For the past two weeks, over a thousand seniors housing and care leaders from across the U.S. have logged on, often from their own home offices, to participate in their industry’s most important event. Of course, ‘the NIC’, in response to the COVID-19 pandemic, is now a virtual experience. But industry professionals have embraced what it has to offer. Many have discovered that ‘the NIC’ is as rich in thought-leadership and opportunities to connect with other decision-makers as ever – and that in some ways, the ‘essential virtual’ experience offers surprising advantages over traditional events.

In the runup to the conference, NIC Founder & Strategic Advisor, Bob Kramer, pointed out that the new platform offers real value for attendees. He said, “The 2020 NIC Fall Conference is not only a uniquely affordable educational opportunity, it also provides an unprecedented new dealmaking platform, the NIC Community Connector™.” The vast majority of attendees are now registered on the NIC Community Connector, ensuring that there are, indeed, plenty of opportunities to connect directly with people in a position to make a deal.

In practice, attending companies were able to extend opportunities to connect and learn to more of their staff than they would otherwise send in person. “We are taking advantage of the virtual format by including more of our team to build on essential relationships and gain invaluable insights from the educational sessions,” said Marilynn Duker, CEO of Brightview Senior Living. Without the cost, both in dollars and time, of travel and booking accommodations, and with a lower price for registration, the conference attracted numerous attendees who might otherwise not have made the trip.

By Popular Demand

In many ways, the conference adhered to traditional educational and thought-leadership programming. In total, more than 50 sessions offered insights, opportunities to participate in substantive discussions, presented the latest data and analysis, and featured some of the nation’s foremost experts and industry leaders. As in any in-person NIC conference, keynote general sessions featured panels of experts who needed no introductions.

Award-winning journalist Soledad O’Brien moderated a discussion with Mark Parkinson, President & CEO, American Health Care Association (AHCA) and National Center for Assisted Living (NCAL), and Andy Slavitt, senior advisor for The Bipartisan Policy Center and former Acting Administrator of the Centers for Medicare & Medicaid Services. Both leaders were frank and forthcoming regarding the impact of COVID-19 on seniors housing and care.

Parkinson, on whether the seniors housing and care industry is prepared for a second wave, said, “We don’t have to have a second wave. What’s so damned frustrating about this is that if everyone would just wear a mask, just that simple, considerate thing, if we would just make a decision as a country that everywhere we go we wear a mask and socially distance, we wouldn’t eliminate this in two weeks – but we would grind it to very low numbers.”

On funding Medicaid, Slavitt said, “In some point of time, whether it’s before or after the election, we’re going to have to do that [fund Medicaid], or many people who are on Medicaid today are going to face challenges, and payments are going to get even lower.” Towards the close of the discussion, Slavitt had this to say about national priorities, ”What we need is some radical introspection, as a country, into what kind of country we want to be. Part and parcel of this is the question of how we take care of people who need our help, they’re no longer at the stage where they can care for themselves, whether it’s because they have a disability, whether it’s because they’re aged, whether it’s because they’re low income, whether it’s because they’re sick. I think that is an enormous part of our national debate.”

Another highly anticipated general session featured an O’Brien-moderated discussion with seasoned political commentators, David Brooks and David Gergen. It felt like an honest, forthright assessment of the impact of the coming election on the sector. David Brooks offered a mea culpa on his 2016 predictions of a Clinton victory, and described his efforts since then to reconnect with the segments of the American populace with whom he’d grown out of touch. Both men offered their insights and predictions for the election – as well as their assessment on the impact it will have on American life and business interests.

The popular NIC Talks series, now a highly anticipated staple of the traditional event, returned —featuring another group of uniquely qualified, passionate thought-leaders, including JoAnn Jenkins, CEO of AARP, addressing the question, “How will COVID-19 impact the future of aging and aging services?” In the style of “TED-Talks,” these often emotionally powerful presentations added some punch to the analysis and data on offer in week one. A week two peer-to-peer discussion offered an opportunity to further discuss the NIC Talks presentations, with moderator Bob Kramer and NIC Talks presenter, Dan Cinelli.

