Interest in telehealth shifted into high gear over the last month as senior living providers quickly recognized the benefits of caring for residents with virtual visits as the COVID-19 pandemic unfolds.

Residents do not have to take the risk of leaving their apartments to see healthcare professionals. Visits can instead be conducted online. Timely consultations help prevent later, more costly interventions.

In a big step toward more widespread adoption, Medicare recently announced that it will reimburse for telehealth provided services for the duration of the COVID-19 public health emergency. The change covers providers such as doctors, nurse practitioners and other clinicians. The visits are paid at the same rate as in-person visits.

Telehealth companies are now fielding more requests for services from senior living providers. The use of telehealth is expected only to grow, becoming a standard tool for resident care across the senior living spectrum.

“Remote healthcare has helped us manage through this crisis,” said Richard Nolden, health center administrator at Monarch Landing, a continuing care community in Naperville, Illinois. “Telehealth is not going away.”

The growing value of telehealth was highlighted at the 2020 NIC Spring Conference.

A session titled, “Telehealth: Boon or Threat to Senior Care,” brought together experts who discussed how the technology will impact staffing, cost of care, site of care, and investment returns.

The category of telehealth covers a broad swath of interventions, noted session moderator Kelsey Mellard, CEO at Sitka, a digital healthcare solutions company. These interventions can include everything from remote monitoring of residents via wearable devices to virtual consultations with doctors who can prescribe treatments and medications.

Telehealth can reduce costs and improve care. Peer-reviewed and anecdotal evidence show up to a 40% reduction in hospital admissions with the use of telehealth in post-acute care settings, according to NIC session panelist Michael Kurliand, director of telehealth and process improvement at West Health, a nonprofit focused on lowering healthcare costs for seniors.

The panel was also joined by Robin Glass, president and chief commercial officer at Doctor on Demand, a virtual care provider.

The timing is right

The overall adoption of telehealth services is surging in the aftermath of the COVID-19 outbreak.

• Virtual health-care interactions are on pace to top 1 billion by year’s end, according to a report by Forrester Research.
• Non-COVID related medical visits are expected to reach 200 million this year, up from an original forecast of 36 million visits, said Forrester.
• March telehealth visits rose 50%, according to research by consultancy Frost & Sullivan.
• Virtual care provider Teladoc reported April 18 that it is providing more than 20,000 virtual medical visits per day in the U.S., more than double the volume of the first week of March as the coronavirus outbreak continues to drive telehealth implementation.

Senior living communities are adopting telehealth solutions.

Holiday Retirement announced in March that it is providing 24/7 telehealth access and services to the residents of its 261 communities through MeMD’s national network of healthcare providers.

Monarch Landing’s health center has been using Third Eye Health, an on-call physician service, for about a year now. Third Eye physicians are available virtually during off-hours.

The care provider or nurse on staff connects via iPad to a Third Eye doctor, available within minutes. The software is integrated with electronic health record systems, including PointClickCare and MatrixCare. Both Third Eye and primary care doctors have access to the medical records.

The doctor conducts a live video visit, assisted by the on-site provider. “Telehealth helps us manage resident care,” said Nolden. The service does not replace the primary care physician, he added, but it does help minimize emergency room visits at times when the primary care physician is not readily available.

With a current census of 74 residents, Monarch Landing is also using the iPad platform to virtually connect with specialists, such as psychiatrists and wound care nurses. These practitioners who visit multiple facilities can be a potential source of new infection during the pandemic. “We can provide service but minimize our exposure,” said Nolden.

Prior to the COVID-19 outbreak, Third Eye technology was in use at about 400 nursing homes. “Now we are doubling our business,” said Dan Herbstman, CEO and co-founder of Third Eye. The service is available nationwide. Assisted living facilities with high-acuity residents are using the service too. “Providers are accepting telehealth,” said Herbstman. “The skeptics are coming around.”

How do residents react?

“The residents are fine with it,” said Deborah Hart, CEO at Montgomery Place, a continuing care community in Chicago. “They think it’s cool.”

Montgomery Place uses Third Eye in its skilled nursing center and sometimes with independent and assisted living residents. “It doesn’t cost them anything, so they like that,” said Hart. She moved on to the campus herself in mid-March, a change that has been well received by residents. Several staffers also stay overnight in case of emergencies. “Residents feel comfort knowing that someone is here. I am one of them,” said Hart.

