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

NIC’s weekly 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 where market conditions are rapidly changing—providing both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions.

This week’s sample (Wave 4) includes responses collected April 20-26, 2020 from owners and C-suite executives of 94 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.

Summary of Insights and Findings

Changes in occupancy rates continued to show declines and move-in rates continued to decelerate for many organizations in Wave 4. The primary reason cited for deceleration in move-ins continues to be slowdowns in leads conversions and sales. However, in Wave 4, more organizations reported an organization-imposed ban on settling residents into their communities than in prior waves of the survey.

• Organizations with assisted living residences and nursing care beds reported the largest declines in occupancy changes from one-month prior among the four segment types. In Wave 4, approximately 80% of survey respondents reported declines in occupancy from the prior month for assisted living units and nursing care beds. For the assisted living care segment, organizations reporting declines in Wave 4 are up to 81% from 65% in Wave 3. However, the proportion of organizations reporting nursing care segment occupancy declines in Wave 4 was similar to Wave 3 (84%).
• Compared with one week earlier, higher shares of organizations reported occupancy declines in Wave 4. Consistent with Waves 2 and 3, about two-thirds of organizations reporting on their nursing care segments noted declines in Wave 4.
• Around 70% of organizations reported the pace of move-ins decelerated in the past 30 days for their independent living, assisted living and memory care segments in Wave 4. Only about one-third to one-quarter report no change in the pace of move-ins for these care segments. While the majority of organizations reporting on their nursing care segments in Wave 4 note a deceleration in move-ins (76%) the share is lower compared to Wave 3 (87%).
• More respondents in Wave 4 cited an organization-imposed ban on settling new residents into their communities than in the prior two waves of the survey. Some reasons for deceleration in move-ins written into the survey comments included fewer hospital referrals and elective surgery rehab residents, moratoriums on tours, more stringent health screenings, and not wanting to admit residents into a 14-day quarantine.
• The majority of respondents continue to report no change in the pace of move-outs in the past 30-days. The independent living segment reported the most stability in Wave 4 with about three-quarters of organizations reporting no change in the pace of move-outs. In contrast, about one-third of organizations with nursing care beds report accelerated move-outs in Waves 2, 3 and 4. Of note, in Wave 4, about one-quarter of organizations with assisted living units report an acceleration in move-outs in the past 30-days (24%), an increasing trend across waves of the survey, and up from 17% in Wave 3.

Wave 4 Survey Demographics

• Responses were collected April 20-26, 2020 from owners and C-suite executives of 94 seniors housing and skilled nursing operators from across the nation.
• Nearly two-thirds of respondents were exclusively for-profit providers (62%), more than one-quarter (28%) were exclusively nonprofit providers, and 10% operate both for-profit and nonprofit seniors housing and care organizations.
• Owner/operators with 1 to 10 properties comprise 56% of the sample. Operators with 11 to 25 properties make up 17%, while operators with 26 properties or more make up 27% of the sample.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 80% of the organizations operate seniors housing properties (IL, AL, MC), 36% operate nursing care properties, and 34% operate CCRCs (aka Life Plan Communities).

Key Survey Results

Change in Occupancy by Care Segment

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

• About two-thirds (68%) of organizations reporting on their independent living and memory care units in Wave 4—across their respective portfolios of properties—experienced a decrease in occupancy from the prior month. Roughly one-third of respondents with independent living and memory care segment units (32%, respectively) saw no change or an increase in occupancy rates from the time they responded April 20-April 26, 2020 to one month prior, down from 49% and 42% in Wave 3.
• In contrast, 81% of respondents with assisted living units and 82% of respondents with nursing care beds reported a decline in occupancy from the month prior. For the assisted living care segment, organizations reporting declines in Wave 4 are up from 65% in Wave 3 to 81%. The proportion of organizations reporting nursing care segment occupancy declines in Wave 4 was similar to Wave 3 (84%).
• Regarding the change in occupancy from one week ago, roughly two-thirds to one-half of organizations with independent living, assisted living and memory care segment units noted no change (between 66% and 49%); however, respondents for all three care segments reported slightly higher shares of occupancy declines. In Wave 4, about two-thirds of the organizations reporting on their nursing care segments noted declines from one week prior (62%), consistent with Waves 2 and 3 (62% and 67%, respectively).