In addition to one of the richest educational programs ever offered at a NIC conference, the event extended a variety of means for attendees to build and grow their business and social networks. Echoing in-person events, the virtual platform reveals to its users who else is in the lobby, or in a breakout session, and allows them to message one another, either in text or via video chat. Anyone who misses running into old friends in hallways should be heartened by this means to interact in such an organic, impromptu manner.

New Ways to Network

The unique, new NIC Community Connector launched in parallel to the event, and is currently only available to its attendees, who may continue to use it free of charge through the end of 2020. The innovative online platform provides a means to search for potential new contacts, and to communicate directly with the deal-makers they need to meet with. NIC is continuing to develop the platform, with new features scheduled to launch this year.

Attendees were also able to set up ‘braindates’ with each other, either one-on-one or in small groups. These intimate, focused exchanges provided not only a means to share thinking, but to connect with fellow attendees, and potentially to begin to build and grow new relationships with peers, based on those interactions. Through braindate™, attendees set up their own focused discussion groups, joined groups set up by fellow attendees, or arranged one-on-one meetings of their own.

In week two, called ‘connections week,’ NIC hosted numerous peer-to-peer discussions, on carefully curated topics of immediate relevance in today’s world. These moderated events offered participants expert thought-leadership, as well as frank discussion, and often eye-opening insights and ideas, offered up by attendees sharing their own real-world experiences and perspectives in more intimate small group breakout discussions.

Beyond educational sessions, the event offered attendees a variety of opportunities to spend time with each other, network, engage in self-care, and even share some cocktails or world-class entertainment together.

A series of ‘Brand, Brain, and Being’ sessions offered attendees a chance to focus on themselves and gain expert tips on improving personal brand, productivity, creativity, and overall wellness. Just as in traditional events, there was a LinkedIn expert on hand to help improve social profiles.

Meanwhile, for NIC MAP® Data Service power users and novices alike, there were opportunities to learn from NIC MAP experts, discuss how they use the NIC MAP Data Service platform, and meet (virtually, of course) with NIC MAP staff to discuss how the industry’s leading data service might benefit their businesses. Discussion groups for NIC MAP users delved into how they use the platform to analyze market feasibility, inform underwriting, and effectively target markets.

As with traditional NIC events, the attendee experience also included world-class entertainment. As week one drew to a close, the Young@Heart chorus, introduced by an impressive collection of A-list celebrity admirers, charmed and entertained with their talented, and infectiously fun, performances. Perhaps the most anticipated session of week two was a behind-the-scenes experience with Broadway and film cast members from “Hamilton!”, who also delighted fans of Broadway’s most popular show with exclusive performances that were simply not to be missed.

Although the conference has ended, attendees will retain access to a library of its many educational sessions and will also be able to use the powerful NIC Community Connector through the end of 2020. As expressed by NIC CEO Brian Jurutka in a press briefing, “I believe this conference – and the NIC Community Connector – will be valuable to thousands of leaders and their businesses, as they begin to craft a new normal and build towards a successful future, both for their businesses and for the millions of America’s elders seeking access and choice in seniors housing and care.”

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 at a time when market conditions continue to change—providing both capital providers and capital seekers with data as to how COVID-19 is impacting the sector.

