As NIC Founder & Strategic Advisor Robert Kramer wrote in this blog’s first post of 2019, Welcome to Senior Care Collaboration, there’s a powerful case for healthcare and seniors housing leaders to pay attention to the disruption now occurring in their industries, and consider working together to achieve common goals. Kramer launched the year (and this brand-new microsite and blog), with the statement:

“Players in various healthcare silos and payors, many of whom would have had no interest in sitting down with our sector previously, are beginning to take an active interest in settings that are home to several million frail seniors with multiple chronic conditions and functional needs each day. As we recently argued in the October Insider, it will be necessary in this new environment for the seniors housing and care sector to develop new partnerships, as it collaborates with healthcare organizations, both upstream and downstream, to meet the needs of our residents in a value-based world.”

Since then, there has been a significant surge in new partnerships, M&A activity, collaborations, and other business initiatives that draw seniors housing and healthcare closer together, often featuring innovative models and new thinking on how to improve outcomes while achieving robust business performance. This trend has been reflected in a long list of headlines focusing on new deals being inked, from major investments by the likes of Amazon, CVS, Walmart, Microsoft, Humana, and other giants, to smaller collaborations and partnerships between seniors housing and healthcare players across the country.

Our recent recap of that news, all of which is carefully, and regularly, curated and presented on the resources page of this website, was selected for Ziegler’s “Senior Living Finance Z-News’ Recommended Reading List” for Q4, 2019.  It’s already one of our most-read blog posts for the year, which likely reflects a growing interest among industry decision-makers in staying informed on the latest deals and innovations in healthcare collaboration.

Kramer’s welcome post also announced what readers could expect: “The ‘Housing and Healthcare’ blog will feature interviews, original articles and analysis, along with commentary on news items and trends. It is a platform both for NIC to distribute analysis and for contributors to voice their perspectives.” Indeed, the blog has featured exclusive interviews with some of the industry’s most influential leaders and produced widely read articles featuring their unique insights. Our two top posts for the year feature such insights from two of the industry’s most respected CEO’s.

The most-read “Housing and Healthcare” blog post for 2019 is “Investor Bets on Medicare Advantage,” which focuses on the investment strategy of former Brookdale Senior Living head John Rijos, and his newly-formed healthcare investment firm, Chicago Pacific Founders (CPF). The post, which blends insights from Rijos with an overview of Medicare Advantage trends, draws attention to what may be an important opportunity for others in the industry, presented with context and some perspective on the underlying drivers of the strategy. We believe its popularity is due in part to interest in a recognized leader, and partly by an interest in understanding how to approach major changes in our healthcare system, which are already beginning to impact the seniors housing and care sector.

Close behind our top post, by only a hundred or so views, is “Marquis Embraces Mission of Collaboration,” another piece that features the insight of a well-known leader in seniors housing and care. CEO Phil Fogg, Jr. discusses Marquis Companies’ I-SNP strategy as an important part of his vision for the business – and for his residents. His exclusive interview with NIC provides blog readers a connection with a leader who is innovating in the space and is willing to outline how he views the market today. The post ends with Fogg directly addressing blog readers: “His advice: Providers should decide whether they want to own or outsource ancillary services. Those providers without the management bandwidth, financial resources, and enough residents or patients to enjoy the benefits of scale should find partners and collaborate with them. Fogg said: “The worst thing someone can do is nothing.”

Specific pain points and solutions, garnered from real partnerships, are featured in our third most-read post of the year. “Collaboration vs. Competition: How to work with a home health agency” features an exclusive interview with Sarah Walmsley, national director of strategic partnerships at Bayada Home Health Care. NIC’s interview focuses on how seniors housing leaders can create better resident experiences and extend length of stay by collaborating well with outside agencies, rather than refusing to work with “competitors.” Walmsley offers practical insight and advice on managing those partnerships.

Some of our posts are intended to shine a light on developing trends, innovations, and investments in the future that may have a real impact on seniors housing in coming years. “America’s New Hub for Innovation is Focused on Senior Care,” is the result of Bob Kramer’s attendance at a major ribbon-cutting in Milwaukee, Wisconsin. The post features Direct Supply’s Innovation & Technology Center, a multi-million-dollar investment focused entirely on improving seniors housing and care. After reporting on the center’s mission and focus, this top post ends with Kramer’s quote, “We are truly fortunate to have an innovation center like this, totally devoted to issues around senior care and senior living.”