  

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…”

• In Wave 4, between 67% and 71% of organizations reporting on their independent living, assisted living and memory care segments noted that the pace of move-ins decelerated. Between 26% and 30% reported no change in the pace of move-ins for these care segments.
• While the majority of organizations reporting on their nursing care segments in Wave 4 note a deceleration in move-ins (76%) the share is lower compared to Wave 3 (87%).

Reasons for Deceleration in Move-Ins

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

• In Waves 3 and 4, roughly two-thirds to one-half of respondents attributed the deceleration in move-ins to a slowdown in leads conversions/sales or resident or family member concerns. However, more respondents in Wave 4 cited an organization-imposed ban on settling new residents into their communities than in the prior two waves of the survey (61% vs. 41% and 49%, respectively).

Move-Outs

• Between 76% and 64% of organizations reporting on their independent living, assisted living and memory care units saw no change in move-outs in the past 30-days. Assisted living saw a greater share of accelerated move-outs in Wave 4 than in Wave 3 (24% vs. 17%). Similar to Waves 2 and 3, about one-third of organizations with nursing care beds noted an acceleration in move-outs in Wave 4 (34%).

This weekly survey is designed for operators to capture high level metrics with minimal time lag to market on important trends for operators and investors. While survey questions will evolve over time, primary key metrics will continue to include changes in occupancy, move-ins, and move-outs as well as COVID-19 related data. With increased participation, future reports will provide COVID-19 related incidence data in seniors housing and care properties, including levels of testing being conducted at the property-level and lab-confirmed positive cases across the industry.

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

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

While the latest NIC data show skilled nursing and seniors housing occupancy and move-in rates declining and daily headlines seem to spotlight COVID-19 infections whenever they occur in these communities, the outlook from some of the sector’s most prominent analysts, while clear-eyed on short-term impacts and challenges, is not all bad. In fact, they see opportunities post-COVID. The third of NIC’s new series of “Leadership Huddle” webinars, held Thursday, April 23, drew over a thousand registrations from across the sector, and delivered again on the expectation of new data, expert analysis, and substantive discussion.

Hosted by NIC Chief Economist Beth Mace, the webinar, titled, “Prominent Real Estate Research Directors Discuss Market Trends and the Economic Outlook,” focused on the outlook for the U.S. economy over the next year, observations on current capital market conditions and assessments on the seniors housing sector from the point of view of investors. As Mace said in her opening remarks, she was joined by, “three of the most respected and brilliant minds in the commercial real estate industry.” As panelist Mary Ludgin, Senior Managing Director of Global Investment Research for Heitman pointed out, she and her fellow panelists, “bring insights that we’ve learned across the three prior recessions.”

Mace presented new findings released that morning from Wave 3 of the weekly “NIC Executive Survey,” saying, “We would expect, due to the COVID, that you’re going to see a decrease in the occupancy rates, and in fact that’s what we have seen.” 84% of respondents with nursing care beds reported declines in occupancy, as did 65% reporting on assisted living, 58% memory care, and 51% on independent living. The survey, which showed results for the week ending April 19, 2020,also reflects a slowdown in move-in rates, with 87% of the respondents reporting a deceleration in move-ins for skilled nursing, 74% for assisted living, and 71% for independent living. Survey findings and analysis are posted weekly on the NIC Notes blog.

Discussing what the economy will look like a year from now,  the panelists generally agreed that much depends on COVID-19-related factors, such as when a vaccine becomes available, testing of the general population occurs, and businesses are able to reopen. They also agreed that, while some return to ‘normalcy’ can be expected, not every sector will look the same. Calvin Schnure, SVP of Research & Economic Analysis at Nareit, said, “Keep in mind it’s not affecting all parts of the economy evenly, and there are going to be some things like travel, restaurants, theatres, and so on, that may not come back at all. The rest of this economy was in fairly good shape before this crisis hit, and that’s going to help lift the economy, but there are going to be different patterns of spending and patterns of activity.”