This Wave 13 survey sample includes responses collected from September 28-October 11, 2020 from owners and executives of 73 seniors housing and skilled nursing operators from across the nation. Detailed reports for each “wave” of the survey can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Wave 13 Summary of Insights and Findings

The shares of organizations with assisted living units and/or nursing care beds reporting an acceleration in the pace of move-ins in the past 30-days rose to the highest levels since the survey began in March (43% and 46%, respectively). Coupled with fewer organizations reporting an acceleration in the pace of move-outs, more organizations reported upward changes in occupancy for these care segments. Acceleration in move-ins was most frequently attributed to increased resident demand, with one-quarter of respondents indicating that their organizations had a backlog of residents to move into their communities. Organizations citing resident or family member concerns as a reason for deceleration in move-ins (presumably due to the uncertainty of the prevalence of COVID-19 in the fall months and potential for restrictions on visitation) declined from three-quarters to two-thirds but remains higher than in prior surveys. While accurate and timely testing (within 48-hours) is crucial to operators’ ability to settle new residents into communities and keep them safe from outside contagion which could be brought in by visitors or staff, nearly two-thirds of respondents were waiting three days or more for test results, and still only about one-half of respondents find it easy to obtain PPE and COVID-19 test kits.

• • In Wave 13, approximately 40% of organizations with independent living, assisted living, and/or memory care segments and nearly one-half of organizations with nursing care beds (46%) reported that the pace of move-ins had accelerated in the past 30 days.
  • The share of organizations citing increased resident demand as a reason for the acceleration in move-ins in Wave 13 remained high (85%). Some respondents noted greater urgency among new residents regarding move-ins in geographies where restrictions have been lifted; others cited new buildings leasing up, and resident transfers to higher levels of care.
  • Regarding reasons for a deceleration in move-ins, more organizations in Wave 13 than in Wave 12 cited a slowdown in leads conversions/sales (82% vs. 55%). Resident or family member concerns also remained high in Wave 13 (68%) but declined slightly since Waves 12 and 11 (73% and 74%, respectively).
  • In Wave 13, organizations with nursing care beds reported both the highest proportion of month-over-month occupancy increases (44%) and decreases (44%). Greater shares of organizations across all care segments in Wave 13 reported upward changes in occupancy than in Wave 12 (to varying degrees). However, more organizations with assisted living and independent living report occupancy decreases than occupancy increases.
  • Looking forward, between 21% and 26% of organizations with independent living, assisted living, and/or memory care units, and 28% of organizations with nursing care beds reported an increase in week-over-week occupancy. Organizations with nursing care beds and/or independent living units reported the highest shares of week-over-week occupancy increases. However, the majority of respondents cited no changes in occupancy from the prior week.
  • The strain on operating costs persist as three-quarters of organizations continued to provide staff overtime hours, and one-half continued to offer rent concessions to attract new residents—up from one-third in Wave 10. Of the organizations that operate any independent living units (including a combination of other seniors housing and care segments), two-thirds (65%) were currently offering rent concessions, followed by roughly one-half of organizations with any memory care and/or assisted living units (58% and 55%, respectively). About two in five organizations with any nursing care beds (41%) reported offering rent concessions.

Wave 13 Survey Demographics

• • Responses were collected from September 28-October 11, 2020 from owners and executives of 73 seniors housing and skilled nursing operators from across the nation. More than half of respondents are exclusively for-profit providers (61%), about one-third (31%) are exclusively nonprofit providers, and 8% operate both for-profit and nonprofit seniors housing and care organizations.
  • Owner/operators with 1 to 10 properties comprise 63% of the sample. Operators with 11 to 25 properties make up 18% of the sample, while operators with 26 properties or more make up 19% of the sample.
  • Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 79% of the organizations operate seniors housing properties (IL, AL, MC), 21% operate nursing care properties, and 34% operate CCRCs (aka Life Plan Communities).

Key Survey Results

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…”

• • The shares of organizations with assisted living units and/or nursing care beds that reported an acceleration in move-ins in the past 30-days increased in Wave 13 to the highest levels since the survey began in March (43% and 46%, respectively). For both of these care segments, the shares of organizations reporting deceleration in the pace of move-ins were the lowest in the time series (23% and 20%, respectively).

