Executive Survey Insights Wave 35: November 8 – December 5, 2021

Wave 35 survey includes responses from owners and executives of 72 small, medium, & large seniors housing and skilled nursing operators.

In the Wave 35 survey, nearly half of organizations with multiple properties (45%) reported staff shortages in all their properties—up from roughly one-third (30%) in the Wave 24 survey conducted mid-March. While attracting community and caregiving staff remains a significant challenge, the percentage of organizations citing staff turnover increased from about one-half (53%) to more than two-thirds (70%) since mid-June. When asked about backfilling staffing shortages, three-quarters (77%) of organizations currently employ agency or temp staff. While more than half (57%) indicated that their agency/temp staff use increased by up to 50% this year, significantly, one out of five (20%) said it increased by 100%. Nearly one-half of organizations with nursing care beds saw an improvement in occupancy (47%) up from 38% in Wave 34. Optimism regarding near-term occupancy recovery to pre-pandemic levels is flagging somewhat from recent surveys. In the Wave 33 survey conducted in September, roughly four out of five respondents expected their organization’s occupancy to recover sometime in 2021 or 2022. That sentiment shifted in Wave 35: nearly nine out of ten organizations expect their occupancy to recover in 2022 or later, with one-quarter (26%) now expecting it to occur in 2023.

–Lana Peck, Senior Principal, NIC

NIC’s Executive Survey of operators in seniors housing and skilled nursing is designed to deliver transparency into market fundamentals in the seniors housing and care space as market conditions continue to change. This Wave 35 survey includes responses from November 8 to December 5, 2021, from owners and executives of 72 small, medium, and large seniors housing and skilled nursing operators from across the nation, representing hundreds of buildings and thousands of units across respondents’ portfolios of properties.

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.

Wave 35 Summary of Insights and Findings

  • Lead volumes are improving. In Wave 35, more than one-third of organizations had lead volume at pre-pandemic levels (36%), up from 20% in April 2021 (and 33% in Wave 34).

Lead_Volume_Graph_576x506

  • The share of organizations that reported that the pace of move-ins accelerated in the past 30-days did not change significantly in Wave 35. Between 39% and 44% of organizations reported an acceleration in their pace of move-ins, with the range varying based on the care segment type. Presumably, due to need-based moves rather than choice-based moves, fewer organizations with nursing care beds reported a deceleration in the pace of move-ins since the summer when the delta variant of the COVID-19 virus was in broad circulation.

Pace_of_Move-ins_Graph_916x616

  • Considering the pace of move-outs in the past 30-days, no change was reported by the majority of organizations across care segments. However, one-quarter of organizations with assisted living units (26%) noted an increase in the pace of move-outs.

    Pace_of_Move-outs_Graph_908x646

  • The chart below illustrates the pace of move-ins experienced by organizations with assisted living units across their portfolio of properties since the beginning of the pandemic (impacting events are observed in the footnotes). The recent slowdown in the pace of move-ins since the Wave 30 survey conducted in June may be due to the spread of the COVID-19 delta variant or waning pent-up demand following the unprecedented third quarter 2021 pace of absorption tracked by NIC MAP Vision, or it could be due to typical patterns of seasonality. The omicron variant may add some uncertainty until we learn more about its characteristics.

AL_Pace_of_Move-ins_Graph_980x626

  • In Wave 35, one-quarter of organizations with assisted living units (24%) saw a decline in occupancy typically associated with natural attrition and transfers to memory care and/or nursing care segments, both of which saw more growth in occupancy than in the prior survey. Nearly one-half of organizations with nursing care beds saw an improvement in occupancy (47%), up from 38% in Wave 34.

Occupany_Change_Graph_902x614

  • Since the Wave 33 survey conducted in September, the share of organizations (of all sizes ranging from single properties to hundreds of properties) reporting staff shortages have oscillated around 100%. Digging deeper, in the Wave 35 survey, nearly half of organizations with multiple properties (45%) reported staff shortages in all their properties—up from roughly one-third (30%) in Wave 24 conducted mid-March.

Staff_Graph_906x516

 

  • Respondents are routinely asked to rank the biggest challenges facing their organizations. Since August, more than four out of five respondents indicated that attracting community and caregiving staff was among their biggest challenges. As shown below, challenges due to staff turnover increased from about half (53%) to more than two-thirds (70%) since mid-June.