Communities are adopting other telehealth platforms.

Belmont Village Senior Living established new protocols in the wake of the pandemic. Routine off-site doctor visits were discouraged early on.

The company contacted residents’ physicians to ask how best to establish a virtual connection, either by Zoom, Skype, FaceTime, or some other method. The effort coincided with the change in Medicare rules that allowed for the reimbursement of virtual visits.

Belmont distributed iPads to its communities to connect residents with their healthcare providers remotely. Disposable anti-microbial iPad pouches were included to reduce contamination. “We are exercising extreme caution,” said Belmont President Mercedes Kerr.

Like other senior living providers finding success with telehealth services, Belmont is now expanding its offerings.

The company plans to roll out a virtual, after-hours physician service this May. The service will be phased in gradually at Belmont communities. And as with other providers, the service is not meant to replace primary care physicians. “It is a supplement for urgent care,” said Kerr. “We hope to reduce transfers to hospitals.”

Telehealth adoption is expected to accelerate as companies forge partnerships with large healthcare systems, insurers, and information technology companies. These big stakeholders share the goals to reduce costs and improve care.

VitalTech, for example, offers a virtual care platform. It has formed alliances with AT&T Business, the American Hospital Association, physician groups and other providers.

The VitalTech service includes wearable devices that monitor the vital signs of residents. Results are delivered via a smart phone application to the resident’s personal healthcare provider or the provider in the building. The company does not employ physicians but facilitates the connection between residents and healthcare providers.

The application includes medication management as well as a video connection to family and friends. VitalTech is a subscription service but it is being offered free for 90 days to senior living providers during the COVID-19 crisis.

Senior communities are stretched very thin, observed Ernie Ianace, executive vice president at VitalTech. He thinks senior living communities were a little behind the curve in terms of adopting new technology, but the unfortunate event of the COVID-19 outbreak is speeding acceptance of virtual care technology. “So many seniors need care,” said Ianace. “Without technology it will be impossible to serve them.”

In response to the COVID-19 pandemic and associated economic crisis, NIC has launched a number of initiatives designed to inform the seniors housing and care industry, even at today’s rapid pace of change. One of these is our “Executive Insights Survey,” which takes the pulse of hundreds of operators, representing thousands of properties across the country. Survey results and analysis are now published weekly, on this NIC Notes blog. Respondents are senior executives, tasked with leading their organizations through this existentially threatening crisis, both in terms of the health of their residents, and the viability of their businesses. Surveys are distributed weekly to assess occupancy rates, move-in and move-out rates, the development pipeline, staffing, and supports for front-line community employees and staff.

NIC has now released the second week’s “wave” of results from the survey, along with expert analysis from NIC Senior Principal, Lana Peck. While many industry stakeholders, including operators, equity and debt providers, institutional lenders, and a host of service providers, are looking at this weekly pulse check as an indicator of the pandemic’s impact on the industry’s ability to maintain occupancy rates and other key metrics, the survey is also providing insight in more human terms. As reflected in many of the comments in the most recent “NIC Leadership Huddle” webinar (another unique NIC initiative), capital providers and operator executives are fighting a tough battle, often with little support from the government, to keep COVID-19 away from their residents. Survey respondents can leave their comments and concerns, many of which reflect the impact of the crisis on a more human level.

“We feel we are alone in a war zone.”

“We do our best; under the current scenario, the worst isn’t here yet.”

Many comments reflect the reality that in most states and localities, seniors housing and care is not being prioritized for the supplies and support that it needs, despite the fact that these communities are caring for millions of high-risk frail elders. Senior executives and hourly workers alike are working long hours, struggling day and night to meet the often complex needs of their residents while simultaneously protecting them from a disease which is highly contagious, impossible to see, and can be carried for weeks by asymptomatic workers. They know that once COVID-19 gets “in,” it will be deadly, particularly for residents with the pre-existing conditions that are commonplace within these communities.

“Tough times…doing everything we can to keep our residents and staff safe.”

“Post-acute providers are getting no supplies and no financial assistance in COVID response planning. We shelter and care for the most vulnerable to the disease and yet there seems to be no incentive to help us shelter them in place while hospital beds are consumed by the 20% most affected.”

One of the key concerns reflected in survey comments is a lack of available, accurate, and timely testing. This was discussed by the panelists in the most recent “leadership huddle,” who agreed that testing is an essential component of protecting these residents – and is in dangerously short supply, is not always reliable, and sometimes takes too long to be effective.