• • In Wave 13, approximately 40% of organizations with independent living, assisted living, and/or memory care segments compared to nearly half (46%) of organizations with nursing care beds reported that the pace of move-ins had accelerated in the past 30-days.
  • The shares of organizations experiencing an acceleration of move-ins in independent living in Waves 12 and 13 were higher than in previous waves of the survey, and near the time series peak reached in Wave 9 surveyed at the end of June.

Reasons for Acceleration/Deceleration in Move-Ins

Respondents were asked: “The acceleration/deceleration in move-ins is due to…”

• • The share of organizations citing increased resident demand as a reason for the acceleration in move-ins in Wave 13 remained high (85%) after peaking in Wave 12 (88%). Organizations citing hospital placement in Wave 13 (30%) is lower since the peak reached in Wave 10 surveyed in the latter half of July (41%).
  • Regarding reasons for a deceleration in move-ins, more organizations in Wave 13 than in Wave 12 cited a slowdown in leads conversions/sales (82% vs. 55%). Resident or family member concerns also remained high (68%) but declined slightly since Waves 12 and 11 (73% and 74%, respectively). Very few organizations cited a moratorium on move-ins as a reason for deceleration in the pace of move-ins (5%). This is down from 61% at its peak in Wave 4 surveyed in the latter half of April.

Organizations Currently Offering Rent Concessions to Attract New Residents and Organizations Experiencing a Backlog of Residents Waiting to Move-In

Respondents were asked: “My organization is currently offering rent concessions to attract new residents,” and “My organization is experiencing a backlog of residents waiting to move-in”

• • Half of the organizations in both Waves 12 and 13 were offering rent concessions to attract new residents (51% and 53%, respectively)—up from one-third in Wave 10 (34%).
  • Of the organizations that operate any independent living units (including a combination of other seniors housing and care segments), two-thirds (65%) indicated they were currently offering rent concessions, followed by roughly one-half of organizations with any memory care and/or assisted living units (58% and 55%, respectively). About two in five organizations with any nursing care beds (41%) reported offering rent concessions.
    • Digging deeper, organizations with CCRCs in their portfolios were less likely to be currently offering rent concessions than organizations without CCRCs (48% vs. 56%). Additionally, the majority of organizations with declining occupancy in assisted living and/or memory care were currently offering discounts.
  • Approximately one-quarter of respondents in Waves 12 and 13 indicate that their organizations have a backlog of residents waiting to move in (25% and 26%, respectively).

Move-Outs

• • The shares of organizations reporting an acceleration in the pace of move-outs decreased in Wave 13 for the assisted living and nursing care segments. The majority of organizations in Wave 13 continue to note no change in the pace of move-outs in the past 30 days. This has been consistent since the survey began in late March.

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)”

• • In Wave 13, organizations with nursing care beds reported both the highest proportion of month-over-month occupancy increases and decreases (44%). The share of organizations reporting nursing care occupancy decreases is the highest since Wave 8 surveyed in late May to early June.

• • Greater shares of organizations across all care segments in Wave 13 than in Wave 12 reported increasing occupancy. However, more organizations with assisted living and independent living report occupancy decreases than occupancy increases.

• • Regarding the change in occupancy from one week ago, between 21% and 26% of organizations with independent living, assisted living, and/or memory care units and 28% of organizations with memory care beds reported an increase in week-over-week occupancy. The majority of respondents cited no changes in occupancy from the prior week. Organizations with nursing care beds and/or independent living units reported the highest shares of week-over-week occupancy increases.

Improvement in Access to PPE and COVID-19 Testing Kits

Respondents were asked: “Considering access to PPE (personal protective equipment) and COVID-19 testing kits, my organization has experienced that access has improved… Very little, it is still difficult to obtain enough PPE/testing kits in most markets/Somewhat, in some markets it is easier to obtain PPE/testing kits than in others/Considerably, we typically have no difficulty obtaining PPE/testing kits, regardless of market”

• • While there’s been some improvement in recent waves of the survey, still only about half of the respondents find it easy to obtain PPE and COVID-19 test kits. Slightly fewer respondents reported no difficulty getting PPE in Wave 13 than in Wave 12 (51% vs. 59%), however, slightly more in Wave 13 noted no difficulty getting COVID-19 test kits (52% vs. 45%).

