Covid-19 Bulletin: Legal Immunity for California Providers in Doubt; Massachusetts Slow to Report Covid-19 Assisted Living Data

Senior Housing News recognizes the seriousness of the Covid-19 pandemic, so we will be updating this bulletin to keep you apprised of the latest developments, focusing on news and information that we identify as especially pertinent to senior living. The team at SHN knows how important your work is right now; we thank you and your teams, and encourage you to reach out to us individually or at [email protected] with news items, topics that you believe are important for coverage, or other feedback.

Bulletin for Wednesday, June 24:

Public health officials in Massachusetts have been slow to publicly release data about the number of Covid-19 infections in assisted living communities and nursing homes, despite a recently passed law requiring these disclosures.

“Details on outbreaks at individual assisted living facilities is particularly sparse,” the Boston Globe reported Tuesday. “The state’s weekly published summaries are currently missing information on the number of deaths at each assisted living facility, information that is available in some states, such as New York and Connecticut.”

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Massachusetts Gov. Charlie Baker is also seeking to pare back requirements about public reporting of Covid-19 infections at independent living facilities, arguing in part that landlords of these properties do not have access to residents’ health records.

The state’s Department of Health (DPH) “hopes” to release the Covid-19 data required under law in the coming weeks, a DPH spokeswoman told the Globe.

Also in the news:

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— California Gov. Gavin Newsom may have changed his mind about granting legal immunity to nursing homes and assisted living communities related to their Covid-19 response efforts, according to KPBS Public Media.

“For weeks, sources told KPBS the governor was close to granting the legal immunity,” reporter Amita Sharma wrote. “But with July approaching, there’s still no executive order from Newsom and no language for immunity legislation from the state Legislature. Newsom’s office has not responded to repeated requests for comment, and lawmakers would not go on the record to talk about the matter.”

Newsom may have been influenced by media reports about nursing homes’ response to outbreaks.

— A senior care home in Brazil created a “hug tunnel” out of a large plastic sheet with arm holes, to allow residents to have contact with loved ones, CNN reported.

— Oregon is embarking on statewide Covid-19 testing in long-term care facilities this week, with testing to then take place in assisted living facilities with memory care, and then in assisted living communities without memory care.

— The robotic pet seal Paro — utilized by some senior living providers — is having another moment in the spotlight as a companion for older adults during Covid-19, Wired reported

Bulletin for June 19 – 21:

Ventas Inc. (NYSE: VTR) on Friday declared a quarterly cash dividend of $0.45 per share, which was a 43% reduction from the Chicago-based real estate investment trust’s Q1 2020 dividend.

“Today’s announcement continues the proactive, prudent and transparent actions the company has taken, including conserving capital and reducing organizational costs, in response to the Covid-19 pandemic and associated macro uncertainty,” Ventas Chairman and CEO Debra A. Cafaro stated.

The dividend reduction conserves approximately $130 million of cash per quarter, compared to the prior dividend level, the company stated in a business update released Friday.

The coronavirus pandemic continues to take a toll on Ventas’ senior housing portfolio, with occupancy continuing to decline and costs remaining elevated. However, there are signs of improvement in leading indicators such as move-ins and leads. Given improvements in the capital markets and greater visibility into second quarter expectations, Ventas intends to pay down $2.3 billion under its $3 billion revolving credit facility by June 30.

Ventas’ senior housing properties are also continuing to ease lockdown restrictions. As of June 3, about 70% of communities in the senior housing operating portfolio were allowing some non-essential visitors and accepting move-ins with strict protocols. Operators are planning to transition about 50% of communities to a “revitalizing” phase by early July. This phase includes larger groups congregating, a gradual return to communal dining, and other steps.

April and May average operating expenses were about 5% higher versus Q1 2020 levels. As the second quarter progresses, expenses are moderating as operators are “flexing labor in light of occupancy declines,” the business update stated. As of June 11, SHOP occupancy stood at 80.7%.

Other highlights of the business update included:

— More than 14,000 employees and 1,400 residents had been tested for Covid-19 as of June 12, at a cost of between $1 million and $2 million, through a partnership with Mayo Clinic Lab

— Out of 426 total SHOP properties, 47 had a current confirmed Covid-19 case as of June 12

— Estimated monthly net operating income for the SHOP portfolio was approximately $36 million for April and May, down from about $56 million for Q1 2020

— Ventas received substantially all its expected June rent from its triple-net lease senior housing tenants

Also in the news:

— Assisted living communities in Virginia are slated to receive $20 million, and Gov. Ralph Northam has also directed the Virginia Department of Health to release the names of all nursing homes and assisted living communities that have experienced a Covid-19 outbreak. The financial support for assisted living providers comes as part of a $246 million allocation to support long-term care facilities.

— Georgia lawmakers added provisions that mandate public reporting of Covid-19 cases to a bill updating regulations for nursing homes and assisted living providers in the state. The measure already passed the House and will now proceed to a full vote in the Senate.

— The Centers for Medicare & Medicaid Services (CMS) announced the members of the Independent Coronavirus Commission on Safety and Quality in Nursing Homes, including executives and associates with senior housing and care companies such as PruittHealth CEO Neil Pruitt Jr., and Eliza Bryant Village Director of Nursing Dallas Taylor.

Bulletin for Thursday, June 18:

Executives with New Senior Investment Group (NYSE: SNR) are more optimistic about second quarter 2020 net operating income (NOI).

Currently, quarterly NOI is trending to be down 5% year-over-year for the New York City-based real estate investment trust (REIT); in May, executives predicted that NOI would be down between 10% and 15% year-over-year.

Occupancy declines have become less dramatic this quarter, expenses have not risen as much as anticipated, and variable and fixed costs have also been lower, according to a business update released Thursday.

More specifically, Covid-19 expenses have been around 3% of incremental expenses, which is better than the 5% to 10% initial estimate. On the occupancy side, move-ins increased 59% in May compared to April, and further improvement is expected this month.

More than 90% of New Senior properties have begun to lift Covid-19 restrictions, with more than 30% progressing to a second phase that includes expanded sales functions. There were 13 diagnosed cases of Covid-19 among New Senior’s resident population as of June 16.

New Senior’s portfolio encompasses 102 independent living assets and one triple-net leased asset. Winter Park, Florida-based Holiday Retirement is its primary operating partner.

Also in the news:

— Assisted living communities are still struggling to acquire personal protective equipment (PPE), with 53% lacking a two-week supply of N95 masks and 52% lacking a two-week supply of gowns. That’s according to a survey of 375 members of the National Center for Assisted Living (NCAL), conducted between June 10-17. Face shields, surgical masks and gloves also are in short supply.

The survey also found that 4 out of 10 respondents reported using improvised or homemade PPE, such as handsewn masks or trash bag gowns.

“Since the beginning of the pandemic, these providers have faced similar challenges as other health care and congregate settings in acquiring this equipment, due to its high demand and world supply chain issues,” NCAL Executive Director Scott Tittle stated. “As many states reinstitute public gatherings as well as plan guidance on ‘opening up’ long term care facilities to visitation, this is a critical time period to ensure our assisted living communities are equipped to keep COVID-19 out of their buildings.”

— Irvine, California-based memory care provider Silverado has released information about its Covid-19 response. Highlights include the creation of “observation areas” used to separate confirmed or suspected Covid-positive residents from the rest of the community, as well as a commitment to have all associates wear KN95 masks — not just surgical masks — at all times.

— Thrive Senior Living captured video of what life is like inside assisted living and memory care communities during Covid-19, and is sharing the content through a partnership with the American Seniors Housing Association. Videos are available at Shining the Light on COVID and through Thrive’s Facebook page.

[youtube https://www.youtube.com/watch?v=-89kJzbycgE&w=560&h=315]

Bulletin for Wednesday, June 17:

Leaders with two nonprofit senior living providers and the CEO of LeadingAge amplified calls for government support, in light of comments from Vice President Mike Pence that the Trump administration’s Covid-19 response is “cause for celebration.”

LeadingAge on Wednesday unveiled a national Act for Older Adults campaign — including a video — asking “all Americans” to demand that Congress allocate financial and other resources to senior housing and care providers. The association of nonprofit providers also held a press call that involved two provider executives: Knollwood Community COO Col. Paul Bricker and The Well-Spring Group CEO and President Stephen Fleming.

Knollwood is a life plan community in Washington, D.C., that specializes in serving retired members of the U.S. Armed Forces — a fact that Bricker underscored.

“The U.S. government must now step up to the plate and take care of older adults who are hurting,” he said. “They served this country, paid their taxes, and it’s up to the government to take care of them.”

Government financial support has been much greater for other sectors of the economy, despite the high proportion of Covid-19 deaths in long-term care settings, he noted. Bricker and Fleming both stressed the operational and financial toll that Covid-19 is continuing to exact; Knollwood has spent about $12,000 to $15,000 on testing, for example. LeadingAge is pushing for the government to allocate a $100 billion fund for nursing homes and other providers.

The lack of support is the culmination of years in which the nation has “undervalued and underinvested” in aging services, LeadingAge CEO Katie Smith Sloan said.

“The opportunity for us is to reassert how the health care system has to be redesigned,” she said. In particular, the pandemic shows how intertwined various health care settings are, and the need for senior living to be “equal status and priority” with other types of providers.

Also in the news:

— Executives with Brentwood, Tennessee-based Brookdale Senior Living (NYSE: BKD) explained the four criteria for beginning to ease restrictions at communities. The criteria relate to licensing/regulatory agency positions; negative test results of residents and associates; 14-day downward trend in Covid-19 cases in the county; 14 days without a positive case at the community.

— A former nurse who is now an assisted living resident spoke to NPR about her experience during Covid-19: “it’s pretty hard to get up at the beginning of the day and know that you’re not going to do anything except to eat or watch something on TV. And so it makes for a long day. And once you’ve gone through months like we have and continue to look like we will, it looks like a never-ending plague.”
— Public health authorities in Minnesota are now allowing window visits to take place at senior housing and care communities, the Star Tribune reported.

Bulletin for Tuesday, June 16:

National Health Investors (NYSE: NHI) has collected 99.4% of contractual June rent, the Murfreesboro, Tennessee-based real estate investment trust stated in a June 16 business update.

The REIT collected 100% of contractual rent in May and 99.7% in April.

Some other REITs have extended rent deferrals to some senior housing triple-net lease tenants during Covid-19, as operators have faced higher expenses and falling occupancy rates due to the pandemic.

Bickford Senior Living is NHI’s largest senior housing tenant, and posted May average occupancy of 82.5%, down from 83.6% in April and 84.8% in March. Excluding five properties that Bickford has operated for fewer than 24 months, occupancy was 84.2% in May.

For its 26 properties in NHI’s portfolio, Winter Garden, Florida-based independent living giant Holiday Retirement posted May occupancy of 83.2%, down from 86.7% in March. And average May occupancy for the nine Senior Living Communities (SLC) in NHI’s portfolio stood at 79%.

As of June 9, NHI had four senior housing properties with two or more confirmed cases of Covid-19 and five buildings with one confirmed case.

Also in the news:

— Assisted living occupancy declined to 85.2% across the nation’s 31 largest metropolitan areas in May, according to newly released data from the National Investment Center for Seniors Housing & Care (NIC).

