New research from NORC at the University of Chicago, funded by a grant from the National Investment Center for Seniors Housing and Care, sheds light on older adults’ vulnerability to declining health outcomes before and after entering a senior housing and care property.

The results of the study provide insights into understanding current and growing demand for senior housing. The study is the first in a four-part research series that assesses the health and well-being of seniors housing and care residents. Subsequent studies will provide insights on access to health care providers, longevity, and health outcomes of residents in senior living settings.

Research findings show that vulnerability – as defined by “frailty levels” of residents – rises in the months leading up to a move into a senior housing and care community. Approximately three months following move-in, however, vulnerability plateaus and thereafter improves. These outcomes are consistent across all senior housing and care property types – independent living, assisted living, memory care, nursing care, and continuing care retirement communities (CCRCs).

While conclusions from this study show that vulnerability improves following a move to senior housing and care, findings do not specifically identify the direct causes for the improvement. Senior housing offers supportive services that can lead to greater resident vitality and quality of life. Indeed, non-medical services provided within senior housing and care settings – social engagement, community involvement, balanced nutrition, transportation, and access to exercise – are likely vital contributors to improving resident health.

The change in vulnerability shortly after moving into a senior housing and care property speaks to one of the many value propositions provided by senior housing settings that are offered to residents.

The findings from this research are foundational and set the table for subsequent studies to examine the impacts of access to healthcare providers, the role senior housing and care plays in resident longevity, and how health outcomes for older adults differ from congregate to non-congregate settings.

Other findings from this study confirm what many operators already understood – vulnerability to declining health outcomes, as defined by “frailty levels” of residents, is highest in communities with the most intensive available support services. Put another way, the proportion of increasingly vulnerable residents increases with expected community acuity.

Vulnerability of older adults is an important concept in senior housing and care research, because it suggests that vulnerability is not a permanent condition, but rather a temporary state of being that can be corrected with the proper interventions. Senior housing and care operators routinely assess residents to mitigate risk and improve health, as even older adults who are relatively healthy could be one incident away from needing higher levels of care.

The methodology for the study utilizes an academically-designed data linkage approach which ties property information from the NIC MAP® Data Service, powered by NIC MAP Vision, with Medicare Current Beneficiary Survey (MCBS) data and comprehensive administrative and claims data. These data sets, combined with Harvard University’s Claims-Based Frailty Index, provide valuable insights into the health and well-being of seniors housing and care residents.

With few data sources available to analyze the health needs of senior housing residents, this nationally representative survey allows senior housing and care stakeholders to better understand the changes in vulnerability that occur after moving to a congregate setting.

To view the complete slide deck of findings, including methodology, vulnerability levels by property type, common conditions, illustrative vignettes, and future planned research, download the Research Report.

CLICK HERE TO ACCESS THE RESEARCH REPORT

Session speakers kickstart inspiration.  

Radical customer engagement can drive business growth. Healthcare and senior living can co-exist to open new possibilities. 

These are just two of the provocative topics to be explored during the NIC Talks session at the 2023 NIC Fall Conference. Four dynamic speakers will each give a 12-minute TED-style talk on innovative approaches to senior living. Other topics include the effective use of artificial intelligence and how to sort through technology offerings.  

“Attendees will hear ideas that challenge established ways of thinking,” said Bob Kramer, NIC Co-Founder/Strategic Advisor and Founder at Nexus Insights. “Innovative perspectives can create new opportunities.”   

The 2023 NIC Fall Conference will be held October 23-25 at the Sheraton Grand Hotel in Chicago. NIC Talks will be a featured Main Stage session on Tuesday, October 24. Kramer will curate the session.  

Two speakers recently previewed their talks. Caroline Pearson will relate a personal experience to explain how connecting healthcare and housing can boost move-ins and margins. Speaker Gerard van Grinsven will detail how to create a hospitality-inspired strategy—an experience blueprint—to outperform customer expectations and deliver superior results. 

Van Grinsven, renowned for his extensive luxury hotel industry experience, passionately emphasizes the importance of crafting an irresistible value proposition that renders customers indispensable. He articulates his unwavering customer-centric philosophy, by urging businesses to embrace a paradigm-shifting mindset. 

With executive stints at the Ritz-Carlton organization, the Henry Ford West Bloomfield Hospital, and the Cancer Treatment Centers of America, van Grinsven unveils the key to his remarkable success: a resolute departure from conventional thinking, guided by his steadfast commitment to satisfying customers’ unexpressed desires. 