Time Frames for Receiving Back COVID-19 Test Results

Respondents were asked: “Regarding COVID-19 test results (either for staff, residents or prospective residents) results typically come back within…”

• • The time frames for receiving back COVID-19 test results did not continue to trend as positively in Wave 13 as Wave 12. Just over one-third of respondents (38%) received their COVID-19 test results within 2 days, down from 43%.
  • Importantly, the majority (62%) note that it still takes more than 3 days to receive test results—however, this is down from 87% in Wave 10.

Labor and Staffing

Respondents were asked: “My organization is backfilling property staffing shortages by utilizing … (Choose all that apply).” Note: this question was asked in Wave 3, and then again in Waves 10-13.

• • Three-quarters of organizations (76%) are continuing to offer staff overtime hours in Waves 12 and 13 (down from 85% in Wave 3), and roughly half are still using agency or temp staff to fill staffing vacancies—up from 36% in Wave 3.

Owners and C-suite executives of seniors housing and care properties, we’re asking for your input! By providing real-time insights to the longest-running pulse of the industry survey you can help ensure the narrative on the seniors housing and care sector is accurate. By demonstrating transparency, you can help build trust.

“…a closely watched Covid-19-related weekly survey of [ ] operators
conducted by the National Investment Center for Seniors Housing & Care…”
The Wall Street Journal | June 30, 2020

The Wave 14 survey is available until Sunday, October 25, and takes just 5 minutes to complete. If you are an owner or C-suite executive of seniors housing and care and have not received an email invitation to take the survey, please click this link or send a message to insight@nic.org to be added to the email distribution list.

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 continuing to change.

Educational session at 2020 NIC Fall Conference highlights onsite service.

Key Takeaways 

• Seniors housing is emerging as a key part of the healthcare continuum. 
• Keeping residents out of the hospital is a major objective. 
• Seniors housing providers are managing healthcare risk onsite for their residents—both for infection and for social isolation/loneliness. 
• Health and healthcare must become an essential focus for seniors housing providers—but they don’t have to be the provider of the healthcare.  

The COVID-19 outbreak has accelerated emerging trends. Consumers are making more purchases online. Virtual meetings are now routine. Telehealth has gone mainstream in a matter of months.   

Likewise, the pandemic is fast-tracking the link between seniors housing and healthcare. Residents not only want a hospitality-type experience but also expect to be protected from infection. Many want access to onsite care, no matter the setting.   

Different approaches are emerging.  

One example of how to partner with a healthcare provider was presented during  Education Week at the 2020 NIC Fall Conference during a session  titled: “What Does Senior Living Look Like in the COVID Era: The New Role of Health and Healthcare Onsite.”    

Separately, a peer-to-peer discussion on the topic was held during the conference Connections Week. Participants shared their experiences with onsite healthcare. 

The educational session was led by Bob Kramer, NIC founder and strategic advisor, and president at Nexus Insights. Participants included Michael Grust, founder and CEO at San Diego-based senior living provider SRG; and Jim Lydiard, staff vice president at CareMore Health, a division of insurer Anthem.    

SRG collaborates with CareMore to offer onsite healthcare services, a partnership that has deepened during the COVID-19 crisis.  

Kramer provided context, noting that older adults have become more fearful about visits to traditional healthcare settings, such as doctors’ offices and clinics. At the same time, new models of care are emerging, including the use of telemedicine. 

“We are at a nexus point as an industry,” said Grust. He explained that the ability to protect the health of residents while creating environments where they can thrive will make a big difference in their decision to leave their homes and move into senior living communities. “We are focused on quality of life,” said Grust. 