When asked what he’s telling his investment committee today, Michael Acton, Managing Director and Head of Research for AEW Capital Management, focused on the near-term impact on NOI, as well as cap rates, but indicated that the crisis will yield opportunities for investors who are ready for them. “There are going to be a lot of opportunities that show up, going forward from here. You can’t have a ten or eleven-year expansion without a lot of people being drawn into industries and investment opportunities that maybe they really shouldn’t be in. There’s very quickly going to be a revelation of weak hands versus very strong hands…we’re trying to get everybody…to be ready to act when things start to present themselves.”

Regarding lessons learned from the 2008/09 recession, Acton said that in general, you need to “triage” in three stages. First, you need to understand the debt maturities of your assets. Second, you need to keep an open dialog between your investors, asset managers and operators, and third you need to keep your team in place. “Things get harder through these events”. You also need to be sure that your capital structure has the flexibility that may be needed in a more challenged investment and economic environment.  

Responding to the same question about what she is telling her investment committee, Ludgin pointed to the bid/ask spread, saying, “We don’t know what valuation metrics will be or what they should be. We don’t know what cash flows are, and therefore we’ll have buyers that have one view of value and sellers that have another view.” She expects to see, “a lot of structured transactions come out of this where those would-be sellers need capital, but they don’t want to sell at the prices buyers are willing to pay.”

Acton pointed to pricing decline patterns seen in REITs over the past several decades, and the fact the biggest declines historically have been closely followed by, “very outsized performance.” He commented that, “these periods of sharp decline, whether it is in the private market or the public market, do create very interesting entry points for investors.” But Acton also said that the seniors housing sector will face numerous challenges in the coming months. Move-ins, and, as a result, occupancy, will drop until the COVID-19 public health crisis is resolved.

As in the 2008 financial crisis, seniors who have trouble selling their homes will be unable to move in, and some adult children will be unable to support move-ins, due to the financial impacts of the crisis. While acknowledging higher infection rates and worse outcomes in skilled nursing, Acton’s big-picture view is that seniors housing is still a very sound sector. He said, “There are a lot of headlines out there that are making people anxious and nervous, but I think the (senior housing) sector as a whole is demonstrating that this is actually a remarkably safe place for your parents to be.”

For Schnure, the biggest risk facing the sector is that the “rising wave of older Americans moving into senior housing” might be “delayed” or even not occur at all. Comparing the sector to those which have seen less construction of supply in recent years, such as office, he pointed out that, with the high supply now on the market, seniors housing has less ability to absorb a drop in demand. He said, “seniors housing has to be able to absorb a fair amount of cushion, so that gives some extra work to do with this crisis.”

In Ludgin’s view, the complexity and operational expertise it takes to do well in a sector in which, “you have to get a lot of things right,” hasn’t been fully reflected in current pricing. She said, “So, I anticipate that there will be an expansion of cap rates in this sector, on a relative basis, in the near term. However, in the long term, she sees that demand remains “extremely strong,” saying, “This pandemic is not going to change that meaningfully, so I stay positive on this sector, but expect some near-term repricing.”

Webinar recordings and recap articles are available for this and prior webinars in the series, on the NIC Covid-19 Resource Center.  

Care collaboration offers solution for the ‘Forgotten Middle.’

Collaboration among various stakeholders will likely play a significant role in securing affordable housing and appropriate care for middle-income seniors—a big group expected to increase in size in the wake of the COVID-19 pandemic.

Medicare Advantage plans, adaptive re-use of commercial properties and telehealth are some of the vehicles that could be leveraged to create new approaches to house and care for middle-income seniors.

“Our nation’s middle-market seniors need a sustainable housing solution that addresses their projected health and wealth characteristics,” said NIC Chief Economist Beth Mace. “Given the COVID-19 pandemic, the need is only going to get bigger.”

NIC first identified the growing number of vulnerable middle-income seniors last year in its report, “The Forgotten Middle: Middle Market Seniors Housing Study.” It showed that 54% of seniors cannot afford today’s senior housing product—based on a monthly cost of $4,500—and do not qualify for assistance under the Medicaid program. By 2029, 14 million seniors will fall into that category.

That number will likely grow because of the pandemic and its economic fallout.

Seniors whose savings are depleted by the economic downturn will likely join the middle-income ranks of those who can’t afford the housing and care they need. And more of today’s middle-income could fall into the low-income category of elders who rely on Medicaid, stretching an already overburdened system.

