Attendees gathered in Dallas for three days of content, connections, and actionable insights.

Against the backdrop of an ever-evolving senior housing and care landscape, the 2024 NIC Spring Conference brought together industry leaders, experts, and stakeholders to exchange ideas, network, learn, and chart a forward-looking course for the sector.   

The conference theme — “Insights into Action” — reflected the event’s goal to give leaders the actionable insights to embrace and capitalize on the future of senior housing and care. Thoughtful and engaging programming highlighted the emerging trends shaping the industry, while addressing current challenges and opportunities.   

Drawing more than 1,800 participants, the conference was held March 5-7 at the Omni Dallas Hotel in Dallas, TX.  

Bob Kramer, NIC co-founder and strategic advisor, kicked off the three-day event. He noted that the focus of the conference was care and housing for older adults but within a broad framework. This comprehensive vision goes well beyond the traditional offerings of providers to include the management of chronic diseases and taking increasing responsibility for resident health and longevity. “This opens the need and opportunity for partners as we address the complete needs of our residents,” said Kramer.   

Here are key highlights from the 2024 NIC Spring Conference. 

Important New Research Shows the Value of Senior Housing. Older adults who live in senior housing communities live longer, receive more home health services, and benefit from greater rehabilitative and preventative care in the two years following move-in than those who do not, according to new research presented at the conference and conducted by NORC at the University of Chicago. “It’s all about outcomes,“ said Dianne Munevar, vice president, Health Care Strategy at NORC. 

Dynamic Main Stage Discussions. Eight main stage sessions brought together top experts on the dynamic trends driving the sector. Three sessions focused exclusively on the skilled nursing segment. Here’s a quick recap of other popular sessions. 

• Medicare Priorities and Programs. Answering the question of how senior housing and care providers can better work with the Centers for Medicare & Medicaid Services (CMS), Dr. Meena Seshamani, Deputy Administrator and Director at CMS, took the stage with Dr. David Grabowski, Professor of Health Care Policy, Department of Health Care Policy at Harvard Medical School. Seshamani said the agency’s expanded definition of care and other initiatives will impact senior housing and care. “It is extremely important to us to encourage data, transparency, and innovation,” she said. 
• Big Retail Healthcare Strategies. The lines between healthcare and retail are blurring. Companies like Kroger and Amazon are diving into the healthcare space at a time when senior living is trying to figure out where it fits in. Leaders from major retailers and healthcare companies including Kroger and One Medical, discussed the opportunities to partner with the senior housing and care industry in new care delivery models. “Amazon and Kroger have invested in data and have evolved. As a senior housing and care industry, we have to change too,” said panelist Chip Gabriel, partner, Senior Living TransFormation Company. “Amazon is customer obsessed, so One Medical is patient experience obsessed” said Lindsay Botsford of One Medical. “We want to make it dramatically easier for customers to find, choose, afford, and engage with the products and professionals that can improve health.” 
• Capital Markets. Commercial real estate faces a difficult financing environment, even as the economy continues to expand. Rising interest rates have slowed senior housing transactions. One of the country’s leading economists, Doug Duncan, chief economist at Fannie Mae, put the discussion in context. He was joined by a panel of senior housing finance executives. Duncan noted that the service side of the economy has continued to show strength despite other soft spots. He expects three interest rates cuts by the Federal Reserve in the second half of 2024. Recognizing an opportunity, the REIT Welltower will continue to put capital into senior housing, according to John Olympitis, senior vice president and head of corporate development at the company. Panelist Jamie Cobb, chief financial officer at Columbia Pacific Advisors, said it’s a good time to deploy capital in the sector, but hard to do since banks are hesitant to finance new development.

Conference attendees can view conference presentations in the conference app. 

Collaborative Innovation Labs. The conference featured five Innovation Lab sessions. The interactive format was brought back from its well-received launch at the 2023 NIC Spring Conference. Attendees collaborated with peers in a small group workshop format. Timely topics included middle market strategies, operating models for baby boomers, and AgeTech, among others

Networking Opportunities. Attendees also enjoyed a variety of opportunities to connect with colleagues. Comfortable networking areas including two designated networking lounges were provided to meet with industry peers. Evening receptions were held outdoors for participants to enjoy the spring weather. First-time attendees participated in a special gathering with fellow inaugural conference participants. 

