testing crisis.” Their volunteer members include leading experts and industry leaders in the science of testing.

The bubble

Kosaraju, who stepped down as president of global healthcare company Penumbra (NYSE: PEN) to focus his efforts on Testing for America, has been working closely with fellow panelist Robby Sikka and the NBA for months. Robby Sikka, an anesthesiologist by training, is the founder and CEO of Sports Medicine Analytics Research Team (SMART), an organization that has assisted numerous NBA, NFL, MLB and NHL clubs with injury data, return to play planning, and player evaluation and development. He is VP of Basketball Performance for The Minnesota Timberwolves, and has been working more broadly with the NBA to develop protocols to protect players and staff from infection as they plan to reopen their season. He described what he calls the NBA’s “bubble and mini-bubble” approach to preventing the spread of COVID-19, which he said could be used within seniors housing and care communities.

The NBA’s approach is to have each team separated into its own mini-bubble within a larger bubble, so that they can train and play together, whilst retaining distancing and protocols designed both to protect from outside, and from bubble to bubble. Sikka said it has been well-documented that the league “went from a 10% positivity rate in the first week amongst players to 0% in the last two weeks. And the reason is, they had mini-bubbles.”

Sikka described a number of approaches that have helped achieve that result. Between June 23 and July 7 the NBA tested every other day. “Your testing cadence really matters because you may not have testing every day. You may also have delays.” When test results are delayed, he assumes there are positives and acts accordingly. “We’re seeing anecdotally its not just the games that are putting players at risk, but group activities. We’re seeing it in baseball and soccer… there are too many things where sharing air in small, confined spaces are leading to outbreaks.” He discussed travel on aircraft and busses, and other instances of close confinement causing outbreaks.

The NBA’s system is a phased approach to allowing players to interact, beginning with social distancing protocols, then increasing levels of testing as teams allowed individual workouts, whittling down the pool of uninfected players until there was a high assurance that it was safe to practice and play in groups. With a COVID-free group, the NBA added rapid testing to their protocol. Today, as the teams prepare to play each other, each team’s mini-bubble practices strict protocols, minimizing exposure, and decreasing the chance of spread. Sikka pointed out that in this system, it is not necessary to test all staff, while observing the bubble system protocols, which strictly limits potential exposure and keeps teams isolated.

Even players’ families must abide by the system. They must test every other day for seven days prior to entering the NBA bubble in Orlando. Once in the bubble, they must quarantine for another seven days, before being able to stay with their loved one. Staff are not allowed visits from family. The organization also enforces a test protocol for anyone reentering the bubble after traveling beyond it, requiring negative results on at least two tests over a 72 hour period prior to gaining entry. “We’ve saved a ton of money because we haven’t spent a single penny on cleaning our building at all,” Sikka said, explaining that with the protocols and testing, they only need standard cleaning. According to Sikka, the protocols are preventing infiltration of the virus, despite rising infection rates within the community outside, and even some positive tests amongst family members.

Sikka also emphasized the critical importance of mask compliance to the program’s success. It is strictly adhered to, particularly to keep mini-bubbles from potentially contaminating each other within the larger bubble. “You don’t need to have a perfect test if you have good communication and compliance with masks,” he said.

Saliva testing

The NBA is funding a study with Yale University, which has developed a $1, reagent agnostic saliva test that can be pooled. According to Sikka, the test may be about two weeks away from gaining FDA “Early Use Authorization” approval, which will allow labs to begin using the test more widely. He envisions labs across the country soon being able to provide saliva tests at scale, and suggested, while not every resident may be able to produce saliva, the test could be used for all staff and visitors, and many residents. “This is a cheap, asymptomatic screening test that can be run rapidly,” he said. Without the need for swabs and for more time-consuming lab work, the test would be quick, comfortable, and lower-risk to administer. He claimed the test is “90% sensitive compared to nasal pharyngeal swabs.”

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Wearables and contact tracing

Another innovation in use by the NBA involves wearable devices, such as the Apple watch, Oura ring, and Fitbit – all devices that the NBA has selected to work with. Already hugely popular, millions of Americans are wearing such devices already, and have smart phones that can enhance the devices’ capabilities. The NBA is using wearables as proximity trackers as well as a means to perform contact tracing. Wearables are promising to be able to detect subtle temperature changes, and to thereby detect a COVID-19 infection up to three days prior to other symptoms appearing. Data from these devices can be used to track and screen groups of people, and to identify higher-risk individuals over larger populations. Proximity tracking can warn a wearer that they are too close to other individuals for an extended period of time.

