In a new question in the Wave 41 survey, respondents were asked whether they found the acuity of new resident move-ins to have increased, decreased, or stayed the same as compared to before the pandemic. Significantly, move-in acuity has increased for 71% of the respondents with assisted living, and for more than 60% of respondents with memory care units and nursing care beds. In independent living settings, 41% of respondents report acuity having increased since before the pandemic. The shares of organizations reporting acceleration in nursing care move-ins continued to increase – from 21% in Wave 37 conducted in January 2022 to 68% in Wave 41. This marks the fourth consecutive wave where the pace of nursing care move-ins has increased from the prior wave. Over one-half of respondents to the Wave 41 survey (53%) reported lead volumes above pre-pandemic levels in May – a noteworthy increase from the Wave 38 survey reflecting results in February (33%).

-Ryan Brooks, Senior Principal, NIC

NIC’s Executive Survey of senior housing and skilled nursing operators was implemented in March 2020 to deliver real-time insights into the impact of the pandemic and the pace of recovery. In its third year, the “ESI” is transitioning away from the COVID-19 crisis to focus on timely industry topics. While some standard questions will remain for tracking purposes, in each new survey “wave,” new questions are added.

This Wave 41 survey includes responses from May 2 to May 27, 2022, from owners and executives of 60 small, medium, and large senior housing and skilled nursing operators across the nation, representing hundreds of buildings and thousands of units across respondents’ portfolios of properties. More detailed reports for each “wave” of the survey and a PDF of the report charts can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

In a new question in the Wave 41 survey, respondents were asked whether they found the acuity of new resident move-ins to have increased, decreased, or stayed the same as compared to before the pandemic started. Of note, increased move-in acuity was reported by 71% of the respondents for assisted living, 61% in memory care, and 62% in nursing care. Only 41% of independent living reported increased resident acuity at move-in.

In the Wave 41 survey, three-quarters of respondents indicated the severity of their staffing shortages across their organizations was moderate (77%). This marks the second consecutive wave in which moderate staffing shortages increased. Conversely, 16% of respondents reported staffing shortages to be severe in the Wave 41 survey. This marks the second consecutive wave in which severe staffing shortages declined, compared to Wave 40 (19%) and Wave 39 (27%).

Despite fewer reports of severe staffing shortages, attracting community and caregiving staff remains to be a top challenge cited by operators (83%). Rising operating expenses (80%) and staff turnover (63%) follow as the second and third most reported challenges.

In another new question in the Wave 41 survey, respondents were asked about their utilization of the CMS nurse aide training waiver, which temporarily waived the 12-hour in-service training requirement for nursing assistants. With the waiver set to expire on June 7, 2022, 43% of respondents reported using the nurse aide training waiver to employ aides for longer than four months, even if those aides had not completed the training and certification requirements. Respondents who reported making use of the waiver were asked what impact the expiration would have on their organization’s ability to staff their properties. All respondents indicated the expiration would have an impact: 25% reported it would have a minimal impact, 58% reported it would have a moderate impact, and 17% reported it would have a strong impact.

Regarding the current share of all full-time, open positions across respondent organizations, in the Wave 41 survey, approximately one out of three respondents have between 11% and 20% of full-time positions unfilled, whereas roughly two out of five respondents have 20% or more positions currently unfilled.

The timeline below shows the share of organizations reporting an increase in the pace of move-ins during the prior 30-days. Data from the Wave 41 survey shows that the increase in pace of move-ins continues to be above the levels reported in Waves 32 through 38. This is an encouraging sign that recovery is continuing.

In the Wave 41 survey (reflecting operator experiences in May), 36% of respondents with independent living, 53% of respondents with assisted living, 51% of respondents with memory care, and 78% of respondents with nursing care reported an acceleration in the pace of move-ins. The portion of respondents reporting an acceleration of move-ins declined for independent living and assisted living, compared to 50% of independent living and 61% of assisted living in Wave 40. The pace of move-ins did increase for the memory care and nursing care segments, compared to 43% of memory care and 63% of nursing care in Wave 40. Since January, the shares of organizations that reported acceleration in nursing care move-ins increased significantly — from 21% in Wave 37 to 68% in Wave 41.

Despite the positive trend in the accelerated pace of nursing care move-ins, it is important to balance this with the corresponding pace of move-outs, which also showed an accelerated pace since Wave 39 in March.

In Wave 41, 54% of respondents indicated lead volumes above pre-pandemic levels, compared to 52% in Wave 40 and 33% in Wave 38 reflecting results in February. In Wave 41, large operators (26+ properties) had the greatest portion of respondents indicating lead volumes above pre-pandemic levels (60%). Mid-sized operators (10-25 properties) reported 57% with lead volume above pre-pandemic levels, followed by single-site operators (53%) and small-sized (2-9 properties) operators (46%). While this is an encouraging sign, this may be reflecting pent-up demand from earlier in the pandemic.