Challenges_Graph_874x542

 

  • NOI has been pressured for many operators due to the impact of labor shortages and higher wages on expenses, rising insurance costs, inflation-related higher-priced materials, the pandemic-related decline in occupancy rates, and the inability to grow rents. When asked how they are backfilling staffing shortages, 100% of respondents cited overtime hours since Wave 31 (data collected between July 12 and December 5). Currently, 77% of organizations indicated using agency or temp staff.
  • In Wave 35, a new question was asked to better understand and track operators’ employment of expensive agency/temp staff to backfill staffing shortages. As shown in the chart below, more than half (57%) indicated that their use of agency/temp staff increased by  50% this year. However, one out of five surveyed (20%) said it increased by 100% (and a few respondents remarked that it increased more than 100%).

Temp_Staff_Graph_682x254

  • Optimism regarding near-term occupancy recovery is flagging somewhat from recent surveys. In Wave 33 conducted in September, roughly four out of five respondents expected their organization’s occupancy to return to pre-pandemic levels sometime this year or in 2022. That sentiment shifted in Wave 35. Currently, nine out of ten organizations (87%) expect their occupancy recovery to occur in 2022 or beyond, with one-quarter (26%) now expecting it in 2023.

Occupancy_Expected_Graph_918x604

 

Wave 35 Survey Demographics

  • Responses were collected between November 8 and December 5, 2021, from owners and executives of 72 seniors housing and skilled nursing operators from across the nation. Owner/operators with 1 to 10 properties comprise roughly two-thirds (63%) of the sample. Operators with 11 to 25 and 26 properties or more make up 37% of the sample (18% and 19%, respectively).
  • Approximately one-half of respondents are exclusively for-profit providers (54%), one-third operate not-for-profit seniors housing and care organizations (33%), and 13% operate both.
  • Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 69% of the organizations operate seniors housing properties (IL, AL, MC), 19% operate nursing care properties, and 39% operate CCRCs (aka Life Plan Communities).

    Owners and C-suite executives of seniors housing and care properties, please help us tell an accurate story about our industry’s performance.

    The current 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 contact Lana Peck at lpeck@nic.org to be added to the list of recipients.

    NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and create a comprehensive and honest narrative in the seniors housing and care space at a time when trends are continuing to change in our sector.

Skilled Nursing Occupancy Declined in September 2021

NIC MAP® released its latest Skilled Nursing Monthly Report which includes key monthly data points from January 2012 through September 2021.

 
Omicron Variant an Added Risk as 2021 Comes to a Close.

 

NIC MAP® data, powered by NIC MAP Vision, released its latest Skilled Nursing Monthly Report on December 2, 2021, which includes key monthly data points from January 2012 through September 2021.

Here are some key takeaways from the report.

Occupancy

After seven months in a row of increases, skilled nursing property occupancy declined from August to September, decreasing 27 basis points to 75.1%. Nevertheless, occupancy was still 355 basis points above the low point of 71.5% reached in January 2021. In general, there remains cautious optimism about improving occupancy trends but there remain challenges including the rapid spread of the contagious COVID-19 delta variant in the summer and fall months as well as labor shortages, which have caused some properties to limit new patient admissions. In addition, there is potential for additional challenges due to a lack of booster shot prioritization among skilled nursing properties, the arrival of the fall/winter season, spread of the new omicron variant, and persistent labor shortages. Occupancy remains very low compared to February 2020 pre-pandemic levels of 85.7% (10.6 percentage points).Skilled Nursing Occupancy January 2012 to September 2021

 

Medicare

Medicare revenue per patient day (RPPD) increased by $2.82 (0.5%) from August, to end September 2021 at $565. Despite the gain, it remained 1.5% below its December 2020 level ($573.68) when cases in skilled nursing properties were spiking and RPPD was higher likely because the federal government had implemented initiatives to aid Medicare fee-for-service reimbursements for situations such as providing higher rates to help care for COVID-19 positive patients requiring isolation. Meanwhile, Medicare revenue mix continued to decline, falling 33 basis points from August to end September at 19.9%, a time-series low. It has been falling since January 2021 when it was 24.9%, the time of peak COVID-19 cases.  Medicare revenue mix 2012 to 2021

 

Managed Care

Managed Medicare revenue mix held relatively steady from August to September at 10.5%. It was down from its recent high of 11.2% in February but was up from the pandemic low set in May 2020 of 8.4%. The increase may be due to growth in elective surgeries from the prior year; elective surgeries often create additional referrals to skilled nursing properties. Meanwhile, Managed Medicare revenue per patient day (RPPD) increased from $447 to $449 in September but was down 3.2% from last year in September 2020.  It has decreased $104 (18.8%) from January 2012 and continues to create pressure on operators’ revenue as Managed Medicare enrollments grow around the country.

