The question of whether senior living should include a healthcare component is no longer up for debate. The COVID crisis has shown in the most dramatic way possible that elderly residents not only need to be kept safe from infection, but also need access to reliable healthcare providers.

In recognition of the quickly accelerating partnership between healthcare and housing, the 2020 NIC Fall Conference will spotlight the trend. The Conference is being held online over two weeks. Education Week (Oct.6-8) covers timely topics and market conditions. Connections Week (Oct.13-15) features peer-to-peer and brainstorming sessions.

A number of Education Week sessions will explore healthcare and housing in the wake of the COVID crisis. Here are a few highlights:

• • “What Does Senior Living Look Like in the COVID Era: The New Role of Health and Healthcare On-site.” (Tuesday, Oct. 6, 1-2 pm) Moderated by Bob Kramer, NIC founder and strategic advisor, and president of Nexus Insights, this session will explore partnerships that can deliver benefits to improve length of stay. Attendees will learn about changing referral patterns and the role of effective care. Speakers include James Lydiard, staff vice president, CareMore Health; and Michael Grust, founder, Senior Resource Group.
  • “Four Weeks Out from the General Election: A Policy Discussion.” (Tuesday, Oct. 6, 2:15-3:15 pm) Government policies will have a big impact on housing and healthcare. Journalist Soledad O’Brien leads a deep dive into healthcare policy in a COVID world with Mark Parkinson, president & CEO of AHCA; and Andy Slavitt, former acting administrator of CMS. The panel will cover regulatory impacts, Medicare & Medicaid, and changes to private health plans.
  • The popular NIC Talks series returns this fall as thought leaders address the future of aging. NIC’s Kramer will moderate “NIC Talks: How Will COVID-19 Impact the Future of Aging and Aging Services.” (Tuesday, Oct. 6, 3:30-4 pm) Telehealth and healthcare delivery will be explored. Speakers include Tim Ferris, MD, CEO, Mass General Physicians Organization, Professor, Harvard Medical School; and Krista Drobac, executive director, Alliance for Connected Care. Another NIC Talks, “How Will Covid-19 Impact the Future of Aging and Aging Services” (Wednesday, Oct.7, 1-1:45 pm) explores ageism and COVID as well as how to create a better future and better designs for senior living. Among the featured speakers is AARP CEO Jo Ann Jenkins.
  • “Operator Spotlight-Decision-Making Roadmap to Rapid Testing.” (Wednesday, Oct. 7, 12:45-1 pm) Lynne Katzmann, president & CEO at Juniper Communities shares how she navigates testing accessibility for her staff.
  • “Technology: Top Trends in Senior Care.” (Thursday, Oct. 8, 2-2:45 pm). The adoption rate of new technologies has increased exponentially amid the COVID crisis. Speakers will explore how operators are using technology to improve care, create a more efficient workplace, and enhance communication with residents, families and staff.

For more information on the 2020 NIC Fall Conference, visit: https://fallconference.nic.org/

The 2020 NIC Fall Conference, which will be hosted on an advanced virtual technology platform, features many of the attractions of its traditional predecessors, while boasting a host of new advantages, including convenience and lower pricing.

‘The NIC’ comes at a time of immense change, intense public scrutiny, and uncertainty for the future. Amidst a pandemic that impacts frail elders disproportionately, major policy shifts, the rise of new technologies and standards, economic and social turmoil, and with a critically important national election only weeks away, the opportunity to gain the latest data, insights, thought-leadership, and to connect with experts, peers, prospects, and old friends, is more valuable than ever.

Here’s an outline of what you and your team can expect from the ‘essential virtual experience’:

Education Week | Tuesday, October 6-Thursday, October 8

Connections Week | Tuesday, October 13-Thursday, October 15

Unmatched Thought-Leadership

Attendees will gain access to over 40 informative, relevant, and thought-provoking sessions, featuring over 50 experts and business leaders, in a three-track program designed to cater to a variety of roles across the sector. Some sessions will be live, and many will be available for on-demand access, both during and after the event.

Expect many of the sessions to cover areas of traditional interest, such as valuations, insights from the latest NIC data, and the real-world challenges and opportunities facing operators and capital providers in today’s markets. Others will delve into the particular issues posed by the COVID pandemic, uncertainty in financial markets, policy and regulatory change, and more.