Assisted living occupancy stood at 86.1% in April and 87.8% in March. In independent living, occupancy declined from 91.4% in March to 90.1% in April to 89.5% in May.

The rate of occupancy loss is slowing, although it may be premature to define a trend.

“It’s too soon to predict whether senior housing occupancy will steady in the months ahead, but it’s a critical piece of information to monitor closely,” said Brian Jurutka, NIC’s president and CEO, in a press release. “Occupancy shifts are key indicators for property operators to guide informed decisions about residency and current and future staffing needs.”

— A special oversight panel of the U.S. House of Representatives launched a probe into how Covid-19 has hit the nation’s long-term care communities, and how the government has overseen these settings. The investigation centers on nursing homes, but the American Health Care Association/National Center for Assisted Living included mention of assisted living in its response:

“America’s nursing homes and assisted living communities have been on the frontlines of the fight against Covid-19 and have performed heroic work to keep their residents and staff safe,” stated AHCA/NCAL President and CEO Mark Parkinson. “From the earliest days of this pandemic, we have been sounding the alarm and calling for help. Unfortunately, in far too many instances, our residents and caregivers were not made a priority.”

As part of the probe, lawmakers are seeking information from companies including Genesis HealthCare (NYSE: GEN) and Ensign (Nasdaq: ENSG).

— Thirty-two executive directors with Brookdale Senior Living (NYSE: BKD) received coaching through a pilot program with Chicago-based Executive Coaching Connections (ECC). “Like so many businesses around the country and the world, our practice was quickly affected by Covid-19. Our coaches had extra time on their hands and, since we had a prior relationship with Brookdale, we thought of senior living as a place where we would be able offer help that would make an impact,” said ECC partner Susan Madonia.

— Mobile video content platform OneDay announced a partnership and integration with sales enablement and CRM solution Sherpa. The integration is meant to give senior living sales professionals a “dynamic new tool” for engaging with prospects. Video has emerged as a key technology during Covid-19 lockdowns in senior living, and OneDay achieved 90% growth in the past nine weeks, the company recently announced.

— The Wall Street Journal reported on the patchwork approach to reopening senior living and care communities across the country: “The pace of reopening elder-care facilities is uneven around the U.S., with a patchwork of rules that is frustrating some of their operators.”

Bulletin for June 4, 2020

Covid-19 continued to take a steep toll on senior living communities, but inquiries and move-ins did increase between April and May.

That’s according to data from more than 2,200 communities, compiled by Enquire and released Thursday.

May inquiries were 22% higher than April’s, although inquiries were still down 27% on a year-over-year basis, the data show. Move-in averages increased by a little more than 10% between April and May, but May move-ins were down 51% compared to last year.

However, there is a great deal of fluctuation in the numbers among different levels of care and in different regions across the country.

For example, inquiries in independent living were down 50% year-over-year in the Southeast but only 14% in the Northeast. And within the Northeast, inquiries were down 47% in New Jersey but only 23% in Massachusetts.

The pandemic has also affected what types of inquiries are most common. Year-to-date, there senior living communities have received 6% more inquiries via web forms than they did by this time in 2019. Tours, home visits and callouts have all decreased compared to last year.

Also in the news:

— Occupancy has declined in continuing care retirement communities (CCRC) due to Covid-19, but less drastically than in other types of senior living settings, according to an analysis of recent Executive Survey data from the National Investment Center for Seniors Housing & Care (NIC). Possible explanations include that incoming CCRC residents tend to be healthier and more active than incoming residents of standalone assisted living, memory care and skilled nursing facilities, and having multiple care levels spread across large CCRC campuses may make it easier to distance the most at-risk residents from others.

— Bellevue, Washington-based Aegis Living has formed a coronavirus advisory council, comprised of leading experts in a range of health and wellness disciplines. The seven members include medical doctors with organizations such as the University of Washington and the University of California, San Francisco.

“Aegis will look to researchers to teach the organization about how the virus travels, how it is evolving and where it may be headed next,” the organization stated in a press release. “It will look to leading medical experts and institutions for progressive thinking on how to best care for its fragile population physiologically, emotionally and cognitively.”

Aegis is evaluating how to share the lessons from its advisory council with the industry as whole.

— Government-supported apprenticeship programs could make a notable difference in alleviating workforce pressures in senior living, and should be ramped up especially in light of Covid-19. This is the argument put forward by NIC and Nexus Insights Founder Bob Kramer and Activated Insights CEO Jacquelyn Kung, in Morning Consult.

“Recently, the Department of Labor awarded a grant of just under $6 million to train 7,239 apprentices in areas such as caregiving and nursing,” they wrote. “At $830 per apprentice, this investment is a bargain compared to recent per capita federal stimulus funding programs, especially as these purpose-driven individuals can learn and apprentice to fill much-needed job vacancies in less than three months.”
— Covid-19 appears to be notably increasing demand for communal senior living in the massive Indian market, including in properties owned and operated by Seattle-based Columbia Pacific, Livemint.com reported.

Bulletin for May 29 – May 31

The Centers for Disease Control and Prevention (CDC) on Friday urged assisted living facilities to report Covid-19 cases, facility staffing and supply information on a weekly basis.

Nursing homes are required to report this information to the CDC each week via the long-term care facility Covid-19 modult of the National Healthcare Safety Network (NHSN). Assisted living facilities are not federally required but are “encouraged” to do the same, according to a May 29 CDC website update.

The module includes four “pathways” that assisted living providers can use to report information about how Covid-19 is impacting:

— residents and facility capacity

— staff and personnel

— supplies and personal protective equipment

— ventilator capacity and supplies

The CDC also stated that assisted living facilities should refer to state and local guidance when making decisions about easing Covid-19 protocols, such as easing visitor restrictions, allowing group activities and restoring communal dining.

“When relaxing any restrictions, ALFs must remain vigilant for Covid-19 among residents and personnel in order to prevent spread and protect residents and personnel from severe infections, hospitalizations, and death,” the web page states.

Also in the news:

— Pennsylvania Rep. Matt Cartwright — in a letter co-signed by 53 other House lawmakers — pushed the Department of Health and Human Services (HHS) to allocate CARES Act funding for senior living providers.

“To date, Medicare providers, hospitals, rural and ‘hot spot’ health care facilities, Indian health care entities, the uninsured, nursing homes, and Medicaid providers have all been allocated funds to help with their expenses,” the May 29 letter stated. “It is critical that operators of senior living communities, which include assisted living, memory care, independent living, and continuing care retirement communities, now also be recognized for the significant efforts they are making to keep their residents and employees safe.”

— “There’s a great danger that the boomers will view senior living as equating to senior dying,” NIC and Nexus Insights Founder Bob Kramer told Barron’s, as part of a deep-dive on how Covid-19 is affecting the assisted living industry. Key takeaways: Expect operational and design shifts and more pressure from aging-in-place alternatives.

— Family members and others will be allowed to visit assisted living residents in Ohio starting on June 8, if the meetings occur outdoors. “We know it is becoming more and more difficult for people. They’ve been away from their relatives,” Ohio Gov. Mike DeWine said, in announcing the policy. “We know this has caused a great deal of heartache inside of these facilities … this is a very difficult issue.” Nursing home visits will still be barred.

— More federal support of Covid-19 testing is needed across all types of senior housing and care settings, LeadingAge wrote in a May 28 letter to Congressional leaders. The industry association criticized federal leaders for telling nursing home providers to “talk to your governor” about help with testing and supplies.

“For aging services providers, especially in congregate settings, particularly those for older people who are disproportionately negatively affected by Covid-19, accurate testing must be available when needed – no matter how often it is needed; results must be available quickly so providers can take steps to treat those who are ill and protect others; and the costs – all the costs – test kits, PPE and staffing — must be borne by government,” the letter states.

— All assisted living facilities with memory care units in the state of Washington are required to test all staff members and residents for Covid-19 by June 26. The state will provide PPE and test kits to all facilities at no cost to carry out this order.

Bulletin for Thursday, May 28, 2020:

The pace of move-ins appears to be improving across senior living, according to the most recent Executive Survey results from the National Investment Center for Seniors Housing & Care (NIC).

From May 11 to May 24, 9% of surveyed assisted living providers reported an acceleration in the pace of move-ins over the past 30 days. That compares to 3% of AL providers who reported accelerated move-ins when surveyed between May 4 and May 10. The trends were also positive in other care segments.

For the latest survey — the seventh that NIC has done since the pandemic began in March — 155 senior housing and skilled nursing providers responded.

Compared to Waves 4 and 5 of the survey, “significantly fewer respondents” in Waves 6 and 7 said that an organization-wide ban on new residents was slowing down move-ins, NIC Senior Principal Lana Peck wrote in announcing the latest survey results.

Although senior living operators are eager to rebuild census lost due to Covid-19, providers are also wary about economies reopening while the pandemic is ongoing. As stay-at-home orders are lifted or eased, some fear that staff will become infected at higher rates and pass the virus to residents. Other countries have seen Covid-19 resurgences, leading some economists and other experts to predict a W-shaped recovery for senior living as infection rates wax and wane.

Also in the news:

— TIME magazine highlights that assisted living facilities have been “largely overlooked in coronavirus-relief efforts.” The article describes industry efforts to garner more aid and family member discontent with how some providers have responded to the crisis.

— The House of Representatives passed a bill to give small businesses more flexibility in how they use Paycheck Protection Program (PPP) funds.

— Knollwood, a large life plan community in the Washington, D.C. area, has pursued widespread testing in the face of several challenges, DCist reported. “It’s almost like flying an airplane in the fog. The results of our testing were literally like a pathway through the fog to help us make informed decisions,” Knollwood COO Col. Paul Bricker told the publication.

— A Place for Mom is partnering with Love for the Elderly on a virtual letter-writing initiative with the goal to deliver messages to 1,000 senior living residents in the next 100 days.

Bulletin for Wednesday, May 27, 2020:

The one-time cost to test every assisted living resident and staff member across the United States for Covid-19 would run to about $232 million.

That’s according to an analysis released Wednesday by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). The organization previously released an estimated cost of $440 million to test every nursing home resident and staff member in the country for Covid-19 one time.

These numbers come as some states are mandating Covid-19 testing in nursing homes and assisted living communities. In New York state, for instance, the governor issued an executive order requiring all assisted living associates to be tested twice a week through early June.

Complying with this mandate is costing around $20,000 a week for just a single community with 100 workers, and it is not clear whether that cost will be borne by the state, Engel Burman Principal Steven Krieger said Thursday, speaking on a Bisnow webinar. Engel Burman is a development, construction and management firm that operates senior living under The Bristal Assisted Living brand across Long Island and Westchester County in New York, and in New Jersey.

Senior living providers are weighed down by numerous costs related to Covid-19, including for additional labor and personal protective equipment. Meanwhile, financial support from government aid packages has been sparse.

Other senior living associations have also spoken out against testing mandates, noting that tests themselves are of variable quality, and they only provide information about a moment in time. Last week, senior living association Argentum released a white paper calling for a “smart” testing strategy rather than an “indiscriminate” approach.

Also in the news:

— KARE — a technology startup that creates a “digital labor marketplace” for senior living workers — is launching in the Atlanta market. KARE has also forged partnerships with hospitality companies to help place laid off workers in senior living jobs. KARE’s backers include various industry leaders, including NIC founder Bob Kramer.