During his tenure at Henry Ford Hospital, van Grinsven dedicated an immersive six-month period to personally visiting local families before the hospital’s grand opening, unearthing their deepest healthcare preferences—unlike conventional focus groups which often fail to capture the subtleties of unspoken aspirations. Instead, he embarked on in-home journeys with prospective customers, unearthing their needs and true desires. The outcome catapulted the hospital to the pinnacle of national rankings for patient engagement scores. 

Moreover, van Grinsven underscores the importance of extending this ethos of engagement to the employees, an imperative made even more pressing in today’s challenging workforce landscape. He strongly encourages organizations to earnestly explore avenues to enrich workplace culture with unwavering trust, respect, and dignity. 

As he embarks on the launch of a visionary luxury lifestyle boutique hotel management company, van Grinsven reiterates the importance of valuing team members, a commitment that both curtails turnover rates, and engenders a deeper emotional connection with customers. 

Van Grinsven anticipates his NIC Talks presentation will inspire attendees to vigorously reassess their modus operandi, by severing the shackles of conventional thinking and embracing innovation and dedication to customer-centricity.” 

Housing and Healthcare Can Co-Exist 

NIC Talks speaker Pearson has long been puzzled by the divide between healthcare and housing in the senior housing market. She is currently the Executive Director of the Peterson Center on Healthcare. Pearson is already familiar to the NIC audience. She was formerly the Head of Healthcare Strategy at NORC at the University of Chicago, a research organization, and led the seminal NIC study, “The Forgotten Middle.”  

Based on her work on the middle market, Pearson views healthcare as an integral component of the senior housing value proposition. “It’s particularly true for those who do not have the resources to easily afford senior housing,” she said.  

Many older people believe they want to age in place, but they reconsider when health, cognition, and mobility issues arise. The stairs are hard to climb. It’s difficult to get to the doctor’s office. “The industry continues to sell lifestyle, community and purpose, which are critically important, but we should embrace what people also need which is a safe caring environment to help them live well.”  

For senior living providers, specific changes might include creating a clinic space on the property for healthcare providers to see residents, and a system to easily handle virtual doctor visits. “Those are huge value adds,” said Pearson.  

Healthcare services, in some form, represent a huge opportunity to broaden the senior housing market, she added. Also, the healthcare system will benefit by closing its gaps in care. The healthcare workforce isn’t large enough to deliver healthcare individually to people in their homes. “Senior housing operators have the geographic efficiency of having residents together,” she said.  

The senior living industry doesn’t want to be seen as the sick care industry. They want to be the place where the vibrant last stage of life can take place. But, Pearson noted, “Those two ideas do not have to be in conflict if operators embrace the integration of housing and healthcare.”

Like so many executives, Ryan Galea was motivated by a personal experience to jump into the senior living industry. He was working on Wall Street investing ​in the healthcare and technology sectors. But when his grandmother became ill, he saw that she didn’t have the best care experience before she passed away.

So, he decided to improve the aging experience by creating a better all-in-one communication and engagement software for organizations that support seniors. Galea consolidated several software platforms in the senior care space and named the company Icon. 

NIC Senior Principal Ryan Brooks recently talked with Galea, CEO at Boston-based Icon. What follows is a recap of their conversation about Icon and its commitment to revolutionize the aging experience by engaging, informing,​ and uniting all stakeholders in the community. 

Brooks: To kick off, can you tell us a little bit about Icon? 

Galea: Before my grandmother passed away, she told me to grab opportunities when you can. That advice had a big impact on me. Based on her disappointing care experience, I came up with the idea to consolidate some of the software platforms in the senior care space. The available platforms were single-point solutions that really didn’t talk to each other. So, in 2021, we acquired VoiceFriend, a cloud-based communications platform. Then, in 2022, we acquired CareMerge, a provider of engagement solutions. We renamed the combined company Icon.   

We reimagined the mission of the company. In our view, Icon is more than a tech platform. We are focused on innovation to equip providers with the tools needed to communicate and engage with the entire community including residents, families, and staff efficiently and effectively. 

Brooks: How many senior housing and care communities is Icon in currently? How do you anticipate that changing in the coming years? 

Galea: We are quite sizable. There wasn’t a lot of overlap between the footprints of VoiceFriend and CareMerge. We’re in more than 2,000 communities in the U.S., and several in Canada. We’re looking to expand there and in Europe and to increase the depth of our offerings. 

Brooks: Users can face a steep learning curve with some technologies. Can you tell us about Icon’s user experience? 