Added to that, consumer confidence will take a hit, said Mace. A rocky stock market and big job losses create uncertainty which can impact decisions to move into seniors housing.

The problem of how to house the rising number of middle-income seniors, many with functional limitations, will be solved in part by an increase in care collaboration.

New approaches were discussed at the NIC Spring Conference during a session titled, “Planning for the Care Needs of the Forgotten Middle.”

Much of the discussion focused on how to integrate healthcare into housing.

“The middle market is where health and housing intersect,” noted Caroline Pearson, senior vice president at NORC, at the University of Chicago. She is co-author of the original ‘Forgotten Middle’ study.

Medicare Advantage insurance plans could help, session participants agreed. These plans, held by a growing number of seniors, are beginning to offer wraparound services such as payments for food, assistance with the activities of daily living and on-site healthcare.

Some senior living providers are forming their own Medicare Advantage plans while others are aligning with healthcare providers.

The big healthcare REIT Welltower, for example, formed a partnership with CareMore Health, a division of Anthem insurance. CareMore enrolls residents in Medicare Advantage plans. They are treated on-site by CareMore healthcare professionals.

“Senior living should be the convener of healthcare,” said session participant Kevin O’Neil, chief medical officer at Affinity Living Group. He added that on-site healthcare can help avoid costly emergency room visits. It’s easier on the resident too.

Working with local health systems is a priority, session participants agreed. But managed care organizations will only partner with senior living providers that can track outcomes, said Diane Burfeindt, vice president of population health at Presbyterian Senior Living. “Data is huge.”

Panelists presented other ideas to lower costs for middle-income seniors. Unused properties, such as vacant schools, could be converted into senior living properties. The low-cost basis of the property would help keep rents in check.

Government programs such as low-income housing tax credits and the rental of ground floor space to retailers are other cost-saving ideas. “It will take a multi-industry mindset,” said James Lydiard, general manager of CareMore’s Touch program for senior living communities.

Technology will help lower costs. Senior living providers are already stepping up their use of telehealth in the wake of the pandemic. Timely, virtual doctor visits will help maintain the health of middle-income seniors at an economical price. “Telehealth is the way to go to reduce the cost curve for the middle market,” said Mace.

The Department of Labor reported that 4.4 million Americans filed for unemployment insurance benefits in the week ending April 18, 2020 as the COVID-19 pandemic continues to cause businesses to lay off or temporarily furlough workers due to lock down across much of the country. This was a decline of 810,000 from the previous week’s upwardly revised level of 5.2 million. The speed and scale of the job losses is unprecedented. In the past five weeks, more than 26 million people have filed claims. By comparison, 9 million jobs were lost over the course of the 2007-2009 recession.

Continuing claims for regular benefits, which are reported with an extra week’s lag, rose 4.0 million to 16 million. This marks an all-time high in the data series. This measure, which accounts for people who are continuing to receive benefits, will keep climbing as jobs continue to disappear. This has also pushed the insured unemployment rate (the share of the labor force that claims unemployment benefits) higher. The insured unemployment rate was 11.0% in the week ending April 11, an increase of 2.8 percentage points from the prior week and up from 1.2% pre-COVID-19. This marks the highest level of the rate in the history of the data series.

Jobless claims are laid-off workers’ applications for unemployment insurance payments. Gig-economy workers, self-employed people and those seeking part-time work are now eligible to apply for benefits in an expanded unemployment assistance program recently created in response to the pandemic. Further, as of last Monday, more than 40 states were paying recipients an additional $600 a week in enhanced unemployment benefits on top of the usual payments.

The largest increases in initial claims for the week ending April 11 were in Colorado, New York, Missouri, Florida and North Carolina.

This week’s increase in unemployment claims marks the fifth consecutive week of surging jobless claims and indicates just how quickly and sharply the economy has collapsed. An 11-percentage point jump in the official BLS jobless rate to as much as 15% to 20% by April is likely and could exceed 20% in May, according to Capital Economics. This would be the highest rate since the 1930s. As recently as February, the unemployment rate was at a 50-year low of 3.5%. In March, the rate had already increased to 4.4%.