Other considerations that Sikka commented on ranged from activity and social gathering protocols, to having the “guts” as an organization to make tough decisions. The NBA is ensuring disposal of playing cards after they are used, and prohibiting doubles play in ping pong, among other steps to ensure safety while allowing limited social interactions. While the organization is less focused on facility cleaning, they believe ventilation “is probably not appreciated enough,” according to Sikka. He also emphasized the importance of early quarantines and early testing, saying, “I will not let someone in my building if they are not tested.”

Contact tracing, according to Sikka, is also essential. “We have 100% compliance on contact tracing and 100% compliance on wearables, and this is because we’ve forced our folks to really understand, hey, this isn’t just about you. This is about everybody else. It’s not about us trying to control your behavior but it is about you participating in a group that really needs every person to step up. We cannot have weak links” he said.

The importance of testing

Kosaraju provided an overview of where we stand on the development of testing for COVID-19, referring to three phases of development. The initial “shutdown” phase saw development of the first tests, such as PCR (polymerase chain reaction) and Isothermal nucleic acid amplification, which require a significant amount of lab work. As we enter a gradual reopening phase, according to Kosaraju, “Not only do we need more testing, its our view that we need to make smarter decisions about testing.” He described using testing as a screening tool, and incorporating testing into the environment, not only for the sick, but to detect potentially asymptomatic carriers. That will require testing more people, and therefore a development of technological capabilities. Once vaccines are “available and effective,” testing will enter a new phase, in which they will help monitor and protect against future outbreaks.

Today we need more testing, and to get tests to the right people, according to Kosaraju. Challenges include mixed messages on the need for testing, and a lack of a centrally coordinated plan that addresses COVID-19 and potential future pandemics. He underlined the importance of providing “accurate, affordable, and rapid” testing, saying, “waiting 7 days for a turnaround time defeats the purpose, if not making it worse.” He then outlined the advantages and disadvantages of today’s testing technologies, as well as new approaches that are being investigated and may soon become more widely available, such as the saliva test in development at Yale. “We’ve come a long way in testing…testing technology is improving. We are making improvements to make it faster, more scalable, rapid, and more cost-effective, ultimately. We are heading down the right path.”

Jurutka posed a few questions submitted by the webinar audience. The first centered on whether and when the saliva test in development at Yale would become approved, and widely available. In response, Sikka pointed out that the protocol for the test is open-source, and publicly available. The test is awaiting the FDA’s Early Use Authorization, which will enable labs to begin using the test, but Sikka expressed hope that a “clear verification” step can be waived. “We’ve seen a negative predictive value that’s equivalent to swabs…we’ve also seen, in a hospitalized population set, 94% sensitivity…so for a screening test its really a perfect test.” While the test will cost $1-2, he suggested a commercial lab will likely mark that up.

Automation, pooling, and more test runs per day will also help scale up testing capacity, on a test that is “much, much more tolerable, and safer” than swab testing. He said, “we’re not going to be swabbing for the rest of the year, we’re going to have alternative tests, and we’re going to have a lot of different tests available by December. But really to get us out of this and to help us get back to whatever the new sense of normalcy is, we’re going to have to have alternatives to swabs.”

NIC MAP^® Data Service clients attended a webinar in mid-July on the key seniors housing and nursing care data trends during the second quarter of 2020. Led by the NIC research team, the webinar presented findings that reflected the impact of COVID-19 across the seniors housing and care sector. Key takeaways included the following:

Takeaway #1: Seniors Housing Occupancy Fell Sharply in 2Q 2020

• The all occupancy rate for seniors housing fell 2.8 percentage points in the second quarter to 84.9%, the lowest level since NIC has been reporting the data in 2005. This drop in occupancy was directly related to the COVID-19 pandemic as net demand fell by an unprecedented 15,100 units. Separately, new supply decelerated to its slowest pace since the first quarter of 2019.
• For perspective, its notable that the drop in net occupied units or absorption, while very large, only pushed total occupied units back to the level of the first quarter of 2019.
• 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 2.9 percentage points to 86.9%, also a record low.
• The gap between all occupancy and stable occupancy was largely unchanged at 2.0 percentage points.