— K4Connect is distributing more than 8,000 Amazon Echo Dot devices to 40 senior living communities on the West Coast, to help residents stay connected with staff, neighbors and loved ones during Covid-19. The devices were donated by Amazon as part of a $5 million donation program. Other tech companies have also been working with senior living providers to implement technology during the pandemic — for instance, Google has teamed with Merrill Gardens on a pilot involving Nest Hub Max devices with special features.

— After a report from the Canadian military raised concerns about infection control in long-term care settings, Ontario Premier Doug Ford said that the government would take over management of communities if necessary. “The system is broken and everything is on the table,” Ford said during a Tuesday briefing. Stocks in publicly traded Canadian senior housing companies fell on the news.

Bulletin for Friday, May 22 – Monday, May 25

The federal government has started to distribute nearly $5 billion in Covid-19 relief to U.S. nursing homes, but private-pay senior living communities still “critically need financial relief,” Argentum President and CEO James Balda stated Friday.

“All in all, expenses for senior living communities are projected to be in the tens of billions over the next year,” Balda stated. “This could cause extreme financial strain on this industry, which currently serves as a safe haven to residents and a backstop to the larger health care system. These communities also desperately need priority access to Covid-19 testing and PPE, but the government has prioritized nursing homes for these critical resources, as well.”

Other industry organizations — including the American Seniors Housing Association and LeadingAge — also have repeatedly called for more support for senior living providers in the midst of the Covid-19 pandemic.

So far, funds from massive federal stimulus programs such as the CARES Act have not flowed in any substantial way to the sector. Another relief package, totaling about $3 trillion, has been passed by the House of Representatives but is stalled in the Senate.

Also in the news:

— Argentum on Friday released a white paper calling for a “smart” Covid-19 testing strategy for senior living residents and staff. States have started to announce mandatory testing for senior living, but these mandates do not address “numerous issues,” including the accessibility and reliability of testing, as well as the financial burden posed by testing. While senior living providers “fully support” and understand the need for testing, until these issues are addressed, “indiscriminate, mandatory testing is inappropriate,” the white paper states.

— At least 30% of association members are still encountering challenges in securing needed personal protective equipment (PPE), Argentum and the American Seniors Housing Association (ASHA) wrote in a May 21 letter to the Senate Special Committee on Aging.

— The Centers for Medicare & Medicaid Services (CMS) on Friday finalized the Medicare Advantage rule for 2021, including expanded flexibilities related to telehealth and people with chronic conditions. Medicare Advantage has made inroads in senior living in recent years, thanks in part to expanded benefits — and some believe that Covid-19 will accelerate this trend.

— With Georgia’s legislatures set to reconvene in June, state lawmakers could move forward with new regulations governing assisted living communities, The Atlanta Journal-Constitution reported. Key provisions of the bill include new certification and staffing requirements for memory care units, as well as nurse staffing requirements for assisted living.

Bulletin for Thursday, May 14, 2020:

The Covid-19 pandemic has weighed on senior housing and care move-ins and occupancy in the past two months — but there are preliminary signs that the needle is starting to move in the right direction.

In particular, 11% of independent living providers, 12% of memory care providers and 21% of nursing care providers reported that occupancy had increased when compared with the prior week’s rates, according to a new Covid-19 survey from the National Investment Center for Seniors Housing & Care (NIC). The survey’s sixth and latest “wave” includes responses from 100 senior housing and skilled nursing operators polled between May 4 and 10.

The numbers represent the biggest reported positive change in occupancy for providers in all three segments since NIC began collecting the survey responses in March. And there are signs of recovery elsewhere in the industry.

Home health, hospice and senior living provider The Pennant Group (NASDAQ: PNTG) posted solid first-quarter earnings Thursday, and it appears as though some of its occupancy pressures may have reached a basement, according to RBC Capital Markets analyst Frank Morgan.

“Volume pressure appears to have bottomed in the first week of May and is showing signs of recovery in both [home health care] and senior living,” Morgan wrote in a note to investors.

Still, NIC cautions more data is needed to draw definitive conclusions about whether occupancy has reached a turning point. And, 63% of organizations with assisted living units noted no change in occupancy rates from the prior week, with none reporting occupancy gains for that segment.

“Other potentially positive signals include a slightly lower percentage of operators reporting decelerations of move-ins in wave 6 relative to wave 5 although the majority of organizations across all care segments did still report that move-ins decelerated in the past 30-days,” wrote NIC Senior Principal Lana Peck. “Additionally, the percentage of respondents citing an organization-imposed ban on move-ins decreased from 59% in wave 5 to 46% in wave 6, and fewer respondents cited resident or family member concerns about moving residents in or out of communities.”

Also in the news:

— Democrats in the House of Representatives released details of a possible $3.3 trillion stimulus package, including several provisions of note for senior living. Notably, it includes a fund to cover hazard pay for essential workers.

LeadingAge, an association of non-profit senior service providers, says the bill would be a step in the right direction for frontline caregivers and the older adults they serve.

The Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act) addresses some of the needs LeadingAge outlined in its five essential actions aimed at protecting older adults. Specifically, the proposed bill includes a $200 billion fund for essential worker hazard pay, which would be doled out to employers to pay their eligible employees.

Still, while the bill is a good start, it does not go far enough, according to the Washington, D.C.-based organization.

“Congress must allocate $100 billion for an emergency relief fund specifically for aging services providers,” the LeadingAge release reads.

— National senior placement franchisor Assisted Living Locators is partnering with memory care training and consulting company Dementia Care Education. Under the partnership, all 140 Assisted Living Locators’ franchisees are now dementia-certified.

— A new online survey on behalf of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) found that many Americans still believe nursing homes and assisted living communities need more support. The survey, conducted between May 6 and 9, found that slightly less than 64% of respondents say those communities need more money for supplies, staffing and increased testing capabilities.

— Invesque Inc. (TSX: IVQ.U), the Toronto-based real estate investment company formerly known as Mainstreet Health Investment, has transitioned a majority of its assets with operator Royal Senior Living to Phoenix Senior Living. Invesque and Royal were joint-venture partners on four properties in South Carolina, which were fully acquired and transitioned to Phoenix; and one property in Florida, which was sold to a third party. Phoenix now operates 45 communities in seven states. Invesque also noted that 560 people residing in 40 of its 108 senior housing and skilled nursing properties had tested positive for Covid-19.

Bulletin for Monday, May 11, 2020:

Senior living industry association Argentum is calling for all states to publicly report Covid-19 information they are collecting from providers, and to include statistics about recoveries as well as infections and fatalities.

“We are … seeing discrepancies in how and which states across the country are publicly reporting data, and we are asking the states to offer full transparency,” Argentum President and CEO James Balda said in a press release issued Monday. “Not only is it important to maintaining trust and integrity; it’s also the right thing to do.”

Argentum would also like to see states distinguish between assisted living communities and nursing homes in their data releases.

Another industry group, the National Investment Center for Seniors Housing & Care (NIC), recently launched a Covid-19 Reach Tracker, drawing on publicly released information to compile statistics such as the number of senior living properties in a given metro area with positive Covid-19 diagnoses among residents or staff.

Also in the news:

— The New York Times published a photo essay on life inside assisted living during Covid-19, using images captured by residents.

— A group of Canadian senior living operators — Chartwell, Revera, Extendicare and Sienna Senior Living — have launched a $2 million fund to provide up to $10,000 in one-time financial support to workers affected by Covid-19. All senior living workers in Canada are eligible to apply, regardless of which company they work for.

— Vice President Mike Pence reportedly suggested to state governors that all nursing home residents be tested for Covid-19 in the next two weeks; President Donald Trump later said he would consider mandating the testing.

— AARP sent a letter to Congressional lawmakers in opposition to legal immunity for nursing homes and assisted living providers related to their Covid-19 response.

Bulletin for Thursday, May 7, 2020:

Since the outset of the pandemic, stories of senior living providers struggling to find enough personal protective equipment (PPE) have become commonplace. But little is often known about who providers turn to when they need to find masks, gowns and gloves.

For Jewish Home Family, a provider of skilled nursing, assisted living, and other senior care services in Bergen County, N.J., one of the most reliable PPE sources is a man whose name remains unknown even to its CEO. They call him “Parking Lot Guy.”

“He’s actually met with us in parking lots,” Jewish Home Family CEO Carol Silver-Elliott said during a Thursday virtual event hosted by trade group LeadingAge. “We’ve been able to take a deep breath and wire money to bank accounts we’ve been told to wire money to, and the supplies thankfully have appeared — and have also been of good quality.”

For more on the virtual event, and on Jewish Home Family’s struggle sourcing PPE, read the full story on Skilled Nursing News.

Also in the news:

— The pace of memory care move-ins continued to slow down during the week of April 27 to May 3, according to the latest Executive Insights survey from the National Investment Center for Seniors Housing & Care (NIC).

— Rick Matros, CEO of Sabra Health Care REIT (Nasdaq: SBRA) is pleased with the performance of the real estate investment trust’s senior housing portfolio during Covid-19. Its Enlivant properties have been somewhat insulated from the effects of the pandemic given that they are located in less dense, secondary and tertiary markets that have not been hit by Covid-19 as hard as larger urban centers, he said during the REIT’s Q1 2020 earnings call on Thursday. And Holiday Retirement has done an effective job of rolling out telehealth programs and keeping infections low in its independent living buildings.

“If you told me two months ago that we’d be sitting here today not having granted any rent relief … I would be surprised. And particularly on the senior housing side, because the senior housing operators don’t have these programs to access,” Matros said, referring to financial support through government initiatives.

— Denver-based OZ Architecture suggested how senior living design might change due to Covid-19 in a new report, “Designing for Emergency Preparedness.” One proposal is for compartmenalized buildings. “Larger assisted living and memory support communities could be designed as a cluster of smaller household models with a common node. This connectability can allow for staff and resource flexibility in an emergency situation, while maintaining the benefit of fewer individuals in contact with the separate households,” the report authors wrote.

Bulletin for Tuesday, May 5, 2020:

Arden Courts is facing similar Covid-19 challenges as other memory care providers across the United States, but has some unique advantages due to its ties with nonprofit health system ProMedica.

Between mid-March and the morning of May 5, Covid-19 had appeared at 20 out of 54 Arden Courts communities, with 201 diagnosed cases among the resident population of about 2,700. That’s according to data provided to Senior Housing News by Dr. Mark Gloth, vice president and chief medical officer of HCR ManorCare.

Arden Courts is the assisted living and memory care brand of Toledo, Ohio-based HCR ManorCare, which also operates more than 150 skilled nursing centers. HCR ManorCare was acquired in 2018 by a joint venture of ProMedica and real estate investment trust Welltower (NYSE: WELL).

Across its portfolio, HCR ManorCare is facing challenges related to a lack of Covid-19 test kits, a strained supply of personal protective equipment (PPE), and workforce pressures, Gloth said Tuesday on a call with reporters. However, the provider is in a better situation than many other senior care providers due to its relationship with ProMedica, Gloth said.