Galea: This is one of the areas where we excel. Last year, we received the “Best Ease of Use” award in our category from Capterra, a highly regarded software review website. That speaks volumes about our design philosophy. We designed our platform with users in mind. They all have smartphones and understand mobile workflows. Older platforms were not built on the new age architecture experience and that’s a big roadblock. We have adoption ​success because our platform feels like all the other applications people are using today.  

Brooks: Data is such an important part of managing the health and well-being of the seniors living in our communities. Can you tell us about the ‘Reporting and Analytics’ solutions that Icon provides? 

Galea: We gather community-level intelligence from the data on the platform to refine the overall resident experience. Operators can gain insights into program effectiveness, engagement, resident and family feedback, and other key indicators. Our new enterprise dashboard allows a central multisite operator to view all of their properties in one place. They can compare properties to see why one has a higher satisfaction score than the others. They can get solid insights into usage patterns to implement best practices across the portfolio. We’ve developed the tools to make that easy.   

Brooks: Socialization is seen as one of the key value propositions in senior living. How does Icon encourage socialization and a sense of belonging? 

Galea: Socialization is the cornerstone of the senior living experience and also a cornerstone of our platform. There are different ways that the platform encourages socialization. We empower residents. There is no better way to foster a sense of belonging than to give seniors the tools they need to make connections themselves. So, we give them the tools to organize their own groups and events. For example, one woman moved to a community after her husband passed away and wanted to meet people. She had liked to watch NASCAR with her husband, so she created a NASCAR group. It turned out that lots of other people in the community liked NASCAR, joined the group, and organized a watch party. We also give the community the data to personalize the resident experience. We can track resident interests so the staff can recommend programs to drive attendance. We can also offer personalized programming suggestions to seniors based on their interests.   

Brooks: What makes an iconic aging experience different from a great aging experience? 

Galea: Successful brands are very focused on the consumer. Apple is an example, or the online pet supply store Chewy. ​Chewy sends each customer a​​ ​handwritten letter on their dog’s birthday. We have an obsession with the consumer that is rare in senior living. Our platform delivers that phenomenal experience to help providers understand what the customer wants.  

Brooks: How do residents’ families view the communication tools provided by Icon? 

Galea: We take an omni-channel approach. Our philosophy is to meet stakeholders where they’re most comfortable. We have a family phone app to show what their loved one is doing day to day and to provide feedback to the community or talk to the staff. We give adult children visibility into their loved one’s day without having to make a lot of phone calls.  

We also provide communication by text, phone call, ​Amazon Alexa, ​or email. ​We can even translate the message if the family member is a non-native speaker to sidestep language barriers. We don’t impose the way we want to communicate with the family. We meet them where they’re comfortable.  

Brooks: How does Icon improve communication with the caregiving staff? 

Galea: We continue to build out this area of our platform. The staff experience is essential to the senior aging experience. A happy staff makes happy residents. We facilitate the ability to communicate with staff and families one-on-one or in group conversations. Senior living has a lot of immigrant labor. Our platform is inclusive and its translation capabilities make it easy to communicate with staff. We have a new employee portal, a hub where the staff can see everything happening from employee events to training sessions. Our awards recognition platform is coming out later this year to drive staff retention. It will provide more instant recognition for the hard work the staff is doing.  

Brooks: Staffing and retention challenges that were prevalent before the pandemic have unfortunately been exacerbated. In what ways does Icon make it easier for staff to be efficient and resourceful in their jobs? 

Galea: A big part of our platform is giving the staff the tools to make their lives easier. Our goal is to streamline data entry, so the staff only has to input information at one point. The data is then pushed to every channel, from PowerPoint slides to printed newsletters and other means of communication. We also store resident bio information to help optimize programming to include the most common interests in the community. ​We make it easier to communicate with residents and family. 

Brooks: One of the key performance metrics for skilled nursing communities is reducing readmissions for discharged patients. How do Icon’s communication tools reduce the likelihood of a discharged resident being readmitted to the hospital? 

Galea: We have a robust workflow automation engine. One of the first big issues we addressed with this platform was post-discharge management. Our tool lets the community design a ​multi-day cadence of messages. On day one, ​for example, ​the primary contact could get a ​message​​ ​“​How are you feeling?​”​ It’s automated, customizable,​ and tracks responses. Anything that is concerning generates a flag alert for a staff follow-up. It’s a scalable system to make sure communication is happening. ​It saves time and promptly identifies the need for treatment.  