Our final top post rounds out the group with another opinion from Kramer. In “Good Care Transitions Are Not Enough,” Kramer appeals to seniors housing and healthcare leaders alike on the subject of improving collaboration in order to improve outcomes. He points out a real problem: in a siloed system, “Each time you hand off to a new setting, the senior healthcare professional in that setting becomes like a dog marking its territory. They routinely overrule the other silo.” Kramer’s post provides a thoughtful, constructive perspective on the issue, and links to a recently published white paper for further reading. We believe that kind of insight on a real problem affecting millions – as well as the post’s directness and potential for controversy – is likely responsible for its popularity.

Look for this blog to continue to deliver exclusive interviews, insights, news, and commentary on the quickly developing phenomenon of housing and healthcare collaboration. As our most-read posts of 2019 clearly indicate, there’s real interest in developing collaborations to improve outcomes and build robust business performance. And you need only subscribe to stay informed of the very latest developments in 2020.

Kate Nicholls of Investments at Ventas, Inc. explores the opportunities and challenges of senior housing and care integration

With options for senior housing and care integration continuing to evolve—and the discussions around the options increasing in frequency and volume—senior living operators may be starting to tune in.

Although the senior housing value proposition has not traditionally included healthcare, it has included offerings known to positively impact residents’ overall health, such as socialization, nutrition, and assistance with activities of daily living. With changes in Medicare and potential future healthcare payment reform, seniors housing providers find themselves in a position where formal involvement with healthcare may make more sense.

In the December issue of the NIC Insider newsletter, Kate Nicholls, Director, Investments at Ventas, Inc.,  offers insights into the opportunities and challenges for seniors housing operators looking to align with healthcare.

Nichols details why alignment may offer positive opportunities and prepare operators for future success, covering points such as:

• why improved care coordination may lead to better outcomes,
• the opportunity for increased revenue,
• potential for cost savings, and
• how the healthcare industry is moving in this direction.

Nicholls also lays out potential risks operators should consider when evaluating healthcare alignment:

• potential high cost to implement,
• increased regulatory risk,
• government reimbursement,
• distraction to the core business, and
• unanswered questions.

As Nicholl’s points out, “There is no one right answer, but operators and investors should avail themselves to all of the information available to decide what is best for their respective businesses.”

Read Kate Nicholls’ full article, “Senior Housing and Care Integration: An Opportunity or a Threat?,” in the December issue of the NIC Insider newsletter.

The Labor Department reported that there were 145,000 jobs added in December. This was less than the consensus estimate of 160,000 and marked the 111th consecutive month of job gains. For all of 2019, employers added 2.11 million jobs. That was a slowdown from the increase of 2.68 million in 2018 and ranked 2019 eighth for job growth in the past 10 years.

Revisions also subtracted a number of jobs to the prior two months. The change in total nonfarm payroll employment for October was revised down by 4,000 from 156,000 to 152,000 and the change for November was revised down by 10,000 from 266,000 to 256,000. Combined, 14,000 jobs were subtracted from the original estimates. Monthly revisions result from additional reports received from businesses and government agencies since the last published estimates and from the recalculation of seasonal factors. After revisions, job gains have averaged 184,000 over the last three months, below the average monthly gain of 223,000 in 2018 (note that this will likely be revised down based on the recent preliminary benchmark revision estimate which indicates that private payrolls were over-counted by 43,000 per month in the twelve months ending in March 2019).

Health care added 28,000 jobs, and has added 388,000 jobs in 2019, similar to the increase of 359,000 in 2018.

The December unemployment was unchanged at 3.5% in December, a 50-year low. Average hourly earnings for all employees on private nonfarm payrolls rose in December by three cents to $28.32. Over the past 12 months, average hourly earnings have increased by 2.9%. For 2018, the year over year pace was 3.0% and in 2017 it was 2.6%. Reasons why wages are not growing faster include the retirement of highly paid baby boomers and relatively weak productivity growth.

The labor force participation rate, which is a measure of the share of working age people who are employed or looking for work was unchanged at 63.2% in December, which was the highest since August 2013.