CareMore’s insurance program—called Touch—provides a full range of medical services to residents who enroll. Many of the CareMore visits by healthcare providers are proactive, which helps contribute to the overall health of residents and improve their quality of life.  

The program is meant to compliment the work of SRG’s hospitality and wellness teams. CareMore does not offer dining services or help with the activities of daily living.  

Kramer noted the distinction between health and healthcare services. Health is related to prevention and wellness. SRG’s ZEST program, for example, keeps residents healthy and engaged. CareMore provides the actual medical services. “Health and healthcare have to be an essential focus, but you don’t have to do it all yourself,” said Kramer. “Partnerships can deliver benefits.” 

Teamwork Succeeds 

CareMore works together with the wellness team onsite. They can communicate with CareMore via text, video and phone. “Residents can get help right way,” said Lydiard, which helps keep them out of the hospital.  

Residents voluntarily sign up for the CareMore program. Enrollees receive a health assessment and a customized care plan. Regular visits from healthcare practitioners are provided as well as telehealth sessions. Mini clinics, operating three to five days a week, are created on campuses with a sizable number of enrollees.  

SRG does not pay a fee to CareMore. The patient’s insurance pays for the service under Medicare, Medicare Advantage or Medicaid. “This does not cost the operator more money,” said Lydiard. He added that the arrangement can help reduce the operator’s costs by eliminating unnecessary healthcare expenses that the operator might incur. Also, residents who enroll in the CareMore  Medicare Advantage plan may save as much as $200-$300 a month.  

Another plus: The partnership aligns the interests of the insurer and the operator. SRG keeps its residents healthier, often resulting in a longer length of stay. CareMore is motivated to keep residents healthy because it is paid through a capitation contract or risk-sharing model.   

Scale matters, however. The ability of CareMore to greatly impact resident outcomes depends on enrolling a critical mass of residents in the program. Membership grows virally after about 20 percent of residents sign up as CareMore’s presence on campus increases and residents see the value of onsite care. “We have to build membership,” said Lydiard.  

CareMore handles the marketing of the plan. But the staff at the community is educated on the benefits. 

 A hurdle to enrollment has been the reluctance by residents to switch insurance plans. They want to keep their primary care doctors, specialists and healthcare networks. 

But a big change will make it easier for residents to sign up. CMS is expanding its value-based care model to allow groups like CareMore to enroll residents with a traditional Medicare plan. They can keep their providers and still get the wraparound services provided onsite by CareMore. “This is a game changer,” said Grust.  

 The panelists agreed that senior living is now a part of the healthcare continuum. “We need to raise our game,” said Grust, noting “We are not post-COVID.” Senior living providers must continue to protect residents while providing an environment where people can thrive. “We have always been focused on the quality of life,” said Grust. “That is our unique selling proposition.”

Marking the sixth consecutive year, NIC once again partnered with National Real Estate Investor (NREI) on an annual investor sentiment survey in late summer 2020. Conducted from August 5 to August 11, 167 surveys were completed answering questions on topics ranging from attitudes on seniors housing market fundamentals to investment attitudes. The points below highlight some of the key survey findings.

Additionally, NREI hosted a webinar with NIC on September 17 which presented further commentary and analysis on the results of the 2020 survey, as well as a broader discussion on the opportunities and challenges facing seniors housing,

• Most survey respondents indicated that the COVID-19 virus was the biggest factor impacting occupancy rates at seniors housing properties over the past six months. Roughly four of every five respondents said the pandemic has had a very significant impact, while a little more than half of the respondents also reported that the state of the economy is having a significant impact. The state of the economy had not been as large an influencing factor since 2016. Further, more than half of the respondents believe that seniors housing sector itself is in recession or at a trough.
  