Wave 41 Survey Demographics

• Responses were collected between May 2 and May 27, 2022, from owners and executives of 60 senior housing and skilled nursing operators across the nation. Owner/operators with 1 to 10 properties comprise roughly one-half (51%) of the sample. Operators with 11 to 25 and 26 properties or more make up the rest of the sample (24% and 25%, respectively).
• More than one-half of respondents are exclusively for-profit providers (58%), approximately one-third operate not-for-profit senior housing and care organizations (29%), and 14% operate both.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 74% of the organizations operate senior housing properties (IL, AL, MC), 31% operate nursing care properties, and 28% operate CCRCs (aka life plan communities).

Owners and C-suite executives of senior housing and care properties, please help us tell an accurate story about our industry’s performance. If you are an owner or C-suite executive of senior housing and care and have not received an email invitation to take the survey, please contact Ryan Brooks at rbrooks@nic.org to be added to the list of recipients.

NIC wishes to thank respondents for their valuable input and continuing support for this effort to provide the broader market with a sense of the evolving landscape as we recover from the pandemic. This is your survey! Please take the Wave 42 survey and suggest new questions for Wave 43.

NIC’s 2022 Leadership Huddle series continued May 25 with a deep dive into real estate market trends and an outlook on economic forces. Beth Mace, chief economist and director of outreach at NIC, was joined by Mike Acton, managing director of AEW Capital Management, and Mary Ludgin, head of Global Investment Research at Heitman, to discuss navigating federal monetary policy shifts, investment strategies amid record inflation, and opportunities in senior housing segmentation.

With the Federal Reserve raising the federal funds rate, Acton explained that now is the time to remember that these cycles happen, and experience should inform investment. “There’s a playbook – we know what we’re supposed to do as these events unfold,” he said. Ludgin added that experience with these cycles suggests investment is still possible: “In that environment, you can invest through debt as opposed to equity.”

Join the Next Complimentary NIC Leadership Huddle
Evolution of Market Segmentation
June 8, 2022 at 1:00 PM ET

{{cta(’70ff9344-7c68-45f6-adf1-606d38de09a4′)}}

To combat the strongest inflation rate in 40 years, Ludgin explained that real estate is in a much better position than stocks and bonds. As supply and demand balance out, senior housing should prove to be an effective inflation hedge, according to Ludgin. Acton agreed, explaining that real assets are key to making smart investments and fighting future inflation.

Discussing the future of senior housing, Mace explained that diversification and segmentation in the industry present a number of opportunities for investors and developers. “It’s an exciting time in senior housing because you’re seeing a lot of change,” Mace said.

“There’s a lot of good opportunities for debt providers, equity providers, as well as operators.”

NIC Leadership Huddles reconvene June 8 with a timely discussion on market segmentation. Join us as “in the know” experts Melissa Andrews, Tom Gaston, and Ashley Fitzgerald discuss the continued evolution of the senior housing sector. Register today. And, watch all past leadership huddles in the NIC Leadership Huddle Archives.

Solid partnerships with high-quality healthcare and ancillary service providers can help create better resident outcomes, longer length of stay, and added revenue streams. But what’s the best way to establish and manage a network of providers in a fragmented care system?

In an insightful discussion, a panel of experienced senior housing industry executives answered questions about how to implement innovative and effective partnerships. The session—“Leaning in and Leveraging Resources for Successful Partnerships”—was held at the 2022 NIC Spring Conference in Dallas.

The discussion was moderated by Brian Cloch, CEO and founder of Innovative Health; and Amy Kaszak, president, Special Needs Plans, AllyAlign. Panelists included Alan Fairbanks, executive vice president, Bickford Senior Living; Sheryl Marcet, chief investment officer, Arcus Healthcare Partners; Laurie Geschrey, director of value-based care and partner relations, Pathway to Living; and Chirag Patel, MD, chief medical officer, Hansa Medical Group.

Here are the key Q&As from the session, edited for length and clarity.

Q: What are the benefits of partnership?

A: Partners add value. For example, Hansa Medical Group offers its medical care services in 120 senior living communities. Medical teams provide daily support to residents, reducing emergency room visits, and increasing the length of stay. The availability of medical support also eases the stress on the nursing and executive directors. “Our involvement reduces the workload of the staff,” said Dr. Patel. “Turnover is reduced.”

Good provider networks can also provide preventative care to help keep residents healthier. “The result is better resident satisfaction, and better staff satisfaction,” said Bickford’s Fairbanks.