The December employment report will support the Fed’s “on hold” stance, at least for the time being. In December, the Federal Reserve left interest rates unchanged and signaled it would stay on hold through 2020, keeping the Fed and its policies on the sidelines during the election year. “Our economic outlook remains a favorable one despite global developments and ongoing risks,” Chairman Jerome Powell told a press conference in mid-December following the FOMC meeting in Washington. He continued that “As long as incoming information about the economy remains broadly consistent with this outlook, the current stance of monetary policy likely will remain appropriate.”

In October, the Federal Reserve lowered interest rates by 25 basis points to a range between 1.50% to 1.75%. This was the third cut in as many months. But Chairman Powell indicated that it may be the last cut, at least in the short term, creating the “on hold” stance viewed by many in the market.
Fed officials also released new quarterly forecasts. These showed:

• The median estimate for the fed funds rate is at 1.6% at the end of 2020, 1.9% in 2021 and 2.1% in 2022. Thirteen officials expect rates to stay on hold next year, while four see a hike as appropriate.
• The jobless rate is expected to be 3.5% by late 2020, the same as it is now. The long-run unemployment rate is seen at 4.1%, down from 4.2% in September.

In 2020, there will be an estimated 23 million Americans over the age of 75 and 8.9 million over 83, a common move-in age of a resident to seniors housing. These will be members of the Greatest Generation and the Silent Generation. And some of these older individuals—roughly 90,000—will be centenarians or older. It’s not until the end of this upcoming decade in 2029 that the oldest baby boomer will have turned 83—effectively opening the proverbial floodgates for seniors housing. 

But that doesn’t mean it’s time to sit back and just wait because there is a lot of change on the horizon for the seniors housing sector. This blog highlights just one of these changes and focuses on technology.

Age-tech, gerontechnology, assistive technology, silver-tech are all descriptors of this emerging focus of technology applications as they specifically apply to older individuals. It’s the intersection of gerontology and digitization and the applications are wide ranging as older adults and their family caregivers adopt technology that can support their shared goals of safety, longevity, independence, quality of life and connection to friends and family.

Aging 2.0 identifies “Eight Grand Challenges” for this intersection of aging and technology: (1) Engagement and Purpose, (2) Financial Wellness, (3) Mobility and Movement, (4) Daily Living and Lifestyle, (5) Caregiving, (6) Care Coordination, (7) Brain Health, and (8) End of Life.

While this commentary is too short to do justice to each these focus areas, below are a few applications being developed by a host of software and hardware entrepreneurs and businesses, including the mega-giants Amazon, Google and Apple. 4Gen estimates that revenues in the U.S. age-tech market exceeded more than $350 billion in 2018, a significant industry indeed.

Brain Health.  Technology has the potential to help with cognitive care and brain health issues related to memory, language, problem solving and other cognitive skills that affect a person’s ability to perform everyday activities.   

Caregiving, Mobility and Movement.  From a health and wellness perspective, telehealth has the potential to reduce health care costs and improve health care coverage by allowing instant connectivity via video conferencing with live doctors. Hand-held devices with medical applications, remote monitoring of residents and connected equipment can provide visibility and insights about exercise regimens, diet and vital signs as well as help with sensory functions such as vision, hearing and motor skills.

Engagement, Purpose and Socialization.  Socialization, engagement and purpose are important considerations in aging.  Studies have found that social isolation and loneliness among seniors has the same impact on health as smoking 15 cigarettes a day, while a strong purpose in life can add five or more years of life span to older adults. Smart phones and appliances, remote sensors, mobile personalized connectivity applications and software systems have the potential to better allow aging in place, independence and virtual socialization.

Daily Living, Lifestyle and Care Coordination.  Robots, virtual assistants, smart phone apps, iPads and other devices can help with medication management, emergency response services, fall detection, vital signs tracking, transportation, finance, sensory aids and mobility aids. The on-demand economy can also help address these issues. Japan, whose society is aging more rapidly than the U.S., and which has a more vexing labor shortage challenge than does the U.S., is a good place to look at advancements in this realm.

As these technologies get tested and winners and losers emerge, the operations, real estate, social and medical aspects of the sector will be forever changed.