In response to the coronavirus crisis, the Federal Reserve has pushed interest rates to zero and enacted nine new lending programs in recent weeks. These include open-ended asset purchases of $1.2 trillion of Treasury securities in just four weeks and the announcement of a series of new lending facilities aimed at households and non-financial businesses, worth up to $2.3 trillion. The FOMC meets next week and may announce further plans to buy more Treasury securities and create new or expand existing loan programs. The Fed’s actions in recent weeks are unprecedented and indicate how troubled the economy is indeed.

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

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

Summary of Insights and Findings

Occupancy rates declined and move-in rates decelerated for many organizations in Wave 3, with data showing distinctive downward trends since the survey began on March 24, 2020.

• In Wave 3, a decline in occupancy rates from the prior month occurred across all care segments, with the deepest declines reported for the nursing care segment. In Wave 3, about 40% of organizations reporting on their nursing care beds note an occupancy decline of ten percent or more from the prior month, up from about 20% reporting an occupancy decline of ten percent or more in Wave 2.
• Regarding the change in occupancy from one week ago, the independent living segment saw the most occupancy stability. However, roughly one-third of memory care units, and under one-half to two-thirds of assisted living units and nursing care beds note a decline in occupancy compared to the prior week, suggesting continued weakness in the near future.
• More organizations report the pace of move-ins decelerated in the past 30-days in Wave 3 than in the prior two waves of the survey. Two-thirds to one half of respondents attribute the deceleration in move-ins to a slowdown in leads conversion/sales, or resident or family member concerns. Overall, slightly fewer respondents in Wave 3 cited an organization-imposed ban on moving new residents into their communities, and slightly more cited resident or family member concerns than in Wave 2.
• The nursing care segment saw the largest deceleration of move-ins in the past 30-days. Reasons cited by respondents include fewer hospitals discharging patients to post-acute care settings for rehabilitative therapy as hospitals defer elective surgeries due to the pandemic, and positive or suspected COVID-19 related moves of residents to isolated units. Nearly one-half of organizations with any nursing care beds cited an organization-imposed ban on move-ins, and nearly one-quarter cited a government-imposed ban on admitting new residents.
• A larger share but still minority of respondents in Wave 3 report an acceleration in move-outs in the past 30-days compared to prior waves of the survey. Roughly two-thirds to three-quarters of organizations reporting on their independent living, assisted living and memory care segments saw no change in move-outs—a steady decline from Wave 1 to Wave 3. Just over one-third of organizations with nursing care beds note an acceleration in move-outs in Wave 3.
• Most organizations continue to mitigate staffing shortages by increasing overtime hours, offering flexible work hours, and remote work where possible. Fewer organizations in Wave 3 than the prior two waves of the survey are hiring agency or temporary staff and professionals from other industries. However, more organizations are beginning to offer additional paid sick leave to support property staff. Survey write-in comments indicate other tactics are being employed such as increasing wages, offering shift bonuses and incentive pay, access to on-site groceries and meals, emergency financial support programs, and temporary housing.
• Like previous waves of the survey, one-half of respondents in Wave 3 expect no change in their development pipeline going forward, however one-quarter expect their development pipeline to decrease citing uncertainty as the primary reason. Some of the respondents shared concerns about the economy, restrictions on moving new residents in, access to capital/debt, and cashflow and liquidity issues. NIC MAP® data has shown a deceleration in new construction relative to inventory trending for several quarters.
• A recent NIC blog post entitled “We Feel We Are Alone in a War Zone” incorporates comments from earlier survey respondents that reflect the impact of the COVID-19 crisis on a human level. One of the key concerns reflected in survey comments is a lack of available, accurate, and timely testing. Survey respondents also worry about the effect that the pandemic is having on already strained labor force issues.

Wave 3 Survey Demographics

• Responses were collected April 13-19, 2020 from owners and C-suite executives of 105 seniors housing and skilled nursing operators from across the nation.
• More than half of respondents were exclusively for-profit providers (59%), about one-third (36%) were exclusively nonprofit providers, and 5% 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 24% while operators with 26 properties or more make up 13% of the sample.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 73% of the organizations operate seniors housing properties (IL, AL, MC), 36% operate CCRCs (aka Life Plan Communities), and 34% operate nursing care properties.