Brooks: Are there any other new features or upcoming releases that Icon plans to introduce?​​     ​  

Galea: Yes, we are introducing the employee engagement platform with rewards and recognition programs. We looked at peer-reviewed literature to improve employee satisfaction and retention and built that into an automated platform. We are also introducing a Smart A​​ging platform to improve wellness. Unlike a lot of today’s platforms which are very passive, our platform engages residents to improve their well-being. We use artificial intelligence to design unique programming to help residents set goals, track their progress,​ and boost overall well-being.   

Brooks: Is there anything else you’d like our audience to know? 

Galea:  At its core, Icon is more than a collection of technologies. It’s a testament to creating a seamless ecosystem to manage the resident experience. ​Our goal is not just to solve problems. We are really helping to sculpt those experiences that inspire growth, foster connections,​ and touch the hearts of residents and family members. Icon is like a digital bridge for connections, transcending the boundaries of what is physically impossible in a physical setting.  

Brooks: AgeTech is a focus for NIC. Can you leave us with your final thoughts on innovations in AgeTech? 

Galea: Innovation is not just doing something new but making a difference with what you are doing.​Innovation is about elevating the human experience. When we think about innovation and AgeTech our goal is for the platform to make a difference. Technology is the means to make a noticeable, measurable impact. That is the future of AgeTech. 

The following analysis examines occupancy and year-over-year changes in inventory, and same-store asking rent growth—by care segment—within CCRCs and non-CCRCs in the 99 combined NIC MAP Primary and Secondary Markets. The analysis also explores the distribution of occupancy rates by payment type across all care segments during the second quarter of 2023.

NIC MAP^®, powered by NIC MAP Vision, collects primary data on occupancy, asking rents, demand, inventory, and construction for about 16,200 independent living, assisted living, memory care, skilled nursing, and continuing care retirement communities (CCRCs—also referred to as life plan communities) across 140 U.S. metropolitan markets. The dataset includes more than 1,165 not-for-profit and for-profit entrance fee and rental CCRCs in these 140 combined markets, including 1,087 in the 99 combined Primary and Secondary Markets.

2Q 2023 Market Fundamentals by Care Segment – CCRCs vs. non-CCRCs

The exhibit below illustrates the relative market performance of CCRCs vs. non-CCRCs by care segment in the second quarter of 2023 and includes year-over-year changes in occupancy, inventory, and asking rent growth.

Occupancy. Overall, the occupancy rate for CCRCs continued to outpace that of non-CCRCs across all care segments. The difference in the second quarter 2023 occupancy rates between CCRCs and non-CCRCs was largest for the independent living segment (6.5pps) and the assisted living segment (4.4pps), and smallest for the nursing care segment (1.4pps).

The CCRC independent living segment had the highest occupancy (90.0%) in the second quarter of 2023, followed by CCRC assisted living and memory care segments (86.9% and 86.4%, respectively).

In terms of occupancy improvements from one year ago, the largest occupancy gains for both CCRCs and non-CCRCs were seen across assisted living and memory care segments, while the smallest gains were seen across independent living segments.

Asking Rent. The monthly average asking rent for CCRCs remained higher across all segments. However, non-CCRCs had relatively larger rate increases from year-earlier levels across all segments except nursing care. The highest year-over-year asking rent growth for non-CCRCs was seen in the assisted living and memory care segments (5.9% to $6,006 and 5.9% to $7,671, respectively). Similarly, asking rent for CCRCs recorded the largest annual growth in the assisted living and memory care segments (5.0% to $6,555 and 5.3% to $8,292, respectively).

Note, these figures are for asking rates and do not consider any discounting that may be occurring.

Inventory. From year-earlier levels, nursing care inventory for both CCRCs and non-CCRCs experienced the largest declines (negative 1.9% and 0.9%, respectively). The highest year-over-year inventory growth was reported for the non-CCRC independent living segments (3.4%) and memory care segments (1.8%).

Negative inventory growth can occur when units/beds are temporarily or permanently taken offline or converted to another care segment, outweighing added inventory.

2Q 2023 Occupancy Distribution by Care Segment – Entrance Fee CCRCs vs. Rental CCRCs

The exhibit below explores the distribution of occupancy rates across entrance fee and rental CCRC care segments and shows a greater prevalence of entrance fee and rental CCRC care segments within the higher occupancy rate ranges.

Entrance Fee CCRCs. The combination of the 80-90% occupancy range and >90% occupancy range shows that 89% of entrance fee independent living segments reported an occupancy rate above 80% in the second quarter of 2023. This represents the largest share across all care segments and payment types. Assisted living follows closely at 82%, while memory care stands at 78%, and nursing care stands at 68%.