“A benefit of being part of the ProMedica system is the ability of our supply chain to work with partner vendors to procure much needed PPE supplies as well as receive donations from the community,” Gloth said in a followup email to SHN after Tuesday’s call. “ProMedica also brings telehealth expertise so we can bring specialists to the bedside while minimizing exposure, and insight into testing efforts and treatment medications. Locally we have partnered to test not only the patients and residents in our senior care facilities, but others in our community.”

In addition, a program was established in Arden Courts buildings to equip and train workers — previously operating on a less medical model — to provide care to Covid-positive residents. And, the ProMedica Foundations have established funds to help workers affected by Covid-19, and so far have provided financial assistance to nearly 3,000 employees.

Also in the news:

— The California Department of Social Services is offering senior and adult care residential facilities up to $1,000 a day to take medically stable Covid-19 patients, to free up hospital capacity, the Mercury News reported. The $1,000 payment is being offered to board-and-care home with six or fewer beds, but larger facilities can also indicate their interest to the state. Health experts have criticized the plan as unsafe. There has been “negligble interest or participation” in the program among members of the California Assisted Living Association, the group’s president and CEO, Sally Michael, said in a statement provided to SHN. That statement also reads:

“From the outset, CALA viewed this proposal with caution. To be clear, when the proposal to move COVID 19 patients into assisted living was brought to light, it was not at the request of, nor was it endorsed by, assisted living providers in California. Rather, we believed the state saw this as a possible necessary crisis response put forth to protect public health by preserving capacity in hospitals for the dangerous surge of cases that could be coming. We don’t believe the state ever envisioned this proposal as something that would apply to a large number of providers.

Fortunately, the need for surge capacity in hospitals has not been an issue to date. This means that the anticipated crisis response of moving COVID 19 patients into isolated areas of assisted living appears unnecessary.”

— The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) called on the Department of Health and Human Services (HHS) to allocate a $10 billion CARES Act fund for skilled nursing facilities, followed by an additional fund for assisted living communities.

— Bonita Springs, Florida-based Discovery Senior Living has launched a nationwide Covid-19 testing initiative, with several thousand tests already completed.

“The testing will be conducted using an ongoing random sampling program at no cost to residents and team members, as this testing will continue to maintain the long-term health of the communities,” Discovery stated in a press release. “All new, incoming residents can choose to be tested as well, especially as the company gets ready for the opening of three new communities: two in Florida and one in Texas.”

Bulletin for Tuesday, April 28

The Covid-19 pandemic could shift consumer preferences away from dense urban centers, further boosting the trend of senior housing affiliated with universities.

That idea was proposed by Bob Kramer, founder and strategic advisor at the National Investment Center for Seniors Housing & Care (NIC) and founder of Nexus Insights.

“Land is a lot cheaper and boomers can be spread out, but they still have vibrancy and intellectual community of sports, culture and ongoing learning where you take classes,” Kramer told Commercial Observer. “That way, boomers get [their] desire for continuing education and culture and the arts.”

The CO article took a broad-based look at the state of senior housing, raising points such as:

— Future investors are likely to judge a potential acquisition in part by how well the building or company fared during Covid-19

— Responding to Covid-19 is similar to a high-stakes game of chess, according to Watermark Retirement CEO David Barnes

— Public confusion over the difference between nursing homes and senior living could hurt the ability of private-pay operators to bounce back from the pandemic

Also in the news:

— A group of industry professionals has launched People of Seniors Housing (POSH). The group has three primary goals, as outlined by Scott Stewart, founder and managing partner of Capitol Seniors Housing:

  1. Recognize and honor overlooked caregivers
  2. Educate and differentiate senior living from hospitals and skilled nursing
  3. Conceptualize a post-pandemic campaign that reaffirms seniors housing as the best/safest home for America’s seniors

Working with PR firm BerlinRosen, POSH is devising a digital-focused public relations campaign beginning with Facebook ads.

— Industry association Argentum launched a Standing with Seniors campaign, aiming to marshal widespread, grassroots advocacy from provider organizations, residents, family members and community staff.

“We are calling on senior living providers to join us as we advocate on behalf of the industry for priority PPE and testing, and the financial support to continue caring for our nation’s seniors now and after the pandemic recedes,” the association stated.

— Filing lawsuits against assisted living providers related to their Covid-19 response is complicated but possible, Northeastern University law professor Daniel Medwed told WGBH.

— Covid-19 has been challenging but also fostered an even stronger “sense of community” among residents and staff at Meadowood Senior Living, the Philadelphia Inquirer reported.

— A new heat map of Covid-19 infections in nursing homes and assisted living communities shows where the virus has hit hardest and could show where outbreaks are worsening. The tool was created by AMDA—The Society for Post-Acute and Long-Term Care Medicine and ASCP, a membership association that represents pharmacists, health care professionals, and students serving the unique medication needs of older adults.

Bulletin for Monday, April 27

Many industry stakeholders believe senior living development activity may ultimately be sidelined due to Covid-19 for a period of six to eight months. On the dealmaking front, a number of transactions are going belly up, but pricing has not deteriorated too much for those that are going through.

That’s according to a new survey from health care real estate advisory firm HealthTrust that collected responses from almost 50 C-suite level lenders, operators and owners in the senior housing space.

The survey’s respondents said they thought lending activity could resume in an average of about three months, acquisition activity could resume in three to five months and development activity could resume in three to eight months. And 90% of those surveyed thought the capitalization rates for seniors housing would rise by as much as 50 basis points in the next 12 to 36 months.

The survey’s respondents also noted that some transactions are falling apart as the Covid-19 pandemic drags on, with 69% reporting at least one deal — defined as a sale or financing — that had been pulled or canceled.

But only some of the deals that have gone through so far were reduced in price, as just 20% of those surveyed indicated a reduction in pricing or proceeds. Many of those cases reflected escrowed or held-back funds contingent on changes in occupancy, price reductions based on changes in occupancy or loan term changes due to increased credit risk, according to the survey.

The low number of deals with pre-Covid-19 sale prices came as a surprise to HealthTrust COO Colleen Blumenthal.

“I think the relatively few number of deals that closed without renegotiating price was a surprise,” Blumenthal told Senior Housing News. “However, I suspect if we asked again in a month, that would be a different story.”

Although Covid-19 is likely to make investors more aware of the potential risk posed by senior housing, Blumenthal does not think it’s a worst-case scenario for the industry.

“The pandemic has opened the broader investment communities’ eyes to the risk of investing in seniors housing, but the sky is not falling,” she said.

Also in the news:

— In light of the Covid-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) is temporarily allowing Medicare Advantage organizations to enhance their benefits packages, including providing phones or tablets that aid in the use of telehealth or remote access technology services.

Though AllyAlign CEO and Founder Will Saunders doesn’t think large MA plans will use this flexibility for non-telehealth supplemental benefits, he told SHN he believes that “many special needs plans will seriously look at the flexibility to provide tablets, et cetera, that enable access to telehealth solutions.” AllyAlign is a partner with several senior living providers that have launched MA plans.

— Senior living tech provider K4Connect and Seniorly are teaming up with Tony Award-winning broadway actress Laura Benanti on an initiative to share concerts with people who are isolated due to Covid-19, including senior living residents.

Bulletin for Friday, April 24 – Sunday, April 26

Senior housing professionals and investors are seeking acquisition opportunities over the next 12 months as the industry grapples with the Covid-19 pandemic. But, investors will shift their focus to value-add and distressed acquisitions, according to new survey results from senior housing investment brokerage firm Heavenrich & Company.

Pricing, meanwhile, will decrease in the near-term, but respondents indicated that it will not drop as sharply as some fear.

Heavenrich & Company reached 448 senior housing owners, operators and investors between April 15 and April 20 to gauge the market impact of the crisis on the industry, President and Managing Director Adam Heavenrich told Senior Housing News.

Overall, the survey is a sign that investors are optimistic about senior housing, due to a combination of its needs-based operational model and favorable demographic trends — 86% of respondents said that they are currently seeking to acquire senior housing.

As Covid-19 persists, value-add opportunities will grow in popularity among investors: 91% of respondents indicated that they were in the market for value-add properties, while 62% said they were exploring acquiring distressed communities. Private equity is driving the charge and these investors are looking to partner with quality operators.

“These folks are also looking to partner with operators which is a positive of this industry. Money [is] waiting in the wings that need operators. [Covid-19] may cause some operators who are thinly capitalized to seek a deep pocketed partner. It they are good operators, they can handle more communities,” Heavenrich said.

One firm implementing a value-add strategy is Dallas-based McFarlin Group, which is launching a $100 million fund to acquire senior housing assets at risk of becoming distressed in part by the coronavirus pandemic, Managing Director Matt Johnson recently told SHN.

A majority of respondents indicated that pricing would decrease because of Covid-19. Around 38% of respondents expect senior housing pricing to fall between 5% and 14% in the next six months, 11% predict pricing to drop less than 5%, while 4% said that there would be no change in pricing.

This indicates investor confidence in senior housing’s strong market fundamentals and belief that seniors will consider a move based on need within the next 12 months, as well as long-term positive demographic trends showing that demand will outstrip supply, Heavenrich told SHN.

Some other notable findings from the survey:

  • More than half of respondents intend to invest the same amount of capital in senior housing (16%) or increase their capital deployment into the sector (36%) in the next 12 months.
  • Investors are most concerned about occupancy and market liquidity as the pandemic continues. Most lenders have already retreated to the sidelines for the time being, but senior housing’s recession-resilient components opens the product up to limited financing vehicles such as HUD, Fannie Mae and Freddie Mac lending.

Also in the news:

— Assisted living providers in Connecticut must report all Covid-19 cases and a variety of other information each day or face financial penalties of $5,000 for each instance of noncompliance, under an executive order issued by Gov. Ned Lamont.

In addition to infection rates, assisted living providers and other senior housing and care providers must report available beds and units, level of staffing and personal protective equipment, CT Mirror reported.

— Vantage Point Retirement Living in Pennsylvania has been supplying health care workers and first responders with “Covid Care Kits,” MyChesCo reported.

— California has joined the growing list of states compiling lists of assisted living communities with Covid-19 outbreaks. In the Golden State, the list includes only those communities with 11 or more confirmed cases of Covid-19, in the interest of protecting resident privacy, KPBS Public Media reported. As of late last week, the list showed 856 Covid-19 outbreaks across the state’s roughly 7,000 assisted living centers.

Bulletin for Thursday, April 23, 2020:

Senior housing occupancy is continuing the downward slide that began last month as Covid-19 spread throughout the United States.

That’s according to data for the week of April 13 to April 19, gathered by the National Investment Center for Seniors Housing & Care (NIC). The organization collected data from 105 owners and C-suite executives of senior living and skilled nursing companies. This is the third round of data NIC has collected through this survey since the pandemic began to gain steam.

“Occupancy rates declined and move-in rates decelerated for many organizations in Wave 3, with data showing distinctive downward trends since the survey began on March 24, 2020,” NIC Senior Principal Lana Peck wrote in a blog post analyzing the results.

Compared to the previous week, independent living fared the best out of all segments, with about 70% of respondents reporting no change in occupancy. A growing number of memory care providers are seeing occupancy declines of 3% or more. About 40% of assisted living providers experienced an occupancy decline of less than 3%.