  
• About 45% of respondents expect occupancy rates to increase, the fewest since the survey began in 2014 and down from 72% in 2019. On the flip side, 42% expect occupancy rates to decline, the most of any survey ever conducted.
• Partly because of the pandemic and the effect it has had on the seniors housing sector, survey respondents had a less favorable view of seniors housing as an investment property than in any of the past seven surveys. Indeed, for the five-year period from 2015-2019, respondents had ranked seniors housing as the most attractive property type for investment out of six property types (apartments, industrial, office, hotel, and retail). When asked to rate the attractiveness of different property types for investment on a scale of 1 to 10, industrial and apartments rated the highest at 7.4 and 7.1, respectively. All other property types showed a decline in sentiment compared to results from the past five years with seniors housing dropping to 6.3 from 7.2 in 2019 and 2018.

  

  • The coronavirus is taking a toll on net operating incomes. The vast majority of respondents (90%) believe there has been at least some increase in expenses due to the virus between March 1 and August 1, with an estimated mean increase of 9.2%. Operators have seen costs rise for bonuses paid to staff, testing for staff and residents, increases related to PPE and additional cleaning. While not asked in the survey, it’s likely that operators could see additional upward pressure on expenses due to potentially higher property taxes and higher insurance costs.
  • Although uncertainty related to the path of the virus is affecting near-term investment decisions, investors seem to be more positive on their long-term plans to increase investment in the sector. Nearly half of respondents expect no change in seniors housing investment in either the near (47%) or long term (52%). However, views are split on whether investment will increase or decrease in the near term versus long term. Roughly 36% of investors said they plan to invest less in the near term compared to 18% who plan to invest more. Those percentages flip when asked about long-term strategies with 34% who expect to invest more in the long-term and 15% who think they will invest less.
  • A large number of respondents believe both equity and debt will be more difficult to get over the next 12 months and more than half anticipate that it will take longer to close a transaction. Roughly 80% of respondents expect underwriting standards to become tighter.
  • Nearly two of three respondents think seniors housing construction starts will decrease over the next 12 months, while one in five percent believe they will remain the same. That is a notable shift compared to survey results over the past five years where nearly half, if not more, respondents consistently anticipated an increase in starts in what had been a robust construction cycle.

  All in all, the 2020 Investor Sentiment Survey results paint a picture of a more cautious view on the sector. This makes perfect sense given the current state of the economy and the capital markets as we all collectively continue to make our way through the crisis of the COVID-19 global pandemic.

The COVID-19 pandemic has created design challenges for the seniors housing and care sector that need to be articulated, addressed and navigated. Achieving the right balance between social connectivity and coronavirus exposure has now become one of the key trials facing seniors housing operators. And with colder weather approaching, move-in restrictions easing, more visitation being allowed, and communal dining returning (albeit with physical distancing and other precautions being observed), operators need to think about design principles that help minimize risks to their residents. This blog post highlights a number of design principles operators may want to consider.

Creating Resident ‘Cohorts’ or ‘Pods’

Socialization has long been an established value proposition for seniors housing. Since the onset of the pandemic in March 2020, delivering on this goal has become more difficult due to the risk of infection transmission. Some operators have found success by forming small group ‘pods’ of residents, usually formed with resident rooms or apartments that are clustered near one another. Although this strategy is limited to certain building designs, these small cohorts of neighbors – usually between eight and ten units – can offer residents a familiar sense of community in addition to serving as a peer support group.

Within each group, residents dine together and visit with each other but avoid mixing with the entire community. Common amenities like kitchens and living rooms can be shared within each of these clusters to avoid relying on higher risk multi-purpose rooms or large shared dining spaces. This strategy helps maintain a degree of the community lifestyle that residents have grown accustomed to.