As we embark on a new year, it’s time to look back for a moment and review the milestones of 2019, which, in addition to our most popular posts, includes the relaunch of this blog platform over the July 4^th weekend. It’s now easier to search for articles by topic and keyword and easier to read on your phone or other device. We also installed better tracking software, enabling us to better understand which posts are most valued by our readers. As explained in our “Welcome to NIC Notes” post, NIC took the opportunity to change the blog’s name, too, in an effort to reduce the potential for confusion around our mission and focus, particularly for new readers from the healthcare space. Hence, “NIC CARES” has become “NIC Notes.”

A review of the new blog’s traffic reveals that it remains popular, and continues to steadily grow, both in terms of overall views and new subscribers. The most popular posts on NIC Notes remain those focused on trends and analysis, although a perspective piece (Bob Kramer’s views on the “Silver Tsunami”) ranks in the top five for the year. In case you missed any of these, here are the top posts for 2019, dating back to the re-launch of NIC Notes.

CCRC Market Trends: 3Q 2019

When measured both by unique page views and time-on-page, NIC Senior Principal Lana Peck’s “CCRC Market Trends: 3Q 2019” post was the most popular in 2019. Clearly, readers found this post interesting enough to rack up an average time-on-page of almost five minutes – a substantial commitment in a world of momentary quick-scans and high bounce rates. Our analytics indicate that many readers spent much more time with the post. As the post provides a substantive, well-considered narrative on the state of CCRCs, supported by the latest NIC data, and illustrated with original graphs, this is hardly surprising. While Peck refrains from stating any opinions, readers likely value her insights as they work to support their own analysis.

Five Key Takeaways from NIC’s Second Quarter 2019 Seniors Housing Data Release

When NIC MAP releases new data each quarter, and accompanies it with a webinar, hundreds of NIC MAP clients pay close attention. But you don’t have to be a client to gain real insights from the latest NIC MAP data. Blog subscribers know that NIC Notes features a breakdown of the key takeaways, complete with key graphs and some of the insights that are shared in the webinar. Perhaps this is why our quarterly “Five Key Takeaways” posts on seniors housing data rate so many readers. This year is no different, with the second quarter post drawing the most pageviews for the year.

Looking into the Future:  How Much Seniors Housing Will Be Needed?

Another big driver of pageviews is NIC Chief Economist, Beth Burnham Mace. When she co-authored a post with NIC Research Statistician, Anne Standish, titled “Looking into the Future:  How Much Seniors Housing Will Be Needed?” the blog saw a spike in traffic. Their analysis of several scenarios projecting future seniors housing needs at different penetration rates concludes that significantly more housing will be needed by 2040. The post includes their base case results, scenario analysis, and conclusions, along with an explanation of their methods and supporting graphs.

Why ‘Silver Tsunami’ is an Ageist Term

Not every top post this year is supported with graphs and statistical analysis. Many readers found NIC Founder and Strategic Advisor Bob Kramer’s post, “Why ‘Silver Tsunami’ is an Ageist Term” worth reading for another form of insight. He uses the blog to draw attention to his view that “Rather than thinking about a catastrophic ‘Silver Tsunami’ we need to be thinking about the potential benefits of a ‘Silver Stimulus.’” The post links to a more in-depth piece published in the NIC Insider, in which Kramer delves into the potential opportunities that a wave of aging baby boomers will open up for the seniors housing sector.

Current Occupancy Performance Patterns of Older Seniors Housing Markets May Surprise You

Rounding out our list of top NIC Notes posts for 2019 (since July 4), is another post from Lana Peck. Titled “Current Occupancy Performance Patterns of Older Seniors Housing Markets May Surprise You” the piece delves into the latest NIC MAP data to raise some interesting insights – and questions – around an aging supply of properties. The piece is brimming with data points, graphical illustrations, and the observations of a senior professional analyst who spends her time focused on the sector.  

As we look forward to a great 2020, NIC Notes resolves to remain as relevant, useful, and interesting as ever. The blog will continue to post detailed analysis based on the latest NIC MAP data, as well as expert insights on market trends, and the occasional perspective on the seniors housing and care industry. Subscribing is simple – and ensures you will receive a single weekly recap email, linking you to the latest posts, many of which will be read and studied across the sector.