Meanwhile, the pace of move-ins continues to slow down across the board. In the “Wave 3” survey, 74% of independent living providers reported the pace of move-ins has decelerated over the last month, compared with 61% the week prior. For memory care, 64% of Wave 3 respondents said the pace of move-ins has declerated over the past 30 days, compared with 34% in Wave 2.

A slowdown in lead conversions/sales was cited as the primary reason for slower move-ins, with resident or family member concerns next, followed by organization-imposed bans.

And, the pace of move-outs has also accelerated across care levels over the last month:

Independent living: 3% of Wave 1 respondents reported accelerated move-outs, versus 18% of Wave 3 respondents

Assisted living: 6% of Wave 1 respondents reported accelerated move-outs, versus 17% of Wave 3 respondents

Memory care: 3% of Wave 1 respondents reported accelerated move-outs, versus 12% of Wave 3 respondents

More overtime remained the primary strategy for addressing staffing shortages, while fewer providers reported hiring temporary staff or professionals from other industries. Compared with Wave 1, more providers are now offering paid sick leave.

On the development front, 49% of Wave 3 respondents expect no change in their development pipelines going forward, and about 25% said they expected it to shrink.

Also in the news:

— As of April 23, Covid-19 had claimed more than 10,000 lives in long-term care facilities, including nursing homes and assisted living, across 23 U.S. states, according to a Kaiser Family Foundation analysis. That number is inclusive of residents and staff members.

“Given that not all states are reporting data yet and the continual lag in testing, the counts of cases and deaths are an undercount of the true number of cases and deaths in long-term care facilities,” Policy Analyst Priya Chidambaram wrote.

— The U.S. House of Representatives passed the $484 billion Covid-19 relief package that cleared the Senate earlier this week. The bill replenishes the Paycheck Protection Program (PPP), through which small businesses can receive forgivable loans, and allocates $25 billion to increase Covid-19 testing.

— The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) is pushing for assisted living and skilled nursing facilities to receive a portion of $10 billion that the Department of Health and Human Services is planning to distribute to health care providers in Covid-19 hotspots.

— Connecticut Gov. Ned Lamont is considering an executive order to mandate that the state’s assisted living communities report Covid-19 cases.

— The Minnesota Statewide Emergency Operations Center has put out a call for licensed and unlicensed medical staff who could help ease labor pressures at the state’s assisted living and long-term care facilities.

— The Centers for Medicare & Medicaid Services (CMS) has put out a telehealth toolkit to help states expand the use of this technology among Medicaid beneficiaries during Covid-19.

— The city of Detroit has been trying to test all nursing home residents for Covid-19, and plans to expand the effort to assisted living facilities next. By the end of Thursday, it’s expected that all nursing home residents will have been tested, according to Mayor Mike Duggan.

— Vendors and other partners who work with senior living providers continue to offer free services and other forms of support during Covid-19, including:

Activated Insights, the firm behind the annual Best Workplaces in Aging Services list that appears in Fortune, is offering complimentary Covid-19 staff surveys to senior care organizations. The surveys are available even to companies that are not pursuing Great Place to Work certification. They are a way for providers to gauge how their staff are doing amidst the Covid-19 crisis, and determine ways to support workers. Results are usually available within a week. Those interested can contact [email protected].

Englewood Construction donated 100 gallons of hand sanitizer and 100 gallons of surface sanitizer to a senior living client experiencing shortages.

“In our line of work, it’s a lot of ‘I’ve got a guy…’ to solve whatever issue might be at hand,” Englewood President Bill Di Santo said in a press release. “And that’s exactly what happened – we knew a local source who could supply us with the sanitizers our client needed. We are so pleased to send this shipment to our client in a gesture of partnership and goodwill – we are all in this together!”

News for Wednesday, April 22, 2020:

Senior living providers have gained allies in their efforts to access federal money to ease Covid-19 financial burdens.

Sen. James Lankford, a Republican from Oklahoma, sent a letter to Health and Human Services (HHS) Secretary Alex Azar, urging the agency to include senior living providers among the recipients of Public Health and Social Services Emergency Fund (PHSSEF) money. The letter was co-signed by 26 other senators.

“As you know, our nursing homes and senior living facilities are experiencing serious shortages of needed staffing and protective equipment during the COVID-19 public health emergency,” the letter stated. “Significant investment is needed to stave off both of these shortages.”

Industry groups Argentum and the American Seniors Housing Association (ASHA) have been advocating consistently for senior living to receive a share of the PHSSEF, which was established as part of the recent $2 trillion stimulus package. The $100 billion fund is dedicated to supporting health care providers, and a first tranche of $30 billion went mostly to hospitals and other providers with large Medicare reimbursements.

Future distributions of the fund will go to other types of providers. The next tranche is expected to go largely to providers that rely heavily on Medicaid, but other types of providers will also be able to apply for funds, the Centers for Medicare & Medicaid Services (CMS) has indicated.

Meanwhile, an “interim” funding package of nearly $500 billion was passed Tuesday by the Senate, which includes a new infusion for a small business loan program that some senior living providers are eligible to tap. The funding package also includes increased funding for Covid-19 testing — which is direly needed in senior living communities.

The House of Representatives is expected to vote Thursday on the package. A larger, fourth stimulus deal is already being negotiated on Capitol Hill.

Also in the news:

— National Health Investors (NYSE: NHI) has named David Travis as senior vice president and chief accounting officer, effective May 1. Travis replaces Ron Peel, who is retiring on December 31. Travis will help the Murfreesboro, Tennessee-based real estate investment trust navigate the “increasingly complex business environment,” CFO John Spaid said in a press release.

As of Tuesday, 27 out of NHI’s 238 senior housing and skilled nursing buildings had two or more confirmed cases of Covid-19.

Travis previously was chief accounting officer with MedEquities Realty Trust, which merged with Omega Healthcare Investors (NYSE: OHI), and Healthcare Realty Trust Incorporated (NYSE: HR).

— More than 100 senior living communities in the United States and Canada are receiving free Cubii compact seated ellipticals. The effort was made possible with support from Welltower (NYSE: WELL), Direct Supply, tech incubator and innovation hubs MATTER and 1871, and Optima Living Communities. Belmont Village and Brandywine Living are among the providers involved.

“COVID-19 has presented an unprecedented challenge for senior care communities,” said Lisa Van Dusen, Vice President of Sales at Direct Supply. “Finding ways to keep residents engaged and physically active during the quarantine has been a big concern. The Cubii elliptical trainers are a great solution for seniors to use within the safety of their rooms. An administrator from one of our communities said this opportunity seems like ‘divine intervention.’”

— The Massachusetts House of Representatives passed a bill that requires public reporting of Covid-19 cases and deaths in assisted living communities, as well as other long-term care settings.

Bulletin for Tuesday, April 22, 2020:

With the coronavirus threatening the lives and wellbeing of senior living residents and staff, providers feel as if they are fighting a war without needed support and equipment.

This is one takeaway from comments that senior living providers have made in recent surveys taken by the National Investment Center for Seniors Housing & Care (NIC). The organization starting conducting “Executive Insights” surveys as the Covid-19 pandemic began unfolding in the United States last month, and recently released the second wave of results.

While the surveys collect data related to occupancy, move-ins, staffing and other metrics, they also gather comments from respondents. NIC shared several of these comments in a recent web post. The comments paint a dire picture of what providers are facing. They include:

“We feel we are alone in a war zone.”

“We do our best; under the current scenario, the worst isn’t here yet.”

“Lack of testing is a major concern. We have positive cases but can’t get all residents tested unless they have symptoms. By that point, it’s almost too late to do anything.”

“Front line staff considering quitting and taking unemployment [versus] caring with no PPE and kids at home without oversight.”

“We have been fortunate that our staff have been able to continue their regular hours of work. Closing down our Health Center and not allowing family or friends to visit has been difficult for residents to understand. Independent living residents don’t like the social distancing. As CEO, I send out updates to residents, families, staff to make sure they are informed and know what we are doing to keep everyone safe.”

Negative media coverage is also harming morale, as many articles and news segments praise hospital workers but take suspicious or critical approach to senior housing and care, the NIC post noted. This issue of media bias against senior housing and care was recently addressed in a column that appeared in The Hill, penned by NIC Founder Bob Kramer and Activated Insight’s Jacquelyn Kung.

Also in the news:

— The Senate on Tuesday passed a $484 billion relief package that includes $310 billion to replenish the Paycheck Protection Program (PPP) and $25 billion to support more Covid-19 testing. The House of Representatives is expected to vote on the package on Thursday.

The PPP was established as part of a previous $2 trillion stimulus package, and was meant to provide financial support to small businesses struggling to meet payroll, pay utilities and otherwise meet basic operating expenses. Senior living providers were among the businesses that rushed to tap the program, which was quickly depleted. As Congress has been negotiating over additional funding for it, the PPP has been a source of controversy. Due to certain exemptions, large chains were able to receive loans while small businesses were shut out. Shake Shack, a nationwide burger restaurant chain, returned its $10 million PPP loan.

The PPP has been one of the few options that senior living providers have for federal financial support in the midst of Covid-19. Industry groups such as Argentum and the American Seniors Housing Association (ASHA) have pushed repeatedly for senior living to receive allocations or at least guaranteed access to other funds, including $100 billion set aside for health care providers in the previous stimulus package.

Testing has also been an urgent need nationwide, and for senior living communities in particular. While some providers have been able to work with private labs to facilitate testing, there is still an acute shortage of tests, leaving providers with no means of knowing whether asymptomatic residents or workers have the virus.

— Older adults living at a senior living community in Massachusetts have become fed up with fellow residents who are not adhering to social distancing best practices, including by repeatedly leaving the property and interacting with people. In response, a group of residents is engaging in a form of “vigilante” enforcement. As reported in The Atlantic:

“For the sake of our community, we are taking a drastic step,” [resident Lucian] Leape wrote in an email obtained by The Atlantic. “With this notice, we are asking everyone to confidentially report … the name of any resident whose behavior appears to be a threat to our safety.” The group would then consult the reported resident to judge whether their behavior posed a threat and, if it did, urge them to stop. If the resident refused, the group would publish their name to the Brookhaven listserv so that other residents would know to avoid them.

— Confirmed Covid-19 cases in California assisted living communities have exceeded 850, according to data released by a state agency on Monday. That number includes both residents and staff who have tested positive, the Los Angeles Times reported.

Monday’s release was the first time that the Golden State has issued this data related to assisted living communities. Other states, including Massachusetts, are also pushing for more disclosure and reporting of Covid-19 within assisted living settings.

Nursing homes in California have logged more than 3,500 residents or staff testing positive, according to the LA Times. On a national basis, more than 1,300 nursing homes — or about 1 in 10 — has publicly reported a case of Covid-19, the Washington Post reported. The actual number is almost certainly higher, as it was just this week that the Centers for Medicare & Medicaid Services (CMS) mandated that nursing homes report all known Covid-19 infections.

Bulletin for Monday, April 20, 2020:

Assisted living providers are coming under increasing pressure to disclose all Covid-19 cases publicly, as nursing homes now are required to report cases to public health authorities and the Centers for Disease Control & Prevention (CDC).