A special Women’s Networking Meetup was held the first morning of the conference to allow attendees to meet and network before the full start of the conference. Colleen Blumenthal, COO at HealthTrust, shared personal stories with advice on how to achieve professional and personal goals. She offered the group some advice: Decide and define what you want to be. Find your people. Let go, occasionally. And set new goals.  

Looking Ahead. Attendees at the 2024 NIC Spring Conference gained a deeper understanding of the opportunities and challenges facing the industry that will serve as catalysts for change. As NIC’s Kramer concluded, “We are turning insights into action.” 

Mark your calendar! Join us at the 2024 NIC Data & Analytics Conference, May 21-22, 2024, in Minneapolis. Registration is now open.     

With more than 1,800 attendees at last week’s NIC Spring Conference, it was the ideal time to ‘take the temperature’ of the stakeholders serving and investing in the senior housing and care landscape.

Attendees were asked, “What is your 2024 outlook for senior housing and care?” to which they selected a response ranging from “Extremely Positive” to “Extremely Negative.” As detailed below, nearly 8 out of 10 attendees responded, “Somewhat Positive” or “Extremely Positive.” 

Not surprisingly, there were differences in outlook across various stakeholder groups with developers, lenders, and investor/equity providers expressing a less positive outlook. Given the current conditions related to access and cost of capital, this result was not unanticipated. The average ratings by attendee category are noted below, with the higher the average representing the more positive the outlook.

Despite the differences, in general, the sentiment on outlook is one that is fairly positive. This is an important finding, particularly given the current headwinds facing the sector. Clearly conference attendees remain bullish on the sector despite some of today’s challenges.

One of the additional goals of asking the outlook question was to develop a sentiment index that can be assessed over time as the industry progresses in the months and years ahead. NIC will again survey conference attendees at the NIC Fall Conference and the 2025 NIC Spring Conference to examine industry sentiment over time.

Older adults who live in senior housing communities live longer, receive more home health services, and benefit from greater rehabilitative and preventive care in the two years following move-in than those who do not, according to new research. The research was supported by a grant from NIC and led by an independent team of researchers at NORC at the University of Chicago. 

Researchers compared older adults who moved into senior housing communities in 2017 and resided there for two years or until their death to a similar group of older adults who remained living in the greater community. They analyzed six measures: mortality, days alive, days away from home due to adverse health events, days receiving home health care, preventative and rehabilitative health services days, and days on anti-psychotics to understand the impact of senior housing.  

On average, older adults who move into senior housing: 

• Live longer—Living more than one week longer than older adults who live in the community, and have a lower mortality rate; 
• Receive more home health care—Receiving 10 more days of home health care services than older adults who live in the community; 
• Obtain more preventative/rehab services at home—Receiving four more days of preventative and rehabilitative services at home than older adults who live in the community; 
• Spend less time on anti-psychotics—Spending three fewer days on anti-psychotics than older adults who live in the community. 

Researchers found that older adults who moved into senior housing properties spend roughly the same number of days away from home to receive high-acuity care as older adults who live in the surrounding community. 

The implications for this type of work are significant and will also inform future research projects. One of the findings was that while on average, senior housing properties have metrics more favorable than for those who live in the greater community, the variability among senior living properties is meaningful. There can be more done to learn about those properties who consistently rate among the highest quartiles and replicate those qualities to narrow the spread of rankings between the highest and lowest performing properties.  

The study is the third part of a four-part project supported by NIC to assess the health and well-being of senior housing and care residents. Previous studies provided insights on the vulnerability of senior housing residents and access to health care providers, and the final study will assess health outcomes of residents in senior living settings. Access the summary report on the longevity findings, which provides more details, here.  

Middle income seniors don’t have a wealth of senior living options. Either they don’t have enough money to afford a market rate community, or too much to qualify for an affordable place.  

To address this widening gap, a panel of experts explored innovative solutions at a recent NIC webinar. About 1,000 people attended the February 1 session, which highlighted the business opportunity for industry stakeholders.   