Rental CCRCs. Approximately 74% of independent living segments reported an occupancy rate above 80%, followed by assisted living and memory care segments both at 75%, and nursing care segments at 66%.

In conclusion, as the senior housing occupancy recovery continues and shows encouraging trends, it’s important to recognize that even high-end properties, with their premium amenities and enhanced living standards, are not immune to the sensitivities of their residents regarding rate increases. Even residents who can theoretically afford these rate hikes may become resistant after a certain limit. It is also important to understand what both current and prospective senior housing residents are prepared to pay and the potential impacts of rate increases on the pace of move-ins and move-outs.

Look for future blog posts from NIC to delve deep into the performance of CCRCs.  
Are you interested in learning more?  To learn more about NIC MAP Vision data, and about accessing the data featured in this article, schedule a meeting with a product expert today.

This article originally appeared in Ziegler’s Senior Living Finance Z-News. 

Senior housing all-occupancy is on track for a ninth consecutive quarterly gain, with a half percentage point increase in the first two months of the third quarter of 2023, i.e., July and August. The all-occupancy rate for senior housing for the 31 NIC MAP Primary Markets edged up to 84.2% in the August 2023 reporting period, up 0.1 percentage points (pps) from the July 2023 reporting period on a three-month rolling basis, according to intra-quarterly NIC MAP® data, released by NIC MAP Vision. From its pandemic record low of 77.8% in June 2021, senior housing all-occupancy increased by 6.4pps and is now 2.9pps below pre-pandemic March 2020 levels of 87.1%.

Occupancy Recovery Varies by Majority Property Type. At 85.8%, the all-occupancy rate for majority independent living (IL) properties for the NIC MAP Primary Markets inched up 0.1pps from July 2023 but remained 3.7pps below March 2020 levels. For majority assisted living properties (AL), the all-occupancy rate for the NIC MAP Primary Markets was up 0.3pps to 82.7% from July 2023 and is now 1.9pps below March 2020 levels. Additionally, as a result of this positive momentum and consistency, the all-occupancy rate for majority assisted living properties for the 68 NIC MAP Secondary Markets (84.4%) has fully recovered and is now 0.2pps above March 2020 levels of 84.2%.

The inventory of majority independent living properties for the NIC MAP Primary Markets increased by 1.0% or 3,561 units from year-earlier levels in the August 2023 reporting period. AL inventory increased by 1.2% over this same period. The pace of year-over-year inventory growth for both IL and AL continued to be relatively slow compared with pre-pandemic levels.

Occupancy Recovery Varies Across Select Metropolitan Markets. The all-occupancy rate for majority independent living properties increased or remained stable in 20 of the 31 Primary Markets in the August 2023 reporting period compared with July 2023. At 84.1%, Sacramento IL occupancy saw the largest increase from the prior month, up 1.9pps but remained 6.6pps below March 2020 levels. Los Angeles IL occupancy had the largest decline and fell by 0.7pps in August 2023 to 85.5% and is now 8.6pps below pre-pandemic March 2020 levels.

For AL, the all-occupancy rate increased or remained stable in 27 of the 31 Primary Markets in August 2023. At 82.0%, St. Louis occupancy saw the largest increase, up 1.3pps from July 2023 but still 3.0pps below March 2020 levels. The AL occupancy rate in Las Vegas fell 1.6pps from the prior month to 78.2% on a three-month rolling basis and remained 3.4pps below the pre-pandemic March 2020 level.

A recent regional analysis of supply, demand trends, and Absorption-to-Inventory Velocity (AIV) ratios showed that the senior housing market’s arena is not homogenous. Distinct regional trends, influenced by factors such as demographics, economic conditions, business development policies and attitudes, supply constraint factors such as physical land barriers, operator performance and reputation, and historical patterns, shape the AIV ratios we observe today. Some regions have shown resilience, moving closer to pre-pandemic occupancy levels, while others still grapple with the ramifications of the pandemic years. As we move forward, it is essential for stakeholders to recognize these regional nuances, tailoring strategies that cater to specific regional needs, opportunities, and resident profiles. In the ever-evolving world of senior housing, being attuned to such regional patterns and insights could very well be the key to future success.

Keep track of the most timely comprehensive review of the sector’s market fundamentals and trends. The NIC Intra-Quarterly Snapshot monthly publication, available for complimentary download on our website, continues 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.   

The September 2023 Intra-Quarterly Snapshot report will be released on our website on Thursday, October 5, 2023, at 4:30pm.  

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