Medicaid

Medicaid patient day mix increased to 66.3% in September, up from the pandemic low of 63.2% set in January 2021. On the other hand, Medicaid revenue mix deceased in September to 50.0%, representing half of all property revenue. In addition, it has increased 314 basis points from the pandemic low of 46.9% set in December 2020. Meanwhile, Medicaid revenue per patient day (RPPD) decreased $1 from August to end September 2021 at $242. However, the latest monthly data in September still represents a 3.3% increase from pre-pandemic levels of February 2020 ($235). Medicaid reimbursement has increased more than usual as many states embraced measures to increase reimbursement related to the number of COVID-19 cases.

To get more trends from the latest data, download the Skilled Nursing Monthly Report. There is no charge for this report.

The report provides aggregate data at the national level from a sampling of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators in order to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form. NIC maintains strict confidentiality of all data it receives.

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

SafelyYou Leverages AI to Reduce Falls & Costs: A Conversation with Tom Bang

Falls are a constant worry and costly problem for senior living owners and operators. The solution could include artificial intelligence (AI).

Falls are a constant worry and costly problem for senior living owners and operators. The solution could be better fall management with artificial intelligence (AI). San Francisco-based SafelyYou has developed an AI-enabled fall management program to detect and prevent falls. The SafelyYou system has already been installed in more than 100 communities, with the backing of REITs, insurers, and healthcare payors.

Ryan Brooks NIC

 

NIC Senior Principal, Healthcare Strategy, Ryan Brooks recently talked with SafelyYou Chief Strategy Officer Tom Bang about how the program works and the results. Here is a recap of their conversation.

 

Brooks: Can you tell me a bit about SafelyYou and how it differs from other products in the fall prevention and management space?

Bang: We’re using some of the most advanced artificial intelligence (AI) to address the industry’s most persistent risk challenges, beginning with falls. The financial and emotional costs are enormous.

We’re the first and only fall prevention and mitigation technology-enabled solution that’s been proven, as published and peer-reviewed, to reduce falls by 40% and emergency department visits resulting from falls by 80%. Notably, given these outcomes, we’re also the only solution paid for in part by REITS, liability insurers, and most recently, healthcare payors.

We’re changing the long-standing perception that falls can’t be avoided and must be accepted by providers, residents, and families. Communities and facilities using SafelyYou are winning move-ins, doubling length-of-stay, empowering staff, increasing staff efficiency while reducing risks and liabilities. Few solutions address so many of the needs of today’s operators.

Brooks: When was the company formed?

Tom Bang High RezBang: The company was launched in 2017 by George Netscher based on his research at the UC Berkeley Artificial Intelligence Research Lab. His family had a history of dementia, and he wanted to create a system with AI to help them.

Brooks: How big is the company?

Bang: We have more than 50 employees. We closed our Series A funding 120 days ago. In the third quarter of 2021, Omega Healthcare Investors led our Series B funding. The SafelyYou system will be installed in Omega facilities. We work with several operators and owners across more than 100 communities.

Brooks: What is your role?

Bang: As chief strategy officer, I’m focused on the ecosystem of REITs, insurers, payors, and all those entities that expect a return from the technology.

I’ve led several senior, and acute care technology providers, including It’s Never 2 Late, a person-centered engagement tool. I consulted with George Netscher, and after 60 days, I approached him and said I want to work for you. SafelyYou addresses the operator’s most pressing needs: occupancy, length-of-stay, staff efficiency, staff empowerment, and the ability to reduce risk and liabilities. As an operator, those are the things you worry about. We are mitigating falls, but the impact that falls have across the community places a substantial value on what we offer.

Brooks: Can you explain how the system works?