“Lack of testing is a major concern. We have positive cases but can’t get all residents tested unless they have symptoms. By that point, it’s almost too late to do anything.”

“Given that our employees could be infected, yet be asymptomatic, it is hard to ever feel comfortable that you are doing enough.”

Another key challenge facing these leaders is the scarcity, and now the high cost, of personal protective equipment (PPE). Many report that they are straining to find sufficient PPE, which is complicating efforts to support exhausted staff, many of whom are fearful for the safety of their own families.

“One of the largest concerns we have now is when will COVID-19 peak and getting the necessary PPE to protect staff and other residents.”

“…there are few if any personal protective equipment (PPE – gloves, gowns, etc.) distributions targeted to senior care.”

“Not surprisingly, call outs have increased and availability of PPE has decreased.”

Survey respondents worry about the effect that the pandemic is having on already strained labor force issues. Many front line workers are parents who have children at home. How are they to work long shifts demanded by the additional effort to protect residents – and prepare meals, home school children, and protect their own families?

“Front line staff considering quitting and taking unemployment verse caring with no PPE and kids at home without oversight”

“Staffing becomes critical once a positive COVID resident is identified.”

“Biggest worry is labor shortages; increasing number of staff either testing positive or presumptive position and calling out because of fear. Have an all-out hiring push on, but it takes time and could be difficult because of fear of virus.”

The comments reveal a perspective that is seldom represented in media reports: that it is no easy task to fight this highly contagious killer, particularly in a senior living environment populated with frail elders who often require hands-on assistance, specialized care services, and close monitoring every day and night. Many operators are fighting to save lives, while simultaneously easing the anxieties and concerns of their residents, staff, and families.

“We have been fortunate that our staff have been able to continue their regular hours of work. Closing down our Health Center and not allowing family or friends to visit has been difficult for residents to understand. Independent living residents don’t like the social distancing. As CEO, I send out updates to residents, families, staff to make sure they are informed and know what we are doing to keep everyone safe.”

Some comments include concerns about the media and public attitudes toward the industry. Headlines on infections and deaths, sometimes characterized as occurring in “nursing homes” are on the front pages of every newspaper and are discussed in prime time on live TV. While many journalists and commenters are rightly lionizing the heroic efforts of the healthcare workers in hospitals, too often they tend to take a different tone when discussing the crisis threatening frail elders in seniors housing and care settings. The operators are noticing this, and it is highly likely that their staff is, too. A recent Op-ed in The Hill, written by Bob Kramer and Jacqueline Kung, highlights the importance of this type of press coverage – and the damage it may be doing to the sector’s ability to function.

“There is lots of confusion in the media and news about all seniors housing being the same – IL, AL and MC are not like nursing or skilled care. As an industry, there needs to be better messaging around how each product and service is different in relationship to COVID-19.”

Across this survey, and other NIC initiatives, it is becoming clear that what is most needed, in order to save lives now, is PPE, access to testing, and support from local, state, and Federal government leaders.  As Kramer and Kung point out in their Op-ed, what is not needed is the public perception that the care workers fighting to keep seniors – and the rest of us — healthy on the front lines of this pandemic are any less heroic and worthy of support than their counterparts working in the hospitals across town. Rather than pointing fingers, it would be helpful to recognize that they are humans, too.

The Department of Labor reported that 5,245,000 Americans filed for unemployment insurance benefits in the week ending April 11, 2020 as the COVID-19 pandemic continues to cause businesses to reduce or furlough their workforces as sales plummet. This was a decline of 1,370,000 from the previous week’s upwardly revised level of 6,615,000. The speed and scale of the job losses is unprecedented.  In the past four weeks, more than 22 million people have filed claims. For perspective, there were about 21.5 million jobs generated during the employment expansion that began in October 2010 or said another way, it took four weeks to lose the jobs it took 9.5 years to generate.

Continuing claims for regular benefits, which are reported with an extra week’s lag, rose 4.5 million to 12 million. This marks an all-time high in the data series. This measure, which accounts for people who are continuing to receive benefits, will keep climbing as jobs continue to disappear. This will push the insured unemployment rate (the share of the labor force that claims unemployment benefits) higher. The insured unemployment rate was 8.2% in the week ending April 4, an increase of 3.1 percentage points from the prior week and up from 1.2% pre-COVID-19. This marks the highest level of the rate in the history of the data series. The previous high was 7.0% in May 1975.