Live Main Stage Sessions

Main Stage sessions will, as always, feature figures of national prominence, discussing issues of the highest relevance to the industry. Award-winning journalist Soledad O’Brien, who currently hosts CNN’s “Matter of Fact,” will moderate 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 and Medicaid Services. From the vantage point of four weeks out from the general election, the panel will help attendees understand the potential policy impacts and what’s at stake for their businesses.

Also likely focusing on the election and associated political realities, household names David Gergen and David Brooks will turn their considerable expertise and experience – and wit – to shed light on the factors to consider as November 5 approaches. This election has the potential to impact the seniors housing and care sector both directly and indirectly, and many attendees will be watching the discussion closely.

NIC Talks

Our popular NIC Talks series returns—featuring another group of uniquely qualified, passionate thought-leaders, including business leaders, academicians, and leading advocates, sharing their perspectives on the question “How will COVID-19 impact the future of aging and aging services?” This year’s speakers include Jo Ann Jenkins, the CEO of AARP, the world’s largest nonprofit, nonpartisan membership organization. She will offer insights from the perspective of 100 million Americans who are 50 and older, who wish to achieve health security, financial resilience and personal fulfillment.

Dr. Louise Aronson, Professor, UCSF Division of Geriatrics, will address “Ageism and COVID-19: Opportunities to Create a Better Future.” Dan Cincelli, Principal, Perkins Eastman, will provide the most recent thinking on architectural and community design innovation, in “How will disruptive forces like COVID-19 impact the design of senior living?” Krista Drobac, Executive Director, Alliance for Connected Care, will bring her audience up-to-date on one of the most widespread innovations to take root during the pandemic, in “Telehealth Beyond COVID-19, A Bigger Leap Ahead.” Another major driver of change in seniors housing and care is in the delivery of healthcare for a population that, due to their frailty and vulnerability, can, in many places, no longer be routinely transported to clinics and hospitals. Dr. Tim Ferris, CEO, Mass General Physicians Organization and Professor, Harvard Medical School, will cover the deep and lasting implications of this development, in “Impact of COVID-19 on Healthcare Delivery.”

Still the best networking opportunity in the sector

Although nothing can replace in-person networking, the 2020 NIC Fall Conference offers the most connectivity available in today’s environment.

The NIC Community Connector™

Attendees who complete a registration form gain exclusive, complimentary access to NIC’s powerful new networking platform, the NIC Community Connector. The innovative online platform provides a means to search for potential new contacts, and to communicate directly with decision-makers across the industry. It was custom designed to suit the needs of capital providers, owners, operators, service providers, and other stakeholders across the seniors housing and care sector.

Braindate

The braindate™ platform, which NIC rolled out for the 2020 NIC Spring Conference, facilitates focused, issue-specific discussions 1-on-1 or in small groups. Braindate offers both the intimacy of a small group discussion on a pre-determined topic of shared interest (which can be defined by participants), and the efficiency and convenience of scheduled online meeting times.

Live Zoom Meetings

Throughout the event, attendees will be presented with numerous opportunities to participate in live Zoom meetings with experts and peers. Some live meetings will be focused on social networking, with happy hours, and even live entertainment (exclusive Hamilton performances, anyone?) on tap. Other Zoom meetings will be oriented to discussions on the most important and relevant issues, as leaders and experts address the challenges and opportunities of today’s marketplace, and help attendees, as they plan for the future. Throughout the event, NIC will facilitate ‘breakout rooms’ via Zoom, designed to allow for more intimate, focused discussions.

A Personal Touch

As with all NIC events, attendee experiences will include opportunities for some personal and professional development, or to take a break to enjoy live entertainment with their peers. ‘The NIC’ will continue to offer a LinkedIn help desk, helping attendees update their profiles and learn the latest tips and techniques for staying connected and visible in the leading social networking platform for professionals. Videos and presentations, primarily available on-demand, will be available for attendees who wish to take a break with a selection of personal development and wellness programming.

Many attendees are NIC MAP^® Data Service subscribers, or may wish to learn how the leading provider of data and analysis for seniors housing and care can help their businesses. NIC will offer a number of opportunities for existing users and those interested in learning more to access NIC MAP staff expertise. Through the Braindate platform, NIC MAP experts will be available to discuss the platform’s potential business impact in 1-1’s and small groups of prospective new subscribers. In other sessions, existing ‘power users’ can dive a little deeper into how the platform works, what it’s latest updates have to offer, and how to get the most out of the many available tools at their disposal.