Takeaway #2: One of Five Properties Had 95% or Higher Occupancy

• There is a wide range of property level performance within the largest metropolitan markets. The average occupancy rate alone is not a tell-all indicator of a metro market.
• The median occupancy rate—which is defined as the mid-point of the distribution, with an equal number of properties below that rate as above that rate—is pulled higher compared with the average occupancy rate because 22% of the properties had a 95% occupancy rate or higher. Additionally, more than 43% of all properties had rates higher than 90%. This may be surprising to some.
• There was a large drop in the number of properties with an occupancy rate above 95%, however. This fell from a share of 33% in the first quarter to 22% in the second quarter.
• The average occupancy rate is being pulled down by the 28% of properties with occupancy rates below 80%, and the 40% of properties having occupancy rates less than 85%.
• Weaker occupancy rates were more prevalent in the second quarter. In the first quarter there were a lesser 31% of properties with occupancies below 85% (versus 40% in Q2) and only 22% with occupancies below 80% (versus 28% in Q2).

Takeaway #3: Largest Occupancy Declines Were in the April Reporting Period

• NIC MAP now offers Intra-Quarterly data results through June by metro area. 
• Over the April, May, June three-month reporting periods, Denver had the largest drop in occupancy, falling nearly 5 percentage points from 87.9% to 83.2%, followed by St. Louis, Sacramento, and Orlando. The smallest decline in occupancy occurred in Cleveland, Washington, D.C., and Baltimore.
• In most instances the largest drops occurred in the April reporting period with lesser deteriorations in the May and June reporting periods.
• Two markets saw a bit of improvement in the June reporting period—Sacramento and Cleveland.

Takeaway #4: More Entities Reported an Increase in Move-Ins

• Since the onset of the pandemic, NIC has been conducting a regularly issued Executive Survey, a survey being conducted by NIC to get timely insights into the impact of COVID-19 on operators in the seniors housing and skilled nursing.
• In Wave 9 of the Executive Survey, the shares of organizations reporting an acceleration in move-ins in the past 30-days—across each of the care segments—is the highest in the time series (March 24 to July 5, 2020), while the shares of organizations reporting deceleration in move-ins is the lowest.
• As shown in the chart below, in Wave 9 of the survey, between 36% and 42% of organizations reporting on their independent living, assisted living, memory care, and nursing care segments noted that the pace of move-ins accelerated in the past 30-days. This is the second consecutive wave showing an increase of organizations reporting accelerated move-ins in the past 30-days, and the highest in the time-series, March 24 to July 5. The independent living care segment saw the most growth in the shares of organizations reporting an acceleration in move-ins between Wave 8 and Wave 9 (from 19% to 42%). Comparatively, between 16% to 26% of organizations with independent living, assisted living and/or memory care units, and 33% of organizations with nursing care beds reported that the pace of move-ins decelerated in the past 30-days—the smallest shares reported in the time series.
• Reasons cited by survey respondents for either an acceleration or deceleration in move-ins varied. In Wave 9 of the survey—as some state and local governments had lifted COVID-19 contagion spread mitigation measures, prompting some organizations to resume pre-pandemic planned move-ins, just over a third of respondents cited an organization-imposed ban or resident or family member concerns as reasons for slumping move-in rates–the fewest since the survey’s inception.

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.

Key Takeaway #5: All Buyer Activity Relatively Weak in 2Q 2020

• Based on this preliminary data, transactions volume in the second quarter totaled only $1.2 billion, which is not very surprising given the pandemic and the challenges within seniors housing and care that were present in the second quarter. That $1.2 billion represented a 64.3% decline from the first quarter of 2020 when volume registered $3.2 billion and a 70.4% decline from a year ago when volume registered $3.9 billion in the second quarter of 2019. For the year-to-date, transaction volume totaled $4.4 billion.
• Overall buyer activity was depressed with the topline dollar volume of only $1.2 billion, but one of the bright spots, although off a very small base, is the increase in activity from the institutional buyer in the second quarter.
• The institutional buyer activity increased 220% from the first quarter to register $309 million in closed transactions. Note however that this is coming off a very small base in the first quarter with only $97 million closed.