Bang: In the typical memory care/assisted living setting, we know that 94% of falls go unwitnessed. We could have put cameras in the residents’ rooms a decade ago to assess their capabilities and make appropriate changes. But we can’t do that from the standpoint of privacy compliance. With the advent of AI, machine learning enables a camera in the room to determine when a human being is on the floor. The video from the camera is deleted by the machine when the resident is not on the floor. But when a person is on the floor, the machine saves the previous 10 minutes of video. In that 10-minute vignette, the staff can see what happened and determine if the person might be injured. We know that 40% of the time, individuals who are not fully ambulatory are self-lowering, putting themselves on the floor. They may want to get to the bathroom or reach something across the room. They might be getting on the floor to exercise or pray. But as an operator, the only way you know how to treat the incident from a liability standpoint is to presume the person has fallen.

Brooks: What happens when the system detects someone on the floor?

Bang: As soon as the technology detects someone on the floor, the SafelyYou team receives an alert. They are available 24/7. They validate that someone is on the floor, and the community is alerted immediately. Other alert systems generate a lot of false positives, creating noise fatigue among the staff. Our system identifies someone on the floor with 99.7% accuracy. When staff gets an alert from SafelyYou, they know it’s the real thing, not noise. Someone is on the floor or was on the floor. We also now know that 17-20% of residents self-recover. The staff can view the video and see whether the resident is ok. They will still examine the resident, but the staff knows what happened and can determine the seriousness of the fall from the video review. If the person is uninjured, a trip to the emergency room is avoided.

Brooks: Since you are using a camera, are there still privacy concerns?

Bang: Both leading operator defense attorneys and liability insurance have embraced our unique solution. And state regulatory agencies also support what we’re doing. Some in fact have stated that our solution should be available in all communities. The only videos that exist are those where the machine detected an on-the-floor event. And those videos are only accessible by the operator’s approved staff. And of course, our solution is HIPPA compliant.

All residents and families are given a choice to opt-in. And our customers enjoy a 90% opt-in rate. We conduct educational sessions with residents and families. About 60-70% of families initially opt-in. But once other families see that they’re not getting calls at 3 a.m. or having to pay for emergency medical services (EMS), the opt-in rate increases.

Brooks: Does the system have other advantages?

Bang: Yes, the staff can see what may have caused the fall. We provide a weekly or bi-weekly fall huddle with a physical or occupational therapist to determine what changes can be made to the environment to make it safer and help prevent future falls.    

Brooks: In the senior housing and care industry, there is tremendous concern about labor shortages and workforce retention. In what ways does partnering with SafelyYou impact frontline staff? Does it make their job easier?

Bang: Yes, our customers tell us that we make the staff’s jobs easier, freeing them for other resident care while reducing emotional strain. Our customers also say the staff feels empowered. For the first time, the caregiver can now tell families not only how someone fell but also how their loved one’s falls will be mitigated going forward. Provider magazine recently published a piece showing that an empowered staff is key to retention.

Remember, 94% of all falls go unwitnessed when not using SafelyYou. And with our technology, we now know that over 40% of the time, someone’s mother, father, or loved who was found on the floor didn’t fall but self-lowered themselves.

Knowing that significantly reduces family concerns, emotional stress, and operator liability. There is also a dramatic efficiency gain for caregivers, first simply by reducing the number of falls but also by reducing reporting and the need for neurological checks in a skilled nursing setting. Think through that a minute. Out of 100 previous fall events, 40 of those are routinely mislabeled as falls! That’s a considerable staff burden and liability exposure, all due to mislabeled events in which operators were unknowingly putting themselves and their businesses in harm’s way.

Brooks: What types of properties is SafelyYou found in?

Bang: Though we began our go-to-market efforts in memory care, which remains our largest footprint, SafelyYou is being deployed in assisted living and skilled nursing settings at an increasing rate. After just a few years of commercialization, we’re now installed in more than 100 communities and facilities, with many of the industry’s leaders.

Brooks: How many units is SafelyYou currently monitoring?

Bang: We see 2,000 falls per month and have evaluated over 25,000 falls in total across our install base. As such, we are unequivocally the leading fall expert. Our occupational and physical therapists staff review all fall events and share their insight and expertise with our customers. We also conduct free monthly webinars, our National Fall Huddles, for the market at large.

Brooks: Falls are a significant concern in senior care facilities and can become significant liability issues. What impact does partnering with SafelyYou have on an operator’s liability?