Key Survey Results

Change in Occupancy by Care Segment

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

• Approximately one-half to two-thirds of organizations reporting on their independent living, assisted living and memory care units in Wave 3—across their respective portfolios of properties—saw a decrease in occupancy from the prior month. This is up from roughly one-third to one-half in Wave 2. Conversely, roughly one-third to one-half saw no change or an increase in occupancy rates from the time they responded April 13-April 19, 2020 to one month prior, down from roughly one-half to two-thirds in Wave 2.
• Organizations with nursing care beds report the largest declines in occupancy changes from one-month prior among the four segment types across the three waves of the survey. In Wave 3, about 40% of organizations reporting on their nursing care beds note a decline of ten percent or more from the prior month, up from about 20% reporting a decline of ten percent or more in Wave 2.
  
• Regarding the change in occupancy from one week ago, the independent living segment saw the most stability with approximately 70% noting no change. In contrast, approximately 40% of organizations with assisted living units report a downward change of less than 3%. While about a third of memory care units report a decline from a week ago, a growing share (10%) show steeper declines of 3% or more. Two-thirds of nursing care beds saw a decline from one week ago, with one-half reporting a decline of 3% or more.

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…”

• In Wave 3, two-thirds to three-quarters of organizations reporting on their independent living, assisted living and memory care segments report that the pace of move-ins decelerated. Only one-third to one-quarter report no change in the pace of move-ins for these care segments.
• The majority of organizations reporting on their nursing care segments in Wave 3 note a deceleration in move-ins, compared to fewer than one-half in Wave 1.
  

Reasons for Deceleration in Move-Ins

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

• In Wave 3, two-thirds to one-half of respondents attributed the deceleration in move-ins to a slowdown in leads conversion/sales, or resident or family member concerns. Overall, slightly fewer respondents in Wave 3 cited an organization-imposed ban on settling new residents into their communities, and slightly more cited resident or family member concerns than in Wave 2.
• Other reasons for deceleration in move-ins written into the survey comments include staffing shortages, fewer hospital referrals and elective surgery rehab residents, inability to engage contractors deemed “non-essential workers” to complete unit renovations, and positive or suspected COVID-19 related moves of residents to isolated units.
• Shown below, the reasons for deceleration in move-ins in the past 30-days for Wave 3 are broken out by organizations without nursing care beds and organizations with any nursing care beds. Considering organizations with any nursing care beds, nearly one-half cite an organization-imposed ban (46%), and nearly one-quarter cite a government-imposed ban (23%).

• About two-thirds to three-quarters of organizations reporting on their independent living, assisted living and memory care units saw no change in move-outs in the past 30-days—a steady decline from Wave 1 to Wave 3 as shown in the chart below.
• Just over one-third of organizations with nursing care beds note an acceleration in move-outs in Wave 3.

Mitigation Strategies for Labor Shortages

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

• Consistent across all three-waves of the survey, most of the organizations report increasing overtime hours to mitigate staffing shortages (89% to 84%). However, fewer organizations in Wave 3 than the prior two waves of the survey are hiring agency or temp staff (36%), and professionals from other industries (22%).
  

Supporting Property Staff

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

• Most respondents across all three waves of the survey report offering flexible work hours and remote work to support property staff. More organizations in Wave 3 than in Wave 1 are offering additional paid sick leave (58% vs. 47%).
• Many respondents in Wave 3 offered written comments about how their organizations are supporting property staff as the pandemic emergency continues for employees and their families, mentioning increases on wages, shift bonuses and incentive pay, access to on-site groceries and meals, emergency financial support programs, and temporary housing.
  

Development Pipeline Considerations

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

• There are generally minimal differences in expectations about organizations’ development pipelines across all three-waves of the survey. One-half in Waves 2 and 3 (46% and 49%, respectively) continue to expect no change in their development pipeline going forward, with one-quarter in Wave 3 expecting their development pipeline to decrease (27%), and 15% expecting it to increase.
• Uncertainty remains the primary reason for expected decline. Others cited concerns about the economy, restrictions on moving new residents in, access to capital/debt, and cashflow and liquidity issues.

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

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