Interested in learning more?

While access to the full presentation of the key takeaways from this article is available exclusively to NIC MAP clients, the abridged version of the 2Q20 Data Release Webinar & Discussion – featuring data graphs and my commentary – is available through the link below.

Download Abridged Presentation

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.

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A lot of economic news today, much of which was not encouraging. First, the long-awaited first estimate of GDP growth in 2Q 2020 was released by the Bureau of Economic Analysis and as anticipated the number was historic, with an annualized decline of 32.9% reported. Second, and for the second consecutive week, the number of initial claims filed for unemployment insurance rose. Third, the Chair of the Federal Reserve, Jerome Powell, encouraged Congress to act quickly to inject further fiscal stimulus into a weakening economic landscape.

Regarding the GDP report, the estimated inflation-adjusted output metric of all goods and services produced across the U.S. economy plunged 32.9% in the second quarter, a record one-quarter contraction of the domestic economy. This was more than three times larger than the previous record quarterly contraction and underscores the unprecedented impact of the pandemic on the broad economy.

A collapse in household spending (down 34.6%), which was already weak in the first quarter (-6.9%), led the plunge reflecting historically large job losses, stay-at-home orders, lockdowns, and large numbers of business closures. Services consumption was down by 43.5%, with the biggest declines coming in healthcare, as non-essential check-ups and procedures were delayed as well as dramatically less spending on entertainment and restaurants. Shutdowns and weak demand also weighed on business and residential investment. In contrast, the federal government fiscal stimulus contributed to a 2.7% rise in government spending, although that metric would have been larger had it not been for a 5.6% drop in state and local spending which reflects the revenue shortfalls at these jurisdictional levels.

Despite the drop in income associated with job losses, inflation-adjusted disposable income jumped by 44.9% at an annualized pace as unemployment insurance payments helped offset the loss of paychecks and tips.

A robust third quarter bounce back in GDP is looking less likely, given a resurgence in coronavirus cases that is weighing on economic activity. COVID-19 virus containment is key. Without it, a more complete reopening of the economy, which is crucial for recovery, will remain out of reach.

Separately, the Labor Department reported that jobless claims rose to 1.434 million in the week ending July 25, up from 1.422 million in the prior week. This marked the second consecutive weekly increase and the 19^th consecutive week that claims exceeded one million. Up until two weeks ago, this metric had been falling on a consistent basis week over week. Continuing claims for regular benefits, which are reported with an extra week’s lag, rose by 867,000 to 17.018 million in the week ending July 18. Including people who are collecting benefits under expanded pandemic assistance, 30.202 million people were receiving unemployment insurance in the week ended July 11. By this measure, the unemployment rate would be calculated as closer to the high teens level versus the 11.2% official rate reported by the Labor Department. The increase in the weekly rates reflects the resurgence in COVID-19 cases which in turn has resulted in a pause or in some situations a rollback of re-openings across some states.

Separately and earlier this week, the Conference Board reported that its index of consumer confidence fell in July as consumers became less optimistic about the short-term outlook for the economy and the labor market.

Meanwhile, the Federal Reserve met this week and provided a downbeat assessment of the economic outlook. While acknowledging that economic activity and employment had “picked up somewhat,” they still “remain well below” pre-pandemic levels. In the post-meeting press conference, Chair Jerome Powell doubled down on that point, calling the spread of the coronavirus “the most central driver” of the economy, and said the renewed surge in cases had led to a “slowing in the pace of the recovery”. At the same time, he acknowledged the uncertainty, saying how large and how sustained that slowdown will be is unknowable. He stressed that additional help from fiscal policy is essential, stating “fiscal policy can address things that we (the Federal Reserve) can’t address.” He called the pandemic and its fallout “the biggest shock to the U.S. economy in living memory.” Powell emphasized the pandemic will dictate the trajectory of economic recovery.

And with that, thank goodness there is no more economic news being reported today…

In a continuation of NIC’s commitment to release data and insights on a monthly basis in response to rapid market changes, NIC released monthly data today from the NIC Skilled Nursing Data Initiative. This release incorporates key takeaways of market trends through May 2020. The following summarizes the monthly release with data from January 2012 through May 2020.