Bang: Industry legal experts have advised that our 40% reduction in falls leads to a 20% decrease in liability claims. As a result, Church Mutual Insurance now subsidizes our technology for their customers. Further, our customers tell us they’re now armed for the first time with factual information—our videos and data—to reduce false narratives which they previously had no way of disputing.

For example, residents may tell their families they were on the floor for hours, but their loved ones received care from staff members within minutes. Or when a resident is admitted to the emergency room and the attending physician records that the injury is more likely from abuse than a fall, our video detection shows the injury was from a fall and not abuse.

We reduce claims for insurance carriers. We reduce unnecessary defensive medical claims for payors. And we enhance and protect the investments of owners. Exposure and liability are reduced across the ecosystem for operators and their sponsors.

Brooks: Does SafelyYou provide any training directly to staff to aid in their fall prevention abilities?

Bang: Yes, we provide initial training as part of our implementation. We then meet weekly or bi-weekly with our customers to review their falls and enhance their training. As I mentioned, we offer monthly webinars to the broader market to share what we are learning.

And finally, we’ve created SafelyYou University, a free video educational program available to all. It’s the first such program of its kind that combines dementia awareness training and fall prevention education.

Brooks: Activating a SafelyYou system can prevent unnecessary emergency department (ED) utilization, avoiding not only stress and anxiety but saving on out-of-pocket costs as well. Has SafelyYou quantified the cost savings to an average resident?

Bang: Yes, residents/patients and their families see direct out-of-pocket co-pay expense reduction from reduced EMS and emergency department visits. Our operators successfully use that to win competitive move-ins and gain some price elasticity.

But we haven’t stopped there! We’ve just finished our first claims analysis across one CMS region. The reduction in EMS and ED visits, and other direct medical claims, is estimated to produce a medical claims savings of over $7,000 per Medicare participant. All payors will benefit, including those sponsoring Medicare Advantage (MA) and Institutional Special Needs Plans (I-SNPs).

Brooks: What impact does activating a SafelyYou system have regarding resident length-of-stay?

Bang: Our customers have seen a two-fold increase in length-of-stay over several two-year studies. These customers experienced a four-fold increase in length-of-stay in the first 90 days in the same studies. Length-of-stay increases can have a significant impact on an operator’s profitability.

Brooks: Can you tell me about SafelyYou’s Fall Technology Grant Program?

Bang: We’ve been very proactive in addressing current market challenges for communities and facilities alike. The most critical concern right now is staffing, and SafelyYou eases the burden on care staff. Our grants are a way to support residents, staff, and fall management goals. Each grant covers the cost of implementation of SafelyYou and also includes a complete assessment of the current fall management program from our fall experts. In addition, we’ve also created “active camera pricing,” which selectively allows customers to enjoy significant discounts and to pay as their business improves with increased occupancy and resident participation, in part driven by SafelyYou.

Brooks: SafelyYou has partnered with products expert, Direct Supply, to create the Essential Guide for Mobility Aids: From Maximizing Function to Reducing Fall Risk. What’s the purpose of this guide, and who is it targeted towards?

Bang: Yes, as mentioned, we’ve partnered with many entities including, REITs, insurers, payors, and Direct Supply, to address this pervasive industry challenge. Many environmental factors create person-centered fall risks. Through our videos, staff better understand these factors, including the best use of mobility aids. Direct Supply is one of our great partners, committed to reducing falls to improve quality of care and reduce costs by advocating for enhanced services that our operators can now provide to their residents, patients and families.

  

Disappointing Gain in November Employment Report: Jobs Up by 210,000

Nonfarm payrolls have increased by 18.5 million, down 3.9 million from pre-pandemic level. The impact of Omicron variant is not reflected in November.

The Labor Department reported that nonfarm payrolls rose by 210,000 in November 2021. The consensus had been for an increase of 550,000. This was a sharp slowdown from October when jobs increased by 546,000 (originally reported as 531,000) and from September when jobs grew by an upwardly revised 379,000 (originally reported as 312,000).