For this strategy to be effective, however, a well-thought out staffing plan needs to be implemented. Ideally, staff should be assigned to specific cohorts and avoid going into other parts of the building. To aid with this, PPE donning and doffing areas should be established outside of each resident cohort area and staff should exit directly to the exterior whenever possible. In some cases, early in the pandemic, these cohorts were made even tighter with staff living in on-site RVs or unoccupied units to further restrict exposure to residents and the community. It should be noted, however, that this plan may contribute to additional staffing costs, boosting what is already the largest operating expenses line item. Where regulations allow, adopting universal staffing patterns, where staff take on multiple tasks, can mitigate some of these additional staffing costs.

Improve Air Flow Through Spaces

A CDC study conducted in the early stages of the pandemic indicated that HVAC systems can be responsible for transmission of the virus. As such, certain mechanical considerations may need to be undertaken to prevent the spread of infection. For example, HVAC systems may need to be ‘zoned’ so that air ducts are not serving multiple pods or established resident cohorts. Other considerations include replacing HEPA filters, increasing maintenance frequency, and adding air exchanges to direct more fresh air into buildings.

In the Joint Center for Housing Studies’ webinar, Designing Senior Housing for Safe Interaction in the Age of COVID-19, balconies were referred to as ‘design heroes’ as they allow residents access to fresh air and a space to interact with others from a safe distance. Unfortunately, adding balconies to existing buildings can neither be done quickly or inexpensively, and in most cases is simply not feasible with residents in place. A more near-term solution is the use of fans to help create negative air pressure environments. Putting an outward facing fan in a window can achieve the desired directional flow of air, especially in high-risk locations such as those with a great degree of shared use or where residents are suspected of being ill.

Design Outdoor Space and Programming to Encourage Use

Most scientists agree that access to outdoor air reduces the risk of infection transmission. Designing outdoor spaces in such a way that encourages outdoor activity gives residents increased opportunity to get both fresh air and exercise. Incorporating frequent points of interest – fountains, flower gardens, picnic areas, and gazebos – along walking paths promotes their recurring use. A NIC Talk being presented at the 2020 NIC Fall Conference, How Will Disruptive Forces like COVID-19 Impact the Design of Senior Living, dives deeper into ways to extend the usefulness and comfortability of outdoor space.

Programming is increasingly moving outdoors as well. Prior to the pandemic, outdoor courtyard spaces may have been underutilized. These spaces are now of the utmost importance and can be reactivated for programming opportunities like outdoor exercise classes. Residents with the option to do so can join from their balcony, while others can participate from a safe distance outdoors.

Sequence Flows Through Buildings to Reduce Pressure on High Traffic Areas

To avoid unnecessary mixing between visitors, staff, and service providers, strong way-finding protocols are an option that can be implemented throughout all parts of a property. A basic strategy is to create one-directional hallways, as is often the case now in grocery stores and retail outlets. In the absence of one-way hallways, and especially for hallways less than six feet wide, an option of recessed pause points may be considered. These can create room for residents to pass each other safely and can also double as rest points along longer corridors. Where possible though, best practice dictates that hallways should be widened to allow two individuals to pass each other while maintaining six feet of distance, although this a challenging proposition, especially in older properties.

High traffic spaces like elevators and common areas should be well thought out as well. Encouraging staff to use stairs instead of elevators helps reduce traffic and leave them available for residents. Improving lighting and even adding music to stairwells can make them more pleasant to use. Other considerations for improving safety of elevator use are to set limits on the number of people who can use the elevator at the same time, creating buffer zones where people can safely queue while waiting, and eliminating the use of buttons altogether by using key cards that can select a rider’s destination.

COVID-19 is causing the industry to rethink senior housing and nursing building design and consider innovative ideas to balance social connectivity and infection exposure. Unfortunately, the upcoming winter months, combined with the easing of move-in restrictions and visitation policies, will bring a renewed threat. This will further prod operators, architects and developers to bring another round of thoughtful implementation of design elements. To hear more on this topic, join David Segmiller, FAIA, Principal, Hord Coplan Macht and myself at the 2020 NIC Fall Conference as we discuss how to balance community, safety, and lifestyle needs for the next generation consumer.