In one example of the spotlight swinging to assisted living, Massachusetts is considering an emergency law that would require all assisted living communities, elderly housing communities and long-term care facilities to report on Covid-19 positive cases and deaths each day to public health departments. The health departments would then publish that information each day on the web.

The legislation is sponsored by Rep. Ruth Blaser of Newton, where an outbreak occurred at a Benchmark community. There, 18 residents diagnosed with Covid-19 had died as of April 15. Blaser praised Benchmark’s transparency in an interview with Wicked Local.

“Some facilities have shared the information, but not everyone has,” Balser said. “Benchmark Senior Living has been a model of transparency.”

Olathe, Kansas-based Bickford Senior Living is another provider taking steps to increase transparency. The provider has committed to displaying the number of active Covid-19 cases for each of its communities on that location’s website.

“In today’s uncertain times, we feel a responsibility to be straightforward as to how our Branches are being affected by COVID-19,” the provider wrote on its website in an April 19 update. “ … At Bickford Senior Living we will lead with transparency so you have the best information available as you make decisions for your loved one.”

On Monday, senior housing and care provider association LeadingAge lodged some concerns about the recently announced reporting mandate for nursing homes. Among the organization’s concerns are that providers might face additional reporting burdens as well as monetary penalties for failure to report, at a time when communities are experiencing staffing challenges and financial hardships.

Also in the news:

— Kindred Healthcare is cutting wages for some of its employees by 10%, and CEO Ben Breier is taking a 15% pay cut. The Louisville, Kentucky-based company’s RehabCare division is under financial pressure due to Covid-19, in part because senior living communities are curtailing group therapy or not allowing therapists into buildings, according to a memo obtained by Fox affiliate WDRB.

— Long-term care pharmacies are experiencing financial distress due to Covid-19, the Senior Care Pharmacy Coalition (SCPC) reported Monday. Average LTC pharmacy revenues dropped 15% or more in areas of the country hit hardest by Covid-19 last month, according to the coalition. The group is calling on the federal government to provide support and financial relief. Members of the SCPC serve about 850,000 people in nursing homes and assisted living communities each day.

Bulletin for Friday, April 17 – Sunday, April 19

Occupancy in the senior housing operating portfolio of Welltower (NYSE: WELL) has declined due to Covid-19, hitting 84.2% as of April 10.

That’s a drop from 85.4% as of March 27, the Toledo, Ohio-based real estate investment trust reported in a business update issued Friday.

Occupancy has been hardest hit in states with the most Covid-19 cases, such as New York, New Jersey, Massachusetts and Washington. The REIT anticipates further occupancy declines as “comprehensive move-in restrictions” are put in place in other markets.

The SHO portfolio incurred about $7 million in unanticipated expenses related to Covid-19 in March, and Welltower now expects that during the pandemic, expenses will rise by approximately 5% compared to the original budget.

So far this year, Welltower has completed nearly $400 million in pro rata acquisitions and joint ventures. The REIT has completed about $781 million in pro rata dispositions. That includes the $64 million disposition of an unconsolidated equity investment.

“Welltower’s primary focus is on the ongoing support of our operating partners through these unprecedented times,” Thomas J. DeRosa, chairman and CEO, stated in Friday’s press release. “We have made progress on the procurement and distribution of critical supplies, including PPE, and will continue to pursue all available options to further assist our operators throughout this pandemic. While the impact of COVID-19 on our industry remains uncertain, we remain committed to making informed decisions during these turbulent times which we believe will lead to the long-term success of the company.”

Other REITs, including New Senior (NYSE: SNR) and Healthpeak (NYSE: PEAK), also have reported slowdows in move-ins and declining occupancy rates in their portfolios.

Also in the news:

— Frontline staff in senior housing and care are doing heroic work and have urgent unmet needs, but they are being undercut by scorn from the media and inaction on the part of government officials.

That’s the take shared in an op-ed in The Hill, penned by Bob Kramer, founder and strategic adviser at the National Investment Center for Seniors Housing & Care (NIC).

Kramer co-wrote the piece with Jacquelyn Kung, CEO of Activated Insights, the work Great Place to Work group that handles the Best Workplaces in Aging Services rankings that appear in Fortune.

Activated Insights surveyed about 2,000 frontline workers in the last two weeks, and found 40% are experiencing “extreme personal hardships” and request “specific resources and support.” Many are their family’s only breadwinner due to layoffs of family members, and they are also contending with child care costs and needs. While on the job, they need more personal protective equipment (PPE) and other supplies.

“We as a public must press all our politicians to designate senior care as part of the health care continuum, prioritized for support and protection,” Kramer and Kung wrote. “Failure to do so is morally incomprehensible. Lastly, with the negative barbs aimed at senior care facilities, we must make sure each frontline hero feels affirmed and appreciated.”

— The White House addressed senior living in “Opening Up America Again,” a three-phased approach that state governors can use when deciding how to re-open businesses and otherwise relax rules put in place to limit the spread of Covid-19.

Visits to senior living facilities would only resume in phase three of the White House’s framework.

“While we appreciate the inclusion of recommendations for senior living communities in the White House’s newly released three-phase reopening plan, we also need to ensure proper attention is given to protecting our workers and residents both now and in phases to come,” stated James Balda, president and CEO of senior living industry association Argentum. “Which is why it is critical that significant efforts are undertaken to ensure sufficient PPE and rapid testing is widely available. It is the only way we will continue to successfully contain the virus among the most vulnerable population until a vaccine is available.

“Additionally, it is important to note that normal community operations were paused early in the Covid-19 crisis. The White House’s plan recommends continuing that pause until phase three; that underscores the critical need to secure added funding and resources for our communities. We’ll continue to see costs rise steeply during this time as we continue to care for the nation’s most vulnerable seniors.”

— The Centers for Medicare & Medicaid Services (CMS) is mandating that nursing homes report Covid-19 cases to state and local health departments, as well as the Centers for Disease Control & Prevention (CDC).

Bulletin for Thursday, April 16, 2020:

The Covid-19 pandemic has started to take a greater toll on senior living occupancy.

That’s according to new findings released by the National Investment Center for Seniors Housing & Care (NIC). Responding to a NIC survey that took place between April 1 and April 12, roughly one-third to one-half of operators reported a month-over-month decrease in occupancy.

More survey respondents reported decreased occupancy in this “Wave 2” survey, compared to a prior “Wave 1” survey conducted between April 24 and March 31.

Assisted living had the most striking change. In the Wave 1 survey, 29% of assisted living operators reported a decrease in occupancy versus one month prior. That number jumped to 54% reporting a monthly occupancy decline in the Wave 2 survey.

Likewise, more assisted living and independent living providers saw a slower pace of move-ins during the April 1 to April 12 time period, compared to the earlier period. Memory care bucked that trend, though.

A slowdown in leads/conversions was cited as the primary reason for a deceleration in move-ins, followed by a ban on move-ins implemented by the provider organization itself, and resident/family member concerns.

Other survey findings:

— Increasing overtime time hours is the most common strategy for mitigating workforce shortages, cited by 89% of respondents

— The three most common staff support measures in place are flexible work hours, remote work and additional paid sick leave

— Uncertainty and lack of construction labor are growing concerns with regard to development pipelines

Also in the news:

A new collaboration will enable more rapid Covid-19 testing for 1,500 assisted living, skilled nursing and long-term care communities in Ohio.

National Church Residences, Ohio Living, LeadingAge Ohio and Central Ohio Geriatrics announced the Post-Acute Regional Rapid Testing (PARRT) program Thursday. The program is being conducted in concert with various health departments in Ohio.

“A team of two technicians, including one skilled medical professional and an assistant, collects swabbed specimens at each site, then delivers samples securely packed in an ice chest to an Ohio Department of Health lab that turns around results within a day,” a press release stated. “The swab team, trained by The Ohio State University, is suited in full Personal Protective Equipment, including a fit-tested N-95 mask, face shield, gown, hair covering, shoe covers and gloves.”

— Dallas-based operator Capital Senior Living (NYSE: CSU) has fallen out of compliance with New York Stock Exchange listing standards. The company’s average global market capitalization over a consecutive 30-day period was less than $50 million and its shareholders equity was less than $50 million, while the average closing price of the company’s common stock was less than $1.00 over the 30-day period.

Capital Senior Living’s share price already had gone through several years of erosion and the company was in the midst of an operational turnaround when the Covid-19 crisis hit. Since then — like publicly traded senior living owners and operators across the board — its share price has taken further hits.

Capital Senior Living now has to submit a plan to the NYSE detailing how it will meet listing standards within 18 months. There will be no immediate impact on the listing of the company’s common stock or on its business operations.

— The Paycheck Protection Program (PPP) — a $350 billion fund to help small businesses maintain payroll in the midst of Covid 19 — has run out of money and stopped accepting claims. Senior living providers were among the many businesses that rushed to tap into the program after its rollout April 3. The U.S. Congress so far has not reached an agreement that would enable further funding.

— Fitbit has introduced new capabilities related to Covid-19. By accessing a new “Covid-19” tab, users gain access to a variety of information and resources, including the ability to book a virtual physician visit via the PlushCare service. Wearables like Fitbit have been a technology trend within the senior living space for several years.

Bulletin for Wednesday, April 15, 2020:

A PBS NewsHour segment that aired Tuesday looked at the contributing factors to why long-term care — notably assisted living and skilled nursing — are ideal incubators for a Covid-19 outbreak.

To date, more than 3,600 Covid-19 deaths in the U.S. can be traced back to assisted living and skilled nursing communities. David Grabowski, professor of health care policy at Harvard Medical School, cited a “perfect storm” of factors contributing to the spread: underfunding of nursing home services; porous models of accountability and oversight; and tight shared living quarters that make it easier for residents and staff who may be asymptomatic to spread the coronavirus.

Grabowski says the actual total is likely to be higher. The federal government is not tracking Covid-19 deaths in assisted living and nursing homes, and some states are not reporting anything while others are completely transparent.

Also in the news:

— Federal agencies are feeling growing pressure to begin tracking coronavirus infections and death in nursing homes, the Associated Press reports. The AP’s tally of Covid-19 deaths in nursing homes, based on media reports and state health agency data, is at 4,485.

Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma told reporters during a Wednesday conference call that there should be more reporting, a sentiment echoed by Grabowski.

“This is basic public health — you track this, you study it, and you learn from it,” he told the AP.

— CMS announced Wednesday that Medicare will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers, as part of the Trump administration’s efforts to expand coronavirus testing.

Through the duration of the national Covid-19 emergency, Medicare will pay laboratories $100 for high-throughput lab tests for increased testing capacity, faster results, and more effective means of combating the spread of the virus. This will benefit nursing homes which are vulnerable to a cluster outbreak. Verma called the announcement a “game changer” for nursing homes.

Bulletin for Tuesday, April 14, 2020:

The effort to ensure that senior living providers receive a share of the $100 billion CARES Act fund for health care providers has escalated, with Argentum and the American Seniors Housing Association (ASHA) laying out the case in an April 13 letter to Vice President Mike Pence.

Initially, Argentum and ASHA sought $20 billion to be reserved for senior living providers from the Public Health and Social Services Emergency Fund (PHSSEF). In the letter to Pence, they requested “significant funds” from the PHSSEF for the industry.