Occupancy

The skilled nursing occupancy rate continued to decline in May due to the impact of the COVID-19 pandemic. Occupancy fell 347 basis points from April to end May at 75.5%. This represents a decline of 784 basis points since March, when occupancy was 83.3% and is down 921 basis points since February, prior to the pandemic. Year-over-year, the occupancy rate is down 862 basis points from May 2019. 

Patient day mix across all four payor types, i.e. Medicare, Managed Medicare, Medicaid and Private, did not see relatively significant movement when compared to the occupancy change from April to May, suggesting admissions decreased across all payor types, except perhaps for Medicare which saw patient day mix uptick slightly.

Medicare

Medicare patient day mix increased 66 basis points from 11.3% in April to 11.9% in May. Since March, it is up 82 basis points. In addition, Medicare revenue mix was relatively steady from April to May, decreasing by only 11 basis points. When compared to overall occupancy, it is likely that the cancellation of elective surgeries continued to have a major impact on Medicare, even as many states have recently started to allow those surgeries to resume. However, Medicare patient days likely did not decrease as much as it would have given that the Centers for Medicare and Medicaid Services (CMS) waived the 3-Day Rule, which waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered skilled nursing stay. This enables more patient days to be covered by Medicare, which can have a positive impact on cash flow, all else equal. Meanwhile, Medicare revenue per patient day (RPPD) increased 0.9% from $548.81 in April to $554 in May. Medicare RPPD likely increased because of additional reimbursement due to COVID-19 positive patients requiring isolation, in addition to the temporary suspension of the 2.0% sequestration cuts by CMS, which will be effective from May 1 through December 31, 2020.

Managed Medicare

Managed Medicare admissions are likely still experiencing declines because of COVID-19 even as some states resume elective surgeries, as many may still be hesitant to move forward with surgeries because of the pandemic. Many insurance plan enrollees will also be cared for at home after surgeries, bypassing skilled nursing properties. Managed Medicare revenue mix has declined significantly since February, dropping 307 basis points to 7.3% in May. Since March, it is down 228 basis points. However, Managed Medicare revenue mix held relatively steady from April to May and only declined by 27 basis points. Year-over-year, it is down 220 basis points from 9.5% in May 2019. Meanwhile, Managed Medicare RPPD increased 0.6% from $453.53 to $456.35 in May. Since March, it has increased by 1.21% suggesting some reimbursement stability from insurance companies during the pandemic. However, year-over-year RPPD is only up 0.4% from May 2019.

Medicaid

Medicaid revenue mix declined 96 basis points from 49.4% in April to 48.5% in May. Medicaid patient days likely decreased as well, due to lower overall admissions in May and some Medicaid patients converted to Medicare given the waiver of the 3-Day Rule. Medicaid revenue mix has declined 240 basis points since March when the mix was 50.9%. Year-over-year, Medicaid revenue mix decreased 268 basis points from May 2019. Meanwhile, Medicaid RPPD increased 0.4% from $230.30 in April to $231.26 in May. However, there has been an increase of $7.13 RPPD from February, representing a 3.2% increase as states embraced measures to help skilled nursing properties such as increasing reimbursement related to the number of COVD-19 cases at properties. Even with this increase the concern continues to be that current Medicaid RPPD does not cover the actual cost of care in most states.

This analysis and commentary is based off of aggregate data from a sample of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators in the NIC Skilled Nursing Data Initiative in order to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form here. NIC maintains strict confidentiality of all data it receives.

A NIC report to provide insight into COVID-19 among current residents and to more clearly understand existing conditions by care setting.

NIC’s monthly Executive Survey Insights: COVID-19 of seniors housing and skilled nursing operators is designed to bring awareness to the operators, their capital providers and business partners, and the general public, on the current COVID-19 penetration rates by care segment. Providing data on current penetration rates gives perspective on how the sector has adapted in the four months since COVID-19 was declared a pandemic. Providing data by care segment enables insights into how COVID-19 has impacted the different populations in each segment, which vary substantially in levels of health.  