The largest increases in initial claims for the week ending April 4 were in Georgia, Michigan, Arizona, Texas and Virginia.

This week’s increase in unemployment claims marks the fourth consecutive week of surging jobless claims and provides a window into the magnitude of the economic downturn into which we are solidly moving. A 11-percentage point surge in the jobless rate to as much as 15% by April is likely, according to a Bloomberg commentary. As recently as February, it was at a 50-year low of 3.5%. In March, the rate had already increased to 4.4%.

Separately, on Wednesday, the Commerce Department reported the steepest monthly drop in retail sales on record going back 30 years and the Federal Reserve said industrial production fell the most since 1946.

Projections of real GDP growth continue to darken, with JPMorgan economists now predicting an annualized rate decline of 40% in the second quarter of 2020. Earlier, the expectation had been a decline of 25%.

The International Monetary Fund (IMF) is also pessimistic, with an expectation of a global contraction of 3% in 2020. This compares with a 0.1% contraction in 2009, the worst year of the previous recession. This amounts to about $2.7 trillion of global losses for the roughly $90 trillion global economy. Such a decline would be unmatched by anything aside from the Great Depression, IMF’s chief economist said. The IMF projects that the U.S. economy will shrink by 5.9% for the year, more than twice as severe as the 2.5% decline in 2009.

In response to the expected sharp slowdown in the economy, the President signed into law a $2 trillion economic stimulus rescue package that broadly expands unemployment benefits. Independent contractors and self-employed individuals are now eligible, at least in some cases. More fiscal stimulus packages are expected to be enacted in the coming months to further blunt the economic fallout of the COVID-19 pandemic.

A NIC report developed to provide timely insights from owners and C-suite operators on the pulse of seniors housing and skilled nursing sectors.

This report marks the second installment of findings from NIC’s weekly Executive Survey of operators in seniors housing and skilled nursing. The report highlights the findings from responses collected at the beginning of the pandemic to now as operators experience changing market conditions due to the COVID-19 threat to residents, staff and business operations; effects of social distancing mandates from state and local governments and seniors housing and care organizations themselves; and the economic effects of shuttered non-essential businesses on local economies.

Summary of Insights and Findings

• The share of organizations reporting lower occupancy rates from the prior month increased in Wave 2. This directional decline in occupancy rates from the prior month occurred across care segments and are supported by anecdotal reports from operators, with some expecting to see greater impact in the coming weeks.
• The segment with the largest share of operators reporting a decrease in occupancy from the prior month was nursing care, with 70% of respondents noting downward directional trends in occupancy rates in Wave 2. The nursing care segment also saw the largest deceleration of move-ins in the past 30-days, likely driven by fewer hospitals discharging patients to post-acute care settings for rehabilitative therapy as hospitals defer elective surgeries due to the pandemic.
• While the majority of organizations continued to report no change in the pace of move-outs by segment, a larger share of respondents reported an increase in move-outs across the board compared to Wave 1. Additionally, the pace of move-ins has decelerated across all segment types compared to Wave 1, except for memory care. Two-thirds attribute the deceleration in move-ins to a slowdown in leads conversion/sales due to a moratorium on in-person tours to keep residents and staff protected from outside contagion. Additionally, about half have an organization-imposed ban on settling new residents into their communities.
• Workforce shortages and staffing challenges are putting financial stress on some organizations. Most are back-filling staffing shortages by increasing overtime hours, and they are supporting the health and wellbeing of property staff by providing flexible work hours and remote work; some are also offering additional paid sick leave and food and meals support for staff and their families.
• Slightly more respondents in Wave 2 expect no change or a decrease in their development pipeline going forward than in Wave 1. While several respondents have new development and/or expansion plans currently underway, uncertainty is a primary concern going forward in the coming weeks and months, despite the prevailing sentiment that demand for seniors housing will continue to grow. This may continue the recent trend seen in NIC MAP data showing a decline in new construction relative to existing supply. 