“The middle market has been underserved,” said Bob Kramer, co-founder and strategic advisor of NIC. “We need practical solutions for this huge and growing cohort.” 

The session was led by NIC Head of Research & Analytics, Lisa McCracken. She was joined by Ryan Brooks and Caroline Clapp, both senior principals at NIC. They reviewed recent research to provide context for the discussion.   

The shortage of senior housing for average Americans was first identified in NIC’s 2019 study, “The Forgotten Middle.” It was updated in 2022. 

The number of middle-income seniors by 2033 will grow to 15.9 million, accounting for 44% of all seniors. About half will have chronic health conditions or mobility limitations. But only 2.2 million will be able to afford assisted living.  

Due to a number of factors, middle market seniors face the dual burden of housing and care. “The private and public sectors have a lot of work to do,” said Clapp. The opportunity for the industry is to create a less expensive senior living model. “As the price point goes down, the potential market goes up,” said Brooks.    

Defining the Middle Market 

Middle income seniors are not all the same, cautioned Kramer. “There is no one-size-fits-all solution.”  

The middle market can be divided into three income segments ranging from 60-150% of area median income (AMI). Kramer challenged providers to ask themselves:  

* What part of the market are you seeking to serve?  

* What level of services will you provide?   

* What are the payment sources?  

* What are the barriers to scale? 

Financing a sustainable model is a big hurdle. A recent Milken report suggests four strategies: 1) Repurpose distressed properties; 2) Create a revolving loan fund; 3) Establish a value-based care delivery and payment model; and 4) Launch a senior housing-payer pilot partnership.  

Two panelists presented their successful approaches.  

Presbyterian Homes & Services targets the higher end of the middle market. “We maintain tight efficiencies and staffing ratios to bring down rents,” said Jon Fletcher, senior vice president at the organization. The goal is to tie increases in rents and expenses to the Consumer Price Index (CPI), so apartments remain affordable.  

Innovation Senior Living repurposes distressed properties, growing in number post COVID. Buildings purchased at reduced prices can keep rents affordable, according to Pilar Carvajal, founder & CEO at Innovation. She also partners with healthcare and community service providers. 

Panelist Lundat Kassa, vice president at Bellwether Enterprise Real Estate Capital, said that financing in today’s capital constrained market takes creativity. Lending sources are available, but public-private partnerships are needed to scale successful models.  

McCracken wrapped up the session with a lighting round question. What key lever would produce more middle market senior housing? 

Suggestions were to repurpose more underperforming properties and expand the definition of affordable housing used by policy makers to include the middle market.  

More public subsidies and social impact investors are also needed. “We have the opportunity to solve this crisis,” said Carvajal.  

The following analysis examines occupancy and year-over-year changes in inventory, and same-store asking rent growth—by care segment—within entrance fee CCRCs and rental CCRCs in the 99 combined NIC MAP Primary and Secondary Markets. The analysis also explores the recovery of regional occupancy rates by majority contract type (entrance fee CCRCs vs. rental CCRCs) and compares the distribution of occupancy among different community types and by contract type during the fourth quarter of 2023. 

Key takeaways

• The occupancy rate for entrance fee CCRCs surpassed 90% in the fourth quarter 2023. 
• Entrance fee CCRCs maintained higher occupancy rates than rental CCRCs across all regions and care segments. 
• Occupancy rates and recovery timelines continue to be uneven across regions. In future publications, NIC Analytics will explore these regional differences to understand the underlying drivers. 
• The memory care segment within rental CCRCs experienced the smallest asking rate growth but the largest annual occupancy gain. 
• Nursing care Inventory within CCRCs is shrinking at a higher pace. There is a trend of CCRCs converting skilled nursing beds to assisted living or memory care units. 

The Occupancy Rate for Entrance Fee CCRCs Surpassed 90% in the Fourth Quarter 2023. In the 99 NIC MAP Primary and Secondary markets, the occupancy rate for entrance fee CCRCs increased to 90.2%, 4.1 percentage points (pps) higher than rental CCRCs (86.1%) and 6.6pps higher than non-CCRCs (83.6%). 