The letter cited findings from a third-party analysis, which determined that Covid-19 could cost senior living providers between $40 billion and $57 billion.

So far, $30 billion have been distributed from the PHSSEF, going primarily to hospitals and other providers that receive significant Medicare revenue. The next tranche to be distributed will go largely to Medicaid providers, federal officials have indicated.

ASHA President David Schless and Argentum President and CEO James Balda still hope that some PHSSEF money will be coming to senior living providers, they said In a joint interview with Senior Housing News last week.

Also in the news:

— Out of nearly 2,500 skilled nursing and assisted living facilities surveyed by health care improvement company Premier, 70% said they are not fully prepared to treat an increasing number of Covid-19 patients.

“In this next phase of the outbreak, states and health care providers are contemplating how they can best provide care for patients who need medical attention but are not critical care status,” John P. Sganga, SVP of Alternate Site Programs at Premier, said in a press release issued Tuesday. “Senior nursing and assisted living facilities can provide quality care for these patients, but this shift will increase their resource and supply needs, from PPE and tests to staffing.”

About 24% of facilities reported no N95 masks on hand, and most said their supply of surgical masks, isolation gowns and face shields will not last two weeks.

In addition, 48% of respondents said that staff attendance has become a challenge.

— OnShift is waiving fees associated with its OnShift Wallet solution, which allows senior living workers to access their wages prior to payday. OnShift Wallet is powered by PayActiv.

“We are incredibly grateful to our clients who are serving our nation’s most vulnerable and fragile population, the elderly,,” said Mark Woodka, CEO of OnShift, in Tuesday press release. “Building on our three-year partnership with PayActiv, we are able to provide additional support to these deserving people by offering greater access to their financial resources.”

So far this year, OnShift Wallet users have accessed more than $12 million in earned wages prior to payday.

— Brookdale Senior Living CEO Cindy Baier contributed the equivalent of more than two months’ salary to the company’s Associate Compassion Fund (ACF). All members of the executive team and some board members also have made donations from their compensation and/or paid time off, the Brentwood, Tennessee-based provider stated in a press release.

Baier earned a base salary of about $782,000 in 2018, according to the most recently available definitive proxy statement for the company. She became CEO in February of that year.

The provider has also expanded the criteria for receiving grants through the ACF.

Bulletin for Monday, April 13, 2020:

Senior living industry associations are urging the Small Business Administration (SBA) to increase providers’ access to the $350 billion Paycheck Protection Program (PPP).

The PPP was established through the CARES Act federal stimulus package, and offers forgivable loans to businesses with fewer than 500 employees. However, affiliation rules limit the ability of senior living providers to access these funds. Although a particular senior living community may employ fewer than 500 workers, that community may be affiliated with a larger operating company that exceeds the workforce eligibility threshold.

The CARES Act waived the affiliation rules for certain types of accommodation and food service businesses that are classified under NAICS codes beginning with 72. Argentum and the American Seniors Housing Association (ASHA) are urging SBA Administrator Jovita Carranza to make similar exceptions for senior living.

“For example, the description for NAICS code 623312, ‘Assisted Living Facilities

for the Elderly,’ is functionally equivalent to the description for NAICS code 721310, ‘Rooming and Boarding Houses, Dormitories, and Workers’ Camps,’” the associations wrote in an April 7 letter to Carranza. “The main difference between these two NAICS codes is that code 623312 is limited to residential services for the elderly.”

On April 12, the American Bankers Association reported that $205 billion of the $350 billion PPP already had been claimed. The Treasury Department has requested $250 billion more for the program, but Congress has not yet passed that additional funding.

Also in the news:

— Congressional lawmakers sparred over several issues of importance to senior living, including the production and distribution of personal protective equipment (PPE), the availability of funds through the Payroll Protection Program (PPP), and premium pay for workers deemed “essential” during the pandemic.

Late last week, the Treasury Department sought an additional $205 billion in funding for the PPP, but Democrats blocked that effort, wanting to include other provisions in the relevant bill. On Monday, Democratic leaders provided more details about what they are seeking, including more funding for PPE and Covid-19 testing.

“We Democrats demand adequate funding for the production and distribution of national rapid testing and Personal Protective Equipment (PPE) – it cannot wait,” Speaker of the House Nancy Pelosi and Senate Minority Leader Chuck Schumer wrote in a joint statement.

Also on Monday, Democratic Sen. Elizabeth Warren of Massachusetts and Democratic Rep. Ro Khanna of California released an “Essential Workers Bill of Rights,” which includes provisions that they would like to see included in the next Covid-19 financial stimulus and aid package. These provisions for workers deemed “essential” during Covid-19 include universal paid sick leave, access to child care and “premium pay.”

The premium pay should “provide meaningful compensation for essential work, be higher for the lowest-wage workers, and not count towards workers’ eligibility for any means-tested programs. It must be retroactive to the start date of the pandemic, and not used to lower the regular rate of pay for any employee,” the Bill of Rights states.

The Bill of Rights also calls for treating essential workers as “experts” and including them in developing plans for distribution of PPE.

Many senior living providers are already offering child care benefits and boosts to workers’ pay rates.

— The Internal Revenue Service (IRS) has extended deadlines relevant to real estate developers and investors. For taxpayers facing a deadline between April 1 and July 14 of this year to invest capital gains in an opportunity zone fund, the deadline now has been moved to July 15. And like-kind exchange deadlines that would normally fall between April 1 and July 14 also have been extended to July 15.

— Covid-19 outbreaks in assisted living communities could lead to more regulatory scrutiny and oversight in the future, according to a special report on seniors housing from Marcus & Millichap.

“The outbreak has illustrated how many communities are not positioned to provide additional levels of medical care, which could place the sector under scrutiny as oversight has historically been relaxed,” the report states.

Bulletin for Friday, April 10 – Sunday, April 12

The CARES Act federal stimulus package included a $100 billion fund for health care providers, and that money is now being disbursed — still with no guarantee that senior living providers will be among the recipients.

On Friday, payments began to be distributed to hospitals and other Medicare and Medicaid fee-for-service providers. They will receive the first tranche of payments, which will total $30 billion. The second tranche will be released within the next 10 days and will go largely to providers serving Medicaid beneficiaries.

Argentum and the American Seniors Housing Association (ASHA) have been urging the Department of Health and Human Services to allocate $20 billion of the fund for senior living providers. ASHA continues to call on members to contact their Congressional representatives, and is now urging more focus on getting access to the fund, versus pushing for a particular dollar amount.

ASHA President David Schless and Argentum CEO James Balda still believe that senior living providers could gain access to the CARES Act fund, they told Senior Housing News in a joint interview Friday.

“I have not lost hope that there will be funding in that grant program that our members will be able to take advantage of,” Schless told SHN.

The senior living industry is facing a potential financial hit in the range of $40 billion to $57 billion due to Covid-19, a recent analysis found.

The CARES Act also established a $350 billion forgivable loan program through the Small Business Administration (SBA), which is an option for smaller providers.

A fourth federal stimulus package is under discussion, which could provide another vehicle for the senior living industry to receive financial assistance.

Also in the news:

— In the first quarter of 2020, senior housing and care merger and acquisition activity fell to its lowest level in two years.

That’s according to the latest data from Irving Levin Associates, which showed 93 deals occurred in Q1 2020. This is the lowest level since Q1 2018 and well behind the pace of 2019, when 450 transactions were publicly announced and more than 600 were likely completed, Ben Swett wrote Friday on the Senior Care Investor.

In terms of deal breakdown, senior housing accounted for 62% of transactions closed in the first quarter of this year, compared with 38% for skilled nursing.

Considering that M&A activity was ongoing until Covid-19 reared its head in mid-March, the pandemic cannot account for all of the decline in deal volume, Swett noted.

On Thursday, the National Investment Center for Seniors Housing & Care (NIC) released data showing the rolling four-quarter cap rate for senior housing deals was at 5.9% in the fourth quarter of 2019, while the rolling four-quarter price-per-unit was $209,595.

Needless to say, Covid-19 has disrupted not only the volume of deals being completed but valuations, with senior housing among the property types to take a hit, perhaps as much as 30%, according to a Green Street Advisors analysis released last week.

— Industry associations are urging assisted living and skilled nursing providers to report all cases of Covid-19 to local health departments and other authorities, to support efforts to distribute personal protective equipment — which is in critically short supply.

“As reported cases of COVID-19 continue to increase, good data is more important than ever before in this pandemic,” said Katie Smith Sloan, president and CEO of LeadingAge. “We underscore our earlier recommendation to our nursing home members that reporting COVID-19 positive cases to their local health departments is paramount. With supplies of personal protective equipment and testing resources in extremely short supply nationwide, case numbers are a critical piece of information to help determine supply prioritization. We fully expect that consistent reporting of cases will lead to adequate and timely access to PPE and testing.”

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) is calling on long-term care providers to report Covid-19 cases to their state survey agency, as well as health departments, and all residents, families and staff.

“Today, AHCA/NCAL updated guidance to long term care providers about the need to notify their state survey agency about COVID positive residents and staff,” AHCA/NCAL President and CEO Mark Parkinson stated in a Saturday press release. “We encourage this information be shared with CMS, CDC and FEMA. We believe this information can help identify long term care providers who are most in need of testing and PPE resources.”

— The Centers for Medicare & Medicaid Services (CMS) proposed a $2.3% increase to the skilled nursing facility Medicare rate for 2021. The agency floated a 2.6% hike for hospice providers.

— More than 2,000 nursing home residents in the New York region have died of Covid-19, The New York Times reported.

— Aegis Living and the Clark Family Foundation have launched an initiative called Seattle Seniors Strong, in an effort to provide services and supports for the city’s population of homeless and homebound seniors as they face Covid-19 challenges.

Through May 31, Aegis and the Clark Family Foundation will be matching all donations by businesses and individuals, up to $50,000, to two organizations: Sounds Generations and Pike Market Senior Center.

— Architects with Bremerton, Washington-based firm Rice Fergus Miller suggest how Covid-19 could change senior living communities in the article “Designing for a Pandemic.” The authors contemplate ways to facilitate resident isolation when needed and create buildings that are more robust from an infection control standpoint.

— ATI Advisory, a research and consulting firm focused on health care and aging, has released a Covid-19 framework for post-acute care. The framework suggests a “four-stage, regionally oriented approach to achieving optimal, system-wide resource allocation across a region’s post-acute service settings and providers over time.” The Covid-19 crisis is changing the role that post-acute and senior care providers play within the health care system, as they are being called upon to take patients who otherwise might go to acute-care hospitals, and are under more pressure than ever to prevent residents from going to the emergency room or other settings where they could contract the novel coronavirus.

— Pen pal programs have sprouted up around the globe to connect residents of senior living communities with kids and teenagers, who are out of school due to Covid-19, The New York Times reported.

“It makes a connection between a younger person and an older person,” a 79-year-old Bickford Senior Living resident told the Times. “It’s interesting for me to hear what these young people are doing.”

Click here to see Covid-19 News Bulletins from previous weeks.

The effort to ensure that senior living providers receive a share of the $100 billion CARES Act fund for health care providers has escalated, with Argentum and the American Seniors Housing Association (ASHA) laying out the case in an April 13 letter to Vice President Mike Pence.