Q: What are the advantages of value-based care partnerships?

A: With value-based care, a case manager follows the beneficiary through the continuum of care. That way, residents can be tracked and typically return to the community. Residents in the fee-for-service Medicare system who go to the hospital can get lost in the shuffle. “They may never some back to the community,” said Geschrey.

Equity provider Marcet said that coordinated care models translate to the bottom line. Capital partners are looking for best-in-class operators. “You’ll be left behind if you are not looking at coordinated care,” she said.

Q: What should you look for in preferred partners?

A: Partners must meet certain criteria, said Fairbanks. Bickford is looking for ways to create win-win partnerships to keep residents healthy, instead of having to react to emergencies. The goal is to incorporate home health, primary care, hospice and other services under one umbrella. “It’s a win for the staff,” said Fairbanks. “They aren’t scrambling to work with multiple doctors.” Geschrey added that providers must agree to work with each other.

Also, providers must be continually vetted and track outcomes. “You need providers you can trust,” said Geschrey. “Our job is to hold them accountable.”

Q: How do you talk to residents about using preferred providers?

A: Residents have to feel they have a choice about their care plan, the experts said. “Choice is about education,” said Cloch. Pathway to Living starts the process when prospective residents and their families come in for a tour. “We are proud of our coordinated care model,” said Geschrey. It’s important to highlight the advantages of the model and that a team is there to take care of their loved one, she added. Also, share results. The value-based care model has been operating in five Pathway communities for two years. About half of the residents are enrolled, reducing the days in the hospital or in rehab from 23%-25%.

For residents who want to keep their long-time doctor, Patel suggests to families that his group act as an in-house back up provider. When the family sees that it is easier to use the in-house doctor rather than taking the resident to outside appointments, the family will often switch to Patel’s group for primary care.

Q: Considering the staffing issue today, who manages the providers?

A: Bickford has a coordinator at the property. “We help them build a network,” said Fairbanks. As the primary care provider, Patel’s group coordinates care with the other providers along with the executive and nursing directors at the property.

Q: Are provider arrangements formal or informal agreements?

A: Both Pathway and Bickford have a written third-party provider agreement that includes operating standards. Patel’s group contracts with the insurance provider, not the building operator. There is, however, an understanding with the operator that Patel’s group will track data to show increased length of stay and reduced hospitalizations.

Conference attendees may access 2022 NIC Spring Conference recordings anytime.

Join us for the 2022 NIC Fall Conference, September 14-16 in Washington, DC; registration is now open.

NIC’s Skilled Nursing COVID-19 Tracker, featuring the most up-to-date CMS data,^* shows that rates of new COVID-19 infections in skilled nursing facilities are rising once again for both residents and staff.

The per-resident rate of new COVID-19 infections increased to 0.50% (50 in 10,000 residents tested positive) for the week ending May 8, 2022, up 0.08 percentage points from May 1 (0.41%) and 0.40 percentage points from just a month earlier (the recent low of 0.10% reported on April 3). Roughly 10% of skilled nursing facilities reported newly confirmed cases among residents on May 8.

Regionally, skilled nursing facilities in the Northeast region reported the highest per-resident rate of new COVID-19 infections at 1.02% (up 0.16pps from May 1 and 0.87pps from April 3), followed by the Midwest (0.42% – up 0.1pps from May 1 and 0.33pps from April 3), the West (0.32% – down 0.06pps from May 1 but up 0.17pps from April 3), then the South (0.25% – up 0.07pps from May 1 and 0.20pps from April 3).

Other highlights from the latest data are noted below.

• Virus cases among staff increased by 13% for the week ending May 8, 2022 — from approximately 4,800 cases on May 1, 2022, to nearly 5,500 new cases on May 8, 2022.
• Weekly cases among residents rose by 16% over the same period, from 4,500 cases on May 1, 2022, to 5,300 new cases on May 8, 2022.

• According to CDC data, U.S. weekly COVID-19 cases among the general population increased by 21%, from 411,000 cases on May 1 to 496,200 on May 8. Weekly cases among the general population increased further by 45% from May 8 to May 22, to 719,400 new cases.
• 71% of residents within skilled nursing facilities have received at least one COVID-19 vaccine booster as of May 8, 2022 and. 46.2% of staff have received a COVID-19 vaccine booster.
• Fatalities as percent of skilled nursing facility residents stood at 0.01% on May 8.
• Staffing shortages persist. Over 25% of skilled nursing facilities reported shortages of aides, 24% reported shortages of nursing staff, and 14% reported shortages of other staff according to the May 8, 2022 data reported by CMS.