NIC Analytics recently published its first occupancy stratification report, which examines the distribution of stabilized occupancy within the senior housing sector in 2023. The report shows that CCRCs had the smallest share of communities with occupancy below 80% compared to other community types. Additionally, only about 10% of entrance fee CCRCs reported occupancy below 80%, less than half the share found in rental CCRCs and the smallest share across NIC MAP Vision dimensions comparisons. 

Across all Regions, Entrance Fee CCRCs Maintained Higher Occupancy Rates than Rental CCRCs in the Fourth Quarter 2023. The largest differences in occupancy between entrance fee and rental were reported for the West North Central and Southeast Regions, where entrance fee CCRC occupancy was 4.8pps higher than rental, followed by the Mountain (4.7pps), and the Northeast (3.4pps). 

Strong Occupancy Rates in Mid-Atlantic and Northeast. The Mid-Atlantic and Northeast Regions had the strongest occupancy rates for both entrance fee and rental CCRCs in the fourth quarter 2023. The occupancy rates within these regions with respect to contract type were well above the average occupancy rate for entrance fee CCRCs (90.2%) and rental CCRCs (86.1%) in the combined 99 NIC MAP Primary and Secondary Markets. 

Mid-Atlantic and Southwest Regions Closest to Recovery. For entrance fee CCRCs, the Southwest and Mid-Atlantic Regions are the closest to fully recovering and returning to the occupancy levels of the first quarter 2020. The Southwest Region has reached 86.9% occupancy, while the Mid-Atlantic Regions is at 92.3%. Both regions are within 0.4pps and 1.0pps, respectively, of reaching pre-pandemic first quarter 2020 levels. As for rental CCRCs, the Southwest Region (84.3%) has fully recovered and returned to the occupancy level of the first quarter 2020. 

In future publications, NIC Analytics will explore these regional differences to understand the drivers behind higher occupancy rates or faster recovery in some regions, and relatively lower occupancy rates or slower recovery in others. 

4Q 2023 Market Fundamentals by Care Segment – Entrance Fee CCRCs vs. Rental CCRCs  

Occupancy. Overall, the occupancy rate for entrance fee CCRCs continued to outpace that of rental CCRCs across all care segments. The difference in the fourth quarter 2023 occupancy rates between entrance fee CCRCs and rental CCRCs was largest for the independent living segment (3.8pps) and the assisted living segment (3.4pps), and smallest for the nursing care segment (1.0pps). 

The entrance fee CCRC independent living care segment had the highest occupancy (91.9%) in the fourth quarter of 2023, followed by entrance fee CCRC assisted living and memory care segments (89.7% and 88.5%, respectively). 

In terms of occupancy improvements from one year ago, the largest occupancy gains for both entrance fee CCRCs and rental CCRCs were seen across assisted living and memory care segments, while the smallest gains were seen across independent living segments (1.0pps and 1.1pps, respectively).  

Asking Rent. The monthly average asking rent for entrance fee CCRCs across all care segments remained higher than rental CCRCs. The highest year-over-year asking rent growth for entrance fee CCRCs was noted in the assisted living and memory care segments (5.8% to $7,380 and 5.7% to $9,051, respectively). For rental CCRCs, the largest year-over-year asking rent growth was noted in the independent living segment (4.2% to $3,518), while the smallest growth was seen in the memory care segment (3.8% to 7,433). Interestingly, the memory care segment experienced the largest annual occupancy gain (3.7pps) across all care segments and payment types.  

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

Inventory. Compared to year-earlier levels, nursing care inventory for both entrance fee and rental CCRCs continued to experience the largest declines (negative 1.2% and 2.0%, respectively). On the other hand, positive year-over-year inventory growth was reported for the entrance fee CCRC assisted living segments (0.2%) and memory care segments (0.2%).  

Negative inventory growth can occur when units/beds are temporarily or permanently taken offline or converted to another care segment, outweighing added inventory. Anecdotally, there is a trend of CCRCs converting skilled nursing beds to assisted living or memory care units. 

Look for future blog posts from NIC to delve deep into the performance of CCRCs.   

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.