Independent Living Faces Covid-19 Vulnerabilities As Less Needs-Based Product

Compared to assisted living and memory care, independent living and active adult communities can be harder to secure during the coronavirus pandemic. The better health, mobility and independent nature of their census can make social distancing a bigger ask, and the leaner staffing necessary to operate these communities means residents have less support in the form of caregiving and other services.

But those obstacles can be turned into advantages, as residents have more ability to take proactive steps to limit the risks of infection. Providers that rally residents to become active players in the pandemic response strategy have a leg up.

The fact that independent living and active adult communities offer a less needs-based product than other types of senior housing also raises questions and doubts about how occupancy will hold up during and after the Covid-19 crisis. This was the hardest hit part of the continuum during the Great Recession, as older adults were unable to sell their homes and make the move. Now, in addition to financial pressures due to stock market declines and housing market instability, there may be an added deterrent for consumers: fear of moving into a congregate housing environment, where infections can rapidly spread.

The sector — which was attracting huge investor interest and growing quickly prior the Covid-19 crisis — is already facing pressure. A judge in Texas urged families to move loved ones out of senior housing and care settings if possible — and, of course, this is easiest for independent older adults with fewer care needs. Even some providers have urged residents to leave their IL apartments and stay with families while the pandemic is ongoing.

But, occupancy across the senior housing spectrum appears to have held relatively steady in the first weeks of the Covid-19 outbreak in the United States, and providers and industry advocates say that these communities are still safe places to live.

“Our top priority has been, and always will be, to keep our residents safe,” LeadingAge Texas President and CEO George Linial told Senior Housing News.

Move-ins, tours slow

The coronavirus impacted move-ins in March across the industry — a trend that is expected to continue as the pandemic peaks in major markets. Independent living is no exception.

New York-based real estate investment trust New Senior Investment Group (NYSE: SNR) reported a 30% dropoff in move-ins last month, compared to January and February averages. The REIT owns a portfolio of 102 independent living communities, with Holiday Retirement as its primary operator.

New Senior did not respond to a request for comment from SHN.

Other REITs are seeing declines in occupancy rates in their senior housing portfolios, as well, and not just in independent living. Healthpeak Properties (NYSE: PEAK) on Tuesday reported a 41% drop in move-ins across its senior housing operating portfolio and its continuing care retirement communities in March 2020 compared to February 2020. Those portfolios represent a combined 27% of the Irvine, California-based REIT’s net operating income.

The decline in move-ins escalated as the month progressed and, with communities now secured, operators are turning to virtual tours and aggressive sales lead management to keep referral pipelines moving, prioritizing prospects who are in immediate need of independent living over those just kicking the tires, Forefront Living CEO Tim Mallad told SHN.

The Dallas-based nonprofit operator’s portfolio includes Presbyterian Village North, a 66-acre continuing care retirement community which includes 480 independent living apartments. It is set to break ground on The Hawthorne, a 112-unit independent living expansion, later this year.

Forefront and other LeadingAge Texas members acted quickly as the virus spread exponentially, sharing best practices on securing communities, as well as sharing techniques to segment sales leads and focus on prospects with a serious, immediate need to move.

All of this was expedited to ensure the safety of residents and staff, Mallad told SHN.

“The different type of staffing [required] for independent living allowed us to be nimble [in our response]. We and other operators are banding together and doing similar things. We transformed the business in 36 hours,” he said.

The quickness of LeadingAge Texas member communities to secure their communities helped counter a Texas judge who urged that families with loved ones in senior care move them home during the pandemic. Dallas County Judge Clay Jenkins, who heads the county judicial system’s emergency management, first made the suggestion after several Dallas-area nursing homes reported positive tests for the coronavirus. He has since ordered nursing facilities that test positive for the virus no longer accept new residents, according to WFAA-TV.

Forefront Living has seen a handful of move-outs in response to Jenkins’ comments, but those have been relegated to the assisted living and nursing home wings at Presbyterian Village North, Mallad told SHN.

More important, staff is encouraging families to weigh their options before making a decision to move a loved one back home for the duration of the outbreak, which could be months.

“We’ve said [to families], we won’t stop you [from moving residents out], but we follow-up with questions on how [they will] do home health and pharmacy services that we already provide,” he said.

Judge Jenkins’ commentary is not unique. Jewish Senior Life, an operator based in Oak Park Michigan, issued a March 26 memo to independent living residents and their families to move their loved ones in with families as the outbreak spreads in Michigan.

Jewish Senior Life operates independent living communities in Oak Park and West Bloomfield, Michigan.

Other operators believe that these are isolated incidents, and that the need for senior housing during this time will prove out, Clover Management founder and CEO Michael Joseph told SHN. Williamsville, New York-based Clover operates 32 middle-market independent living communities, with another four under development. The firm struck a $343 million deal with Toledo, Ohio-based health care REIT Welltower (NYSE: WELL) last August.

Clover is still doing move-ins of new residents in clusters, and tours for prospective residents have dropped off as communities have been secured to non-essential personnel. But Joseph does not see move-outs increasing in the immediate future, and Clover has always incorporated virtual tours as part of its marketing and sales strategy — a process that will grow.

“We’re almost 97% occupied across our portfolio. Unless a rash of [Covid-19 related] deaths happen, we’re not worried,” he said.

Healthier censuses

Independent living residents’ better health and mobility, relative to assisted living and memory care residents, allow operators to secure the communities more easily, in part because their ability to process and understand the gravity of the situation results in them being proactive sheltering in place without encouragement, Joseph told SHN.

“Our tenants are concerned [about the pandemic]. The average age [in a Clover community] is 80 years. They’re healthier, with fewer immune system issues,” he said.

Still, Clover took steps to secure its communities further. It sealed off group amenities such as fitness centers and community rooms. Mail time, where residents gather daily in large groups, is no longer allowed. And tenants are limited to one essential guest at a community per day.

Forefront Living implemented social distancing procedures outlined by the Centers for Disease Control and local public health departments, and found that residents are understanding and compliant.

Forefront has also been successful in delivering services to individual apartments in areas such as dining, as meals are being delivered door to door. Online shopping orders are inspected at the gate before delivered to tenants. Communal amenities have been secured. The operator is also looking to assist residents with alternative forms of delivery, since Presbyterian Village North has limited entrance and egress to the campus.

Finally, Forefront cross-trained its independent living staff to handle multiple tasks, Mallad told SHN.

“Everyone is wearing multiple hats,” he said.

Testing for coronavirus — for residents and staff — remains an issue, however. Forefront and other LeadingAge Texas members are conducting daily temperature checks of staff. But testing is hard to come by for many operators, and the ones that are testing are seeing delays in results.

“A lot of these cases were transmitted through asymptomatic people. Unless we get mass testing quick, senior living should be [one of the] first [groups] on the list [for testing],” Linial said.

Clover is not testing staff or residents, but is monitoring both in compliance with CDC and local health department guidelines. And Joseph is optimistic that the pandemic will prove out the value of senior housing, including independent living.

“One of the things our kind of housing proves is that our seniors, rather than being siloed in their homes or in intergenerational apartments, are among peers who look out for each other. Combined with better access to health care, [that] shows that this is where the future is, which is what we’ve found the past 20 years,” Joseph said.