The Most Accessible NIC Conference, Ever

Aside from the obvious cost-savings that come with a virtual platform, such as the elimination of travel and hotel costs, this year’s attendees will enjoy a time-savings by staying at home or in the office, while participating over two convenient weeks and, for many sessions, by accessing content on-demand, both during and after the event. The online platform introduces the possibility that many more team members within a given organization can participate without heavily impacting operations and productivity.

To learn more about the 2020 NIC Fall Conference, view a ‘what to expect’ video here, or visit fallconference.nic.org today. 

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Like many property types, seniors housing investment returns fell in the second quarter of 2020 as the effects of the COVID-19 global pandemic and the utter collapse of the economy took their toll. The total investment return for the seniors housing sector was a negative 1.00% in the second quarter of 2020, the first negative return since 2Q 2012.

The income return remained positive but was the smallest increase on record as far back as 2003. The appreciation return fell 2.04%, the third consecutive quarterly decline, making the valuation return a negative 2.43% since 4Q 2019. Many investors reduced their appreciation expectations in the first half of the year as the impact of the coronavirus weighed heavily on their view of the sector.

Comparatively, the total negative return of 1.00% was on par with the NPI which fell by -0.99%, but was slightly worse than the apartment sector performance, which dropped by -0.63%. Hotels plunged by a whopping 16.59%, retail by 3.85% and office by 0.50%. The only sector that did not see declines was industrial, but even there, the appreciation return was negative, albeit slightly (- 0.07%). It is notable that, like other property types, transaction volumes were very limited in the second quarter, making price discovery challenging.

The annual total return through the second quarter of 2020 was 3.52%, outpacing the NCREIF Property Index (NPI) result of 2.69% and the apartment result of 2.98%. On a ten-year basis, total returns are higher at 11.79% for seniors housing—more than 2 percentage points higher than the NPI or apartment returns. The total annual return for seniors housing has been trending down since mid-2014 when it peaked at 20.37%. This pattern can also be seen in the broader NPI index and is due to the appreciation return which tends to slow at this point in the real estate cycle.

These performance measurements reflect the returns of 123 seniors housing properties, valued at $6.3 billion in the second quarter.

See my full Quarterly Highlight in the recent National Council of Real Estate Fiduciaries (NCREIF) Real Estate Performance Report.

NIC MAP^® Data Service released its first ever Skilled Nursing Monthly Report on August 31, 2020, which includes key monthly data points from January 2012 through June 2020.

Here are some key takeaways from the report:

1. With few signs of abating, the effects of the COVID-19 pandemic were still evident in the June skilled nursing data. The pace of the decline in occupancy slowed in June, but the rate hit a new record low of 74.8%. The 41 basis-point decline from May was the first month-over-month decline in occupancy less than 100 basis points since the start of the pandemic in March. This suggests that occupancies at skilled nursing properties may be starting to stabilize. However, significant uncertainty remains, especially as fall and winter approach. New challenges could arise with arrival of the flu season complicated by a possible resurgence of the COVID-19 virus. Since March, the occupancy rate has fallen 853 basis points from 83.4%. It is now down 990 basis points below February’s level.  The year-over-year occupancy rate is down 930 basis points from June 2019 and down 871 basis points from the previous low set in June 2018, prior to the pandemic. Urban area occupancy has declined significantly more than rural areas, declining 970 basis points since March compared to 539 basis points in rural areas.
2. Managed Medicare patient day mix increased slightly from May, ending June at 5.5%. This was the first month-over-month increase, albeit small, since the pandemic started. However, it is still down 109 basis points since March and down 158 basis points since February when the managed Medicare patient day mix was 7.0%. In addition, managed Medicare revenue mix seems to be stabilizing. It was flat from May to June, ending June at 7.4%. However, it has declined 224 basis points since March and 303 basis points since February when it was 10.5%. The stabilization in June suggests that insurance enrollees may have started to resume elective surgeries as states began lifting the suspension of such procedures.
3. Medicare revenue mix declined slightly from May to June, ending at 20.4%. Although down, Medicare revenue mix has held up relatively well since the pandemic began in March, compared with other payors. It is only down 89 basis points since March compared to managed Medicare (down 224 basis points) and private (down 102 basis points). In addition, Medicare patient day mix has increased since March, from 11.2% to 11.9% in June. Although overall occupancy has declined dramatically during the pandemic creating significant pressure on skilled nursing operators, Medicare patient days likely did not decrease as much as it would have given that the Centers for Medicare and Medicaid Services (CMS) waived the 3-Day Rule, which required  a 3-day inpatient hospital stay prior to a Medicare-covered skilled nursing stay. 
4. Medicare (RPPD) was essentially flat from May to June, ending at $557.76. However, Medicare RPPD has increased 1.9% since March. It likely increased because of additional reimbursement for COVID-19-positive patients requiring isolation, in addition to the temporary suspension of the 2.0% sequestration cuts by CMS (effective May 1-December 31, 2020). The trend varies, however, in urban and rural areas. The increase in Medicare RPPD since March was only 0.2% in rural areas, but 2.4% in urban areas. This most likely reflects the increase in Medicare support for urban areas with higher levels of COVID-19 cases.