Through November, the year-to-date monthly average job gain has been 555,000. Nonfarm payrolls have now increased by 18.5 million since their pandemic trough in April 2020 but are still down by 3.9 million or 2.6% from their pre-pandemic level in February 2020.The potential negative impact of the newly identified Omicron variant on jobs is not reflected in the November data. It’s far too early to tell. The data show that the labor market continues to be affected by the Delta variant especially in the hospitality sector. Indeed, leisure and hospitality payrolls edged up by a muted 23,000, following large gains earlier in the year. Employment in the leisure and hospitality industry increase by 164,000 in October and has risen by 2.54 million thus far in 2021, but it is still down by 1.3 million or 7.9% from February 2020.  

Health care added 2,000 jobs in November. Nursing and residential care facilities lost 11,000 jobs.   The broad health care sector is down by 450,000 since February 2020. Employment in with nursing and residential care facilities account for nearly all the loss. Jobs have been on the decline in nursing care since 2011.

2022_NNB_Unemployment_NBER_graph_1081x930

Separately and from a different survey, the Labor Department reported that the supply of labor as measured by the labor force rose by a solid 594,000 in November. With the household measure of employment rising by more than 1.1 million, the jobless rate fell 0.4 percentage point to 4.2% in November. The labor force is 2.4 million below the February 2020 level. The jobless rate is now 0.7 percentage points above the pre-pandemic level of 3.5% seen in February 2020, and well below the 14.7% peak seen in April 2020.

The underemployment rate or the U-6 jobless rate was 7.8% down from 8.3% in October 2021. This figure includes those who have quit looking for a job because they are discouraged about their prospects and people working part-time but desiring a full work week.

The labor force participation rate edged up 0.2 percentage point to 61.8% in November but remains 1.5 percentage points lower than in February 2020.

2022_NNB_EmploymentChange_NBER_graph_792x856

Further, weekly claims for unemployment benefits fell last month below their pre-pandemic numbers for the first time since the recovery started. The four-week moving average of benefit claims dropped to 238,750 — the lowest level since the middle of March 2020, when the pandemic’s effect on the labor market began to gain speed.

Nevertheless, businesses continue to struggle to find staff. The BLS JOLTS data for September showed that there were 10.4 million job openings and the highest quit rate on record.

Concerns about rising wage costs will remain after this report. Indeed, average hourly earnings for all employees on private nonfarm payrolls rose by $0.08 in October to $31.03, a gain of 4.8% from a year earlier.

Monthly NIC Intra-Quarterly Snapshot Tracks Agility and Evolution

From March through May, the headlines reflect cautious optimism of stabilization, which then begins to take hold in June 2021, as demand improved.

 

A Pandmeic Initiative

In spring 2020, responding to the onset of the COVID-19 pandemic, NIC launched numerous initiatives to help senior living leaders understand and improve their responses to the crisis. Given the pace of change impacting the industry, NIC began to produce a high volume of relevant and timely data and analysis more frequently than ever before. In just a few months, NIC produced an entire suite of resources aimed  at improving access to data and analysis relevant to the impact of COVID-19 on the senior housing and care industry. Part of that effort was to release the NIC Intra-Quarterly Snapshot  reports, which, like several other pandemic-related NIC initiatives, is still being produced today.  

Each monthly report, based on three-month rolling data from NIC affiliate NIC MAP Vision, provides the most timely comprehensive review of the sector’s market  fundamentals and trends. In addition, the report provides economic trends, inventory growth data, and occupancy rates, with analysis and insights from the NIC Analytics team, including myself and NIC Chief Economist, Beth Mace. In addition to analysis of the most recent data, the reports show three-month rolling data on either total or stabilized occupancy for both seniors housing and nursing care properties over the prior 13 months, offering a perspective on broader trends.  

Today, Intra-Quarterly Snapshot reports continue to provide a powerful and closely watched means to stay ahead of industry trends, even as senior housing markets sustain a fast pace of evolution and adaptation, amidst an apparent recovery. 

Intra-Quarterly Snapshot Headlines Track the Trends 

A look back at Intra-Quarterly Snapshot headlines, pulled from the top of every report published over the eighteen months, illustrates just how well these reports have tracked with industry trends, practically in real time. Each headline, as charted below, tracks with the key trends and inflection points over the pandemic to date. The The market’s initial contraction was identified in the first Intra-Quarterly Snapshot, in April 2020, and developed over subsequent months, through February 2021. From March through May, the headlines reflect cautious optimism of stabilization, which then begins to take hold in June 2021, as demand improved. From July of this year, each report has reflected improvements in occupancy rates. 
 IQ Headlines_Heatmap_April 2020 - October 2021_Good

If we chart just the changes in occupancy and stabilized occupancy, as reported in Intra-Quarterly Snapshot headlines, we find similar tracking with current market trends. 