 Wave 2 Survey Demographics

• Responses were collected April 1-12, 2020 from owners and C-suite executives of 146 seniors housing and skilled nursing operators from across the nation.
• 59% of respondents were exclusively for-profit providers, 31% were exclusively nonprofit providers, and 10% operate both for-profit and nonprofit seniors housing and care organizations.
• Owner/operators with 1 to 10 properties comprise 61% of the sample. Operators with 11 to 25 properties make up 21% while operators with 26 properties or more make up 18% of the sample.
• 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), 34% operate CCRCs (Life Plan Communities), and 32% operate nursing care properties.

Key Survey Results

Change in Occupancy by Care Segment

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

• Approximately one-third to one half of organizations reporting on their independent living, assisted living and memory care units in Wave 2—across their respective portfolios of properties—saw a decrease in occupancy from the prior month. Roughly one fourth saw a decrease compared with the prior week. There were more survey respondents reporting a decrease in occupancy in Wave 2 results than in Wave 1 results.
• Conversely, roughly half to two-thirds of organizations reporting on their independent living, assisted living and memory care units in Wave 2 saw no change or an increase in occupancy rates from the time they responded April 1-April 12, 2020 to one month prior; down from roughly two-thirds to three-quarters in Wave 1.
• Organizations with nursing care beds reported the largest directional declines in occupancy among the four segment types and more respondents reported declines in Wave 2 than in Wave 1. Nearly three-quarters to half of organizations with nursing care beds and assisted living units reported occupancy declines in Wave 2.
• Compared to one week prior, most organizations report little change in occupancy by care segment, except nearly two-thirds of organizations saw occupancy declines in nursing care beds from a week ago, and a quarter saw occupancy increases in memory care units.
  

Pace of Move-Ins and Move-Outs

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

• Generally, more organizations in the recent Wave 2 survey than in Wave 1 report that the pace of move-in rates decelerated over the past 30-days. Approximately two-thirds to three-quarters report a deceleration in move-ins. Only one-third of organizations reporting on their memory care units noted a deceleration.
• The majority of respondents noted no change in move-outs, with generally slight declines from Wave 1 to Wave 2.Nursing care beds had a higher pace of accelerated move-outs compared to other care segments in Wave 2.
  
• About two-thirds to one half of respondents attributed the deceleration in move-ins to a slowdown in leads conversion/sales, an organization-imposed ban and/or resident or family member concerns. At this point in the pandemic, fewer than a quarter of organizations attribute a deceleration in move-ins to a mandatory government ban.
  

Mitigation Strategies for Labor Shortages

Respondents were asked: “My organization is back-filling property staffing shortages by utilizing… (Choose all that apply)”

• Consistent with Wave 1, organizations in Wave 2 are:
  • increasing overtime hours (89%)
  • hiring agency or temp staff (43%)
  • hiring professionals from other industries (29%)
  • using volunteers (14%)

Supporting Property Staff

Respondents were asked: “My organization is supporting property staff who may be experiencing challenges by providing… (Choose all that apply)”

• Most respondents in Wave 2 and Wave 1 report offering flexible work hours and remote work. Others provide additional paid sick leave and to-go meals for families; some are addressing challenges by providing staff childcare.

Development Pipeline Considerations

Respondents were asked: “My organization’s projected development pipeline going forward is expected to… (Choose all that apply)”

• There are generally minimal differences in expectations about organizations’ development pipelines between Wave 2 and Wave 1, however slightly more respondents expect no change (46% vs. 42%) or a decrease (35% vs 25%).
• Uncertainty (95% vs. 88%), and lack of construction labor (13% vs. 3%) between Wave 2 and Wave 1 appear to be growing concerns. Like Wave 1, about 20% in Wave 2 cite supply chain disruptions.

NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and transparency into market fundamentals in the seniors housing and care space at a time where trends are rapidly changing. Your support helps provide both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions. 

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

More seniors will need an affordable alternative for housing and care as the consequences of the pandemic unfold.

As seniors housing owners and operators grapple with the day-to-day challenges of the COVID-19 pandemic, the longer-term ripple effects of the crisis are just now coming into focus.

A growing number of middle-income elders will likely be unable to afford today’s seniors housing and care offerings as the economic fallout of the pandemic plays out. Middle-income seniors had already been identified last year as a vulnerable population in the NIC-sponsored project, “The Forgotten Middle:  Middle Market Seniors Housing Study.”

“Given the COVID-19 pandemic, the need for housing and care for the ‘Forgotten Middle’ is only going to get bigger,” said NIC Chief Economist Beth Mace.