Initially, Argentum and ASHA sought $20 billion to be reserved for senior living providers from the Public Health and Social Services Emergency Fund (PHSSEF). In the letter to Pence, they requested “significant funds” from the PHSSEF for the industry.

The letter cited findings from a third-party analysis, which determined that Covid-19 could cost senior living providers between $40 billion and $57 billion.

So far, $30 billion have been distributed from the PHSSEF, going primarily to hospitals and other providers that receive significant Medicare revenue. The next tranche to be distributed will go largely to Medicaid providers, federal officials have indicated.

ASHA President David Schless and Argentum President and CEO James Balda still hope that some PHSSEF money will be coming to senior living providers, they said In a joint interview with Senior Housing News last week.

Also in the news:

— Out of nearly 2,500 skilled nursing and assisted living facilities surveyed by health care improvement company Premier, 70% said they are not fully prepared to treat an increasing number of Covid-19 patients.

“In this next phase of the outbreak, states and health care providers are contemplating how they can best provide care for patients who need medical attention but are not critical care status,” John P. Sganga, SVP of Alternate Site Programs at Premier, said in a press release issued Tuesday. “Senior nursing and assisted living facilities can provide quality care for these patients, but this shift will increase their resource and supply needs, from PPE and tests to staffing.”

About 24% of facilities reported no N95 masks on hand, and most said their supply of surgical masks, isolation gowns and face shields will not last two weeks.

In addition, 48% of respondents said that staff attendance has become a challenge.

— OnShift is waiving fees associated with its OnShift Wallet solution, which allows senior living workers to access their wages prior to payday. OnShift Wallet is powered by PayActiv.

“We are incredibly grateful to our clients who are serving our nation’s most vulnerable and fragile population, the elderly,,” said Mark Woodka, CEO of OnShift, in Tuesday press release. “Building on our three-year partnership with PayActiv, we are able to provide additional support to these deserving people by offering greater access to their financial resources.”

So far this year, OnShift Wallet users have accessed more than $12 million in earned wages prior to payday.

— Brookdale Senior Living CEO Cindy Baier contributed the equivalent of more than two months’ salary to the company’s Associate Compassion Fund (ACF). All members of the executive team and some board members also have made donations from their compensation and/or paid time off, the Brentwood, Tennessee-based provider stated in a press release.

Baier earned a base salary of about $782,000 in 2018, according to the most recently available definitive proxy statement for the company. She became CEO in February of that year.

The provider has also expanded the criteria for receiving grants through the ACF.

Bulletin for Monday, April 13, 2020:

Senior living industry associations are urging the Small Business Administration (SBA) to increase providers’ access to the $350 billion Paycheck Protection Program (PPP).

The PPP was established through the CARES Act federal stimulus package, and offers forgivable loans to businesses with fewer than 500 employees. However, affiliation rules limit the ability of senior living providers to access these funds. Although a particular senior living community may employ fewer than 500 workers, that community may be affiliated with a larger operating company that exceeds the workforce eligibility threshold.

The CARES Act waived the affiliation rules for certain types of accommodation and food service businesses that are classified under NAICS codes beginning with 72. Argentum and the American Seniors Housing Association (ASHA) are urging SBA Administrator Jovita Carranza to make similar exceptions for senior living.

“For example, the description for NAICS code 623312, ‘Assisted Living Facilities

for the Elderly,’ is functionally equivalent to the description for NAICS code 721310, ‘Rooming and Boarding Houses, Dormitories, and Workers’ Camps,’” the associations wrote in an April 7 letter to Carranza. “The main difference between these two NAICS codes is that code 623312 is limited to residential services for the elderly.”

On April 12, the American Bankers Association reported that $205 billion of the $350 billion PPP already had been claimed. The Treasury Department has requested $250 billion more for the program, but Congress has not yet passed that additional funding.

Also in the news:

— Congressional lawmakers sparred over several issues of importance to senior living, including the production and distribution of personal protective equipment (PPE), the availability of funds through the Payroll Protection Program (PPP), and premium pay for workers deemed “essential” during the pandemic.

Late last week, the Treasury Department sought an additional $205 billion in funding for the PPP, but Democrats blocked that effort, wanting to include other provisions in the relevant bill. On Monday, Democratic leaders provided more details about what they are seeking, including more funding for PPE and Covid-19 testing.

“We Democrats demand adequate funding for the production and distribution of national rapid testing and Personal Protective Equipment (PPE) – it cannot wait,” Speaker of the House Nancy Pelosi and Senate Minority Leader Chuck Schumer wrote in a joint statement.

Also on Monday, Democratic Sen. Elizabeth Warren of Massachusetts and Democratic Rep. Ro Khanna of California released an “Essential Workers Bill of Rights,” which includes provisions that they would like to see included in the next Covid-19 financial stimulus and aid package. These provisions for workers deemed “essential” during Covid-19 include universal paid sick leave, access to child care and “premium pay.”

The premium pay should “provide meaningful compensation for essential work, be higher for the lowest-wage workers, and not count towards workers’ eligibility for any means-tested programs. It must be retroactive to the start date of the pandemic, and not used to lower the regular rate of pay for any employee,” the Bill of Rights states.

The Bill of Rights also calls for treating essential workers as “experts” and including them in developing plans for distribution of PPE.

Many senior living providers are already offering child care benefits and boosts to workers’ pay rates.

— The Internal Revenue Service (IRS) has extended deadlines relevant to real estate developers and investors. For taxpayers facing a deadline between April 1 and July 14 of this year to invest capital gains in an opportunity zone fund, the deadline now has been moved to July 15. And like-kind exchange deadlines that would normally fall between April 1 and July 14 also have been extended to July 15.

— Covid-19 outbreaks in assisted living communities could lead to more regulatory scrutiny and oversight in the future, according to a special report on seniors housing from Marcus & Millichap.

“The outbreak has illustrated how many communities are not positioned to provide additional levels of medical care, which could place the sector under scrutiny as oversight has historically been relaxed,” the report states.

Bulletin for Friday, April 10 – Sunday, April 12

The CARES Act federal stimulus package included a $100 billion fund for health care providers, and that money is now being disbursed — still with no guarantee that senior living providers will be among the recipients.

On Friday, payments began to be distributed to hospitals and other Medicare and Medicaid fee-for-service providers. They will receive the first tranche of payments, which will total $30 billion. The second tranche will be released within the next 10 days and will go largely to providers serving Medicaid beneficiaries.

Argentum and the American Seniors Housing Association (ASHA) have been urging the Department of Health and Human Services to allocate $20 billion of the fund for senior living providers. ASHA continues to call on members to contact their Congressional representatives, and is now urging more focus on getting access to the fund, versus pushing for a particular dollar amount.

ASHA President David Schless and Argentum CEO James Balda still believe that senior living providers could gain access to the CARES Act fund, they told Senior Housing News in a joint interview Friday.

“I have not lost hope that there will be funding in that grant program that our members will be able to take advantage of,” Schless told SHN.

The senior living industry is facing a potential financial hit in the range of $40 billion to $57 billion due to Covid-19, a recent analysis found.

The CARES Act also established a $350 billion forgivable loan program through the Small Business Administration (SBA), which is an option for smaller providers.

A fourth federal stimulus package is under discussion, which could provide another vehicle for the senior living industry to receive financial assistance.

Also in the news:

— In the first quarter of 2020, senior housing and care merger and acquisition activity fell to its lowest level in two years.

That’s according to the latest data from Irving Levin Associates, which showed 93 deals occurred in Q1 2020. This is the lowest level since Q1 2018 and well behind the pace of 2019, when 450 transactions were publicly announced and more than 600 were likely completed, Ben Swett wrote Friday on the Senior Care Investor.

In terms of deal breakdown, senior housing accounted for 62% of transactions closed in the first quarter of this year, compared with 38% for skilled nursing.

Considering that M&A activity was ongoing until Covid-19 reared its head in mid-March, the pandemic cannot account for all of the decline in deal volume, Swett noted.

On Thursday, the National Investment Center for Seniors Housing & Care (NIC) released data showing the rolling four-quarter cap rate for senior housing deals was at 5.9% in the fourth quarter of 2019, while the rolling four-quarter price-per-unit was $209,595.

Needless to say, Covid-19 has disrupted not only the volume of deals being completed but valuations, with senior housing among the property types to take a hit, perhaps as much as 30%, according to a Green Street Advisors analysis released last week.

— Industry associations are urging assisted living and skilled nursing providers to report all cases of Covid-19 to local health departments and other authorities, to support efforts to distribute personal protective equipment — which is in critically short supply.

“As reported cases of COVID-19 continue to increase, good data is more important than ever before in this pandemic,” said Katie Smith Sloan, president and CEO of LeadingAge. “We underscore our earlier recommendation to our nursing home members that reporting COVID-19 positive cases to their local health departments is paramount. With supplies of personal protective equipment and testing resources in extremely short supply nationwide, case numbers are a critical piece of information to help determine supply prioritization. We fully expect that consistent reporting of cases will lead to adequate and timely access to PPE and testing.”

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) is calling on long-term care providers to report Covid-19 cases to their state survey agency, as well as health departments, and all residents, families and staff.

“Today, AHCA/NCAL updated guidance to long term care providers about the need to notify their state survey agency about COVID positive residents and staff,” AHCA/NCAL President and CEO Mark Parkinson stated in a Saturday press release. “We encourage this information be shared with CMS, CDC and FEMA. We believe this information can help identify long term care providers who are most in need of testing and PPE resources.”

— The Centers for Medicare & Medicaid Services (CMS) proposed a $2.3% increase to the skilled nursing facility Medicare rate for 2021. The agency floated a 2.6% hike for hospice providers.

— More than 2,000 nursing home residents in the New York region have died of Covid-19, The New York Times reported.

— Aegis Living and the Clark Family Foundation have launched an initiative called Seattle Seniors Strong, in an effort to provide services and supports for the city’s population of homeless and homebound seniors as they face Covid-19 challenges.

Through May 31, Aegis and the Clark Family Foundation will be matching all donations by businesses and individuals, up to $50,000, to two organizations: Sounds Generations and Pike Market Senior Center.

— Architects with Bremerton, Washington-based firm Rice Fergus Miller suggest how Covid-19 could change senior living communities in the article “Designing for a Pandemic.” The authors contemplate ways to facilitate resident isolation when needed and create buildings that are more robust from an infection control standpoint.

— ATI Advisory, a research and consulting firm focused on health care and aging, has released a Covid-19 framework for post-acute care. The framework suggests a “four-stage, regionally oriented approach to achieving optimal, system-wide resource allocation across a region’s post-acute service settings and providers over time.” The Covid-19 crisis is changing the role that post-acute and senior care providers play within the health care system, as they are being called upon to take patients who otherwise might go to acute-care hospitals, and are under more pressure than ever to prevent residents from going to the emergency room or other settings where they could contract the novel coronavirus.

— Pen pal programs have sprouted up around the globe to connect residents of senior living communities with kids and teenagers, who are out of school due to Covid-19, The New York Times reported.

“It makes a connection between a younger person and an older person,” a 79-year-old Bickford Senior Living resident told the Times. “It’s interesting for me to hear what these young people are doing.”

Click here to see Covid-19 News Bulletins from previous weeks.

Companies featured in this article:

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