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

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

The NIC MAP^® Data Service recently released national monthly data through June 2020 for actual rates and leasing velocity. In this release, NIC also provided data on three metropolitan areas for which there is enough data to report:  Atlanta, Philadelphia, and Phoenix.

A few of the key takeaways from the 2Q2020 Seniors Housing Actual Rates Report are listed below. Full access to the reports and other takeaways are available to NIC MAP Data Service clients. 

• Average initial rates for residents moving into independent living, assisted living and memory care segments were below average asking rates, with monthly spreads generally largest for memory care, followed by independent living segments and then assisted living segments. Care segments refer to the levels of care provided to a resident living in an assisted living, memory care or independent living unit.
• The average discount for the memory care segment was the largest of the three care segments in June 2020 and averaged 8.5% below average asking rates. This equates to an average initial rate discount of 1.0 month on an annualized basis, less than 1.5 months at the end of 2019.
• Average in-place rates for residents in assisted living and memory care segments were below average asking rates. The discount was smaller for in-place rates than initial rates compared with asking rates.
• For the assisted living segment, average in-place rates consistently were below average asking rates since reporting began in January 2017. The monthly gap between these rates was 0.8% or $40 in June 2020, the equivalent of 0.1 month. It has averaged 0.2 month over the past six months.
• The rate of move-outs has exceeded or equaled the rate of move-ins for nine of the prior twelve months for both the independent living and assisted living segments, and for seven of the last twelve months for the memory care segment as of June 2020.

The NIC Actual Rates Initiative is driven by the need to continually increase transparency in the seniors housing sector and achieve greater parity to data that is available in other real estate asset types. Now, more than ever, in the world of the COVID-19 pandemic, having access to accurate data on the actual monthly rates that a seniors housing resident pays as compared to property level asking rates helps NIC achieve this goal.

The Seniors Housing Actual Rates Report available in NIC MAP provides aggregate national data from approximately 300,000 units within more than 2,500 properties across the U.S. operated by 25 to 30 seniors housing providers. The operators included in the current sample tend to be larger, professionally managed, and investment-grade operators as we currently require participating operators to manage 5 or more properties. Note that this monthly time series is comprised of end-of-month data for each respective month.

Note that the data reported here is on care segment, where care segment type refers to each part or section of a property that provides a specific level of service, i.e., independent living, assisted living or memory care. NIC also has this data for majority property type, where majority property type refers to which care segment comprises the largest share of inventory. In addition, care segment actual rates data is also available for the Atlanta, Phoenix and Philadelphia CBSAs.

While these trends are certainly interesting aggregated across the states, actual rate data is even more useful at the CBSA level. As NIC continues to work toward growing the sample size to be large enough to release more data at the CBSA level, partnering with leading software providers like Yardi, PointClickCare, Alis, and MatrixCare makes it easier for operators to contribute data to the Actual Rates Initiative. NIC appreciates our partnerships with software providers and our data contributors and their work in achieving standardized data reporting.

If you are an operator or a software provider interested in how you can contribute to the Actual Rates Initiative, please visit nic.org/actual-rates.