Changes in occupancy/stabilized occupancy as reported in Intra-Quarterly Snapshot headlines.

Table_Heatmap_IQ Headlines_1475x185

All-occupancy is defined by NIC MAP® as percent of existing inventory’s units that are occupied by residents as of the end of the month. Stabilized occupancy is defined by NIC MAP® as the occupancy of properties that are (a) at least two years old, or (b) if less than two years old, properties that have achieved occupancy of at least 95.0% since their opening. 

Phase 1: March 2020 to March 2021 

From March 2020 to March 2021, the largest occupancy decreases were reported in the April and July 2020 and January 2021 reporting periods. During this period, senior housing all-occupancy fell by 8.7 percentage points (pps) and stabilized occupancy fell by 8.5pps. Meanwhile, senior housing inventory increased by 2.8%, or 17,950 units. Demand through this period, as measured by occupied units of senior housing properties for the NIC MAP Primary Markets decreased by 7.5% or 42,344 units.

Phase 2: March 2021 to June 2021 

During this time period as the vaccine rollout was nearly completed for most residents in seniors housing and skilled nursing properties, occupancy started to stabilize but continued to be challenged due to inventory growth. Quarterly absorption (% change in occupied units) turned green for the first time since the onset of the pandemic. Senior housing occupancy remained largely unchanged, mainly due to inventory growth offsetting demand growth. The inventory of senior housing properties for the NIC MAP Primary Markets increased by 0.7% or 4,354 units and demand increased by 0.6% or 3,364 units.

Phase 3: June 2021 to September 2021 

Occupancy started to improve as demand rebounded over the Summer of 2021. The industry registered its strongest increase in the number of occupied units since NIC MAP began reporting the data back in 2005. The inventory of senior housing properties for the NIC MAP Primary Markets increased by 0.5% or 3,441 units and demand increased by 2.3% or 12,318 units. During this period, occupancy saw the largest quarterly growth since 2005 of 1.4pps.

To view what is happening today, and to gain insight into the continuation of occupancy gains, see the recently released October 2021 Intra-Quarterly Snapshot report. 

Future Outlook 

The October Intra-Quarterly Snapshot reveals that senior housing stabilized occupancy rose for the fourth consecutive reporting period. Notably, the stabilized occupancy rate for senior housing increased to 82.6% in the October 2021 reporting period for the NIC MAP Primary Markets, up 1.6pps from its time series low of 81.0% in the June 2021 reporting period and 0.4pps from the September 2021 reporting period on a three-month rolling basis. Senior housing stabilized occupancy continued the road to recovery but remained seven full percentage points below pre-pandemic March 2020 levels of 89.6%. 

We cannot yet know how pandemic-derived challenges will unfold in future months, or when they will be fully behind us, but as the Intra-Quarterly Snapshot’s headlines reveal, the senior housing industry has weathered this extremely difficult period and begun the path to recovery.

At the 2021 NIC Fall Conference, senior housing constituents, while addressing the most pressing challenges facing the industry, nevertheless demonstrated reasons for optimism over the short, intermediate, and long term. The positive gains in occupancy over the last four intra-quarterly reporting periods provide a bullish indicator that the senior housing market outlook remains positive. Taken in combination with other market realities, such as the resilience of need-based demand, the ready availability of affordable financing, and major demographic tailwinds, conference attendees were understandably ready to look to the future with excitement and renewed positive energy. 

Many conference attendees reflected on the past eighteen months, which for many may have been the toughest period in memory.  Analysts may agree that the senior housing sector underwent perhaps its most severe era of demand loss and uncertainty on record. However, as revealed in every month’s Intra-Quarterly Snapshot, the industry is clearly demonstrating that, through innovation, collaboration, creativity, and risk tolerance, it is agile and resilient enough to bounce back even from that.  

The data underlying every Intra-Quarterly Snapshot report is available to NIC MAP Vision clients. Data highlights, along with expert analysis and commentary, are provided in the complimentary Intra-Quarterly Snapshot monthly publication, available for download on nic.org.

The November 2021 IQ Snapshot report will be released on nic.org on Thursday, December 9, 2021 at 5:00pm.