Wave 2 of the survey includes responses collected July 6-July 19, 2020 from owners and executives of 52 seniors housing and skilled nursing operators from across the nation. Detailed reports for this wave, along with past survey findings can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Summary of Findings of Staff and Residents in Place on June 30, 2020

Data collected in a survey of seniors housing and care operators by the National Investment Center for Seniors Housing & Care (NIC), shows operator average COVID-19 penetration varies by care setting among current residents, ranging from 0.4% in independent living, 2.9% in assisted living, and 3.9% in memory care. As was the case with Wave 1, operator average COVID-19 penetration rates were lowest in the least acute care setting of independent living and increased with acuity. Due to sample size limitations, operator averages for nursing care have not been included.

Wave 2 data shows higher COVID-19 testing across all care segments, with an operator average ranging from 18.5% in independent living up to 45.7% in memory care. Survey findings also show an operator average of 78.5% of community staff in place on June 30, 2020, regardless of care setting, had been tested for COVID-19.

Key Findings

Testing and Current Penetration of COVID-19 by Care Segment

Respondents were asked: “Distributed into the following categories, the total number of my organization’s (independent living, assisted living, memory care, nursing care) residents were: 1) Tested for COVID-19 with a PCR test, 2) Laboratory confirmed positive PCR test, and 3) Suspected COVID-19”

• In Wave 2, the operator average percent of residents tested for COVID-19 (of residents in place on June 30, 2020) for independent living is 18.5%. For assisted living the operator average percent residents tested is 41.7%, and for memory care is 45.7%.
• The operator average percent of confirmed or suspected COVID-19 in independent living is 0.4%. For assisted living the operator average percent is 2.9%, and for memory care is 3.9%. Due to sample size limitations, operator averages for nursing care have not been included.
• In Wave 2, operator average testing penetration for independent living was 18.5%, for assisted living was 41.7%, and for memory care was 45.7%. In both Waves 1 and 2, operator average testing penetration increased as care setting acuity increased.

Testing and Current Penetration of COVID-19 Among Community Staff

Respondents were asked: “Distributed into the following categories, the total number of my organization’s staff were: 1) Tested for COVID-19 with a PCR test, 2) Laboratory confirmed positive PCR test, and 3) Suspected COVID-19”

• The operator average percent of community staff tested for COVID-19 (of staff in place on June 30, 2020) regardless of care setting is 78.5%. Of total staff, an operator average of 5.2% tested positive and another 0.9% suspected positive, for a community staff operator average penetration rate of 5.9%.

Demographics

• Responses were collected July 6-July 19, 2020 from owners and executives of 52 seniors housing and skilled nursing operators from across the nation.
• More than one half of respondents were exclusively for-profit providers (56%), 33% of respondents were exclusively nonprofit providers, and 11% operate both for-profit and nonprofit seniors housing and care organizations.
• Owner/operators with 1 to 10 properties comprise 50% of the sample. Operators with 11 to 25 properties make up 28% while operators with 26 properties or more make up 22% of the sample.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 51% of the organizations operate seniors housing properties (IL, AL, MC), 22% operate nursing care properties, and 27% operate CCRCs (aka Life Plan Communities).

Methodology

Answering on behalf of their organizations, seniors housing and care owners and executives provided the COVID-19 incidence data shown above. The data is self-reported, non-validated, and based on a convenience sample.

Data is reported as operator averages to prevent the skewing of data that can be caused by larger-sized operators.  Operator averages are obtained by first calculating rates for each operator survey response and then taking an average of those rates across the sample.

Definitions

The following definitions were included with the survey instructions to ascertain specific responses from operators:

• Lab Tested Positive: Includes only residents who have been tested for active infection with PCR test. Serology antibody tests should not be included. Includes residents who have tested positive for COVID-19 at a CDC, state or local laboratory.
• Suspected Cases: means the resident is managed as if they have COVID-19 with signs and symptoms suggestive of COVID-19, but do not have a laboratory positive COVID-19 test result or those with pending test results. 
• Recovered: For residents in a hospital or rehab setting, “recovered” is defined as having had two consecutive negative tests at least 24-hours apart; for residents in-house, 1) 72-hours symptom-free with no medication, and 2) at least ten days from onset of symptoms.
• Active Cases: Those who are laboratory-tested positive, suspected positive, or diagnosed by a physician, and are still in place but not deceased and do not meet the criteria for “recovered.”

NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and transparency into the seniors housing and care space.

If you are an owner or C-suite executive of seniors housing and care properties and have not received an email invitation but would like to participate in the current Executive Survey, please click here for the current online questionnaire.