The high caseload recorded in January 2022 exacerbated staffing shortages due to sickness-related absenteeism among skilled nursing facility workers. However, since January 2022, staffing shortages started to alleviate, and the decline in facilities reporting shortages of nursing staff is likely due to the fast retreat of Omicron and the reduced level of illness among nursing staff. It is still difficult to say whether the industry is in recovery from its pandemic shortage, especially while rates of new COVID-19 infections in the country and within skilled nursing facilities are rising once again.

NIC’s Skilled Nursing COVID-19 Tracker shows the week-over-week change rate for new resident cases of COVID-19 within skilled nursing facilities on a per-facility basis, by geography. The data is displayed in an easy-to-use interactive dashboard that allows sorts down to the county level. The Tracker and Supplemental Data provide an indicator on the rate of virus spread within skilled nursing communities by geographic location, offering a way to better understand where and why cases are spreading, slowing, or remaining flat. Historical data are available back to June 2020.

Visit the NIC Skilled Nursing COVID-19 Tracker for details and the latest data.

—

^*Data referenced in this blog are based on Skilled Nursing COVID-19 Tracker reports updated and published with the CMS data (cases in skilled nursing facilities) as of May 8, 2022, and CDC data (U.S. cases) as of May 22, 2022.

Here are some actionable insights.

Amid an industry-wide frustration with an exceptionally tight labor market and quickly rising wages, new approaches to recruit and retain good workers were detailed at the 2022 NIC Spring Conference in Dallas. The session, “Fostering Meaningful Engagement: Industry Staffing and Labor Needs,” included presentations by four experts followed by a brainstorming session for industry stakeholders to share ideas on effective strategies.

“We have a problem,” said panelist Jacquelyn Kung, CEO, Activated Insights, which runs the Great Place to Work certification program for senior care. She breaks the problem into three parts: recruitment, retention, and growth. Based on data from 500,000 residents and family members, she made three recommendations.

Be great. Senior living providers are not getting enough applicants. Other industries with hourly pay receive 21-25 applicants per job compared to 13-15 applicants for senior living. In order to get more applicants, senior living companies need to be great and stand out, according to Kung.

Engage more. Retention is linked to worker engagement. The annual turnover rate among senior living workers is currently about 85%. Prioritize employee engagement especially at the properties that tend to receive less attention.

Promote from within. Only 17% of promotions in senior living come from within, compared to 46% at hospitals. Try to fill 40% of promotions internally to grow a pipeline of leaders.

Panelist Myra Norton, CEO, Arena Analytics noted, “The labor market is not going back to the way it was. We have to navigate the new reality.”

Norton offered five strategies that address the current labor environment.

1. Tap non-traditional labor pools by considering those with different backgrounds, experience, and education.
2. Support work/life integration. Help employees integrate meaningful work into their lives.
3. Hire for outcomes. Focus on the qualities in applicants to produce the desired outcomes for residents.
4. Rethink your staffing mix. About 40% of part-time workers want more hours. Take advantage of that reality.
5. Co-create solutions. Look for answers to problems from your staff.

How to Boost Engagement

Speaker Ed Frauenheim, co-founder of The Teal Team, an organization of consulting executives, offered leadership tips. He suggested that leaders should know their strengths and weaknesses and take time off to reduce personal stress. Understand employees and support them as people, not just workers. And create a culture of mutual care where workers can support each other.

Engaged workers produce better results. But engagement and satisfaction are not the same thing, said panelist Craig Deao, managing director at Huron Consulting Group. Satisfaction is a measure of what the worker gets from the relationship, such as a paycheck. Engagement is about putting forth discretionary effort when no one is watching. “Engagement is the difference between commitment and compliance,” he said. Commitment is built on a foundation of trust.

Leaders can boost engagement by promoting the company’s mission and values. Compensation and benefit packages should be competitive. Also, create a feedback loop to collect information from workers and build relationships. Help workers find their own solutions to problems. “Relight the flame so people realize they can bring their best selves to work,” said Deao.

Small group brainstorming sessions followed the experts’ presentations, allowing audience members to discuss and generate actionable insights to apply in their own workplaces. Some of the suggestions included: educational scholarships for employees, mentorship programs, internships, and flexible scheduling.

Speaker Deao concluded by emphasizing that the senior care profession is rewarding because it makes a difference in people’s lives by caring for the elderly and helping families ease their caregiving duties. “Everyone is here for intrinsic reasons,” said Deao. “You can unlock that energy that was there when your staff decided to join the profession.”

2022 NIC Spring Conference recordings are available to conference attendees.

Join us for the 2022 NIC Fall Conference, September 14-16 in Washington, DC.