A townhall-style session at the NIC Spring Conference addressed how best to provide housing and care for the growing number of middle-income seniors, a situation even more urgent in the wake of the disease outbreak. Session participants offered a number of creative ideas: providing services through Medicare Advantage plans; adaptive re-use of commercial properties; and the increased use of technology such as telehealth.

The “Forgotten Middle” study showed that 54% of seniors cannot afford today’s senior housing product, based on a monthly cost of $4,500, and do not qualify for assistance under the Medicaid program. By 2029, 14 million seniors will fall into that category.

Mace now expects that number to grow. While it’s hard to predict the depth of the economic upshot of the pandemic, several scenarios seem likely.

Seniors who draw down their savings will join the middle-income ranks of those who can’t afford the housing they need. At the same time, more of today’s middle- income seniors could fall into the low-income category of seniors dependent on Medicaid, putting more strain on an already overstretched program. 

The slowed economy will impact consumer confidence, said Mace. “Confidence is a big factor in people’s decisions to move into seniors housing because it often involves choice.”

Consumers regard the stock market as a metric of wealth. Job losses grab headlines.

“Everyone gets skittish when a lot of people aren’t working,” said Mace. Also housing sales could slow to a trickle. That could impact the seniors housing market, at least in the near term.

Multi-Faceted Solutions

Amid this growing need for middle-market housing, the ideas presented at the NIC Spring Conference are even more relevant, noted Mace. The session was titled, “Planning for the Care Needs of the Forgotten Middle.”

The challenge is to create a housing and care model that is affordable. New approaches will be needed to finance projects and deliver care at a low cost.  

“The middle market is where health and housing intersect,” said study co-author and session participant Caroline Pearson, senior vice president, at NORC at the University of Chicago, which conducted the original research.

Medicare Advantage plans, which cover a growing number of senior living residents, could provide a way to pay for the extra services needed by middle-income seniors, session participants agreed.  Insurers are beginning to recognize the importance of the social determinants of health, such as safe housing, good nutrition and access to healthcare.

Expanded benefits for residents under Medicare Advantage plans could include payments for meals and the activities of daily living, according to Jan Eyer, regional president at Optum, a division of United HeathGroup. Optum consults with seniors housing providers on Medicare Advantage plans.

Different types of partnerships between senior living companies and insurers are emerging. Some operators are forming their own Medicare Advantage plans, while others are aligning with healthcare providers.

The big healthcare REIT Welltower formed a partnership with CareMore Health, a division of Anthem insurance. CareMore enrolls residents in Medicare Advantage plans and then offers healthcare on site at several Welltower-owned buildings. The arrangement helps offset costs, according to James Lydiard, general manager of CareMore’s Touch program for senior living communities.

Integrated healthcare models can reduce costs, said Kevin O’Neil, chief medical officer at Affinity Living Group. Many residents have chronic conditions and functional limitations best addressed in the senior living environment rather than in the more expensive hospital system. “Senior living should be the convener of healthcare,” he said.

Working with local health systems is a priority, session participants emphasized.

Presbyterian Senior Living offers middle market housing. Most of its projects are in Pennsylvania. A hospital system opened a clinic in one of the group’s buildings to help reduce hospital admissions.

“It took a long time of sitting together to figure out how to solve this problem,” noted Diane Burfeindt, vice president of population health, Presbyterian Senior Living. Managed care organizations will only partner with senior living providers that can track outcomes, she noted. “Data is huge.”  

Serving middle-income seniors calls for multi-faceted solutions. Food costs could be reduced through programs such as Meals on Wheels. A small middle market property operated by Presbyterian Senior Living, for example, developed a relationship with a local restaurant to serve meals at the community.

Capital costs represent a big challenge. “Who will finance these projects?” asked Mace.

Unused properties, such as vacant schools might be converted into seniors housing. The low-cost basis of the property would help keep rents in check.

Government programs such as low-income housing tax credits could be expanded to provide an affordable financing vehicle to lower rents. Ground floor space could be rented to retailers to help subsidize costs. “It will take a multi-industry mindset,” said Lydiard.  

Technology will play a big role to lower costs. Senior living providers are already adopting telehealth solutions in the wake of the pandemic. Remote visits by health care providers will help keep middle-income seniors healthier and avoid the costs associated with emergency room visits.

“Telehealth is the way to go to reduce the cost curve for the middle market,” Mace concluded.