Senior Housing News recognizes the seriousness of the Covid-19 pandemic, so we will be periodically updating this bulletin to keep you apprised of 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@example.com with news items, topics that you believe are important for coverage, or other feedback.
Bulletin for Oct. 1, 2020:
As the Covid-19 pandemic stretches on, senior living operators are turning more to agency staff and are offering more rent concessions.
These are among the findings of the latest Executive Insights Survey from the National Investment Center for Seniors Housing & Care (NIC).
NIC has been conducting these surveys on a regular basis since the early days of the pandemic, and on Thursday released findings from its 12th wave of the survey. Responses for this wave were collected between Sept. 15 and Sept. 27, from owners and executives of 67 senior housing and skilled nursing operators across the country.
One notable finding: About half of Wave 12 respondents reported that their organization is offering rent concessions, compared to 34% of respondents offering concessions as of Wave 10.
Over the last few months, some provider executives have warned that rent concessions are a dangerous way to rebuild occupancy, and have urged their colleagues to hold the line on rate. Concessions can help boost raw occupancy numbers but without substantial improvements to net operating income (NOI), and some industry leaders fear that concessions send the wrong message to consumers about the value of the services provided.
An increase also has occurred in the proportion of respondents who said their company is utilizing agency staffing. In Wave 12, 57% reported using agency or temp staffing, compared to 36% in Wave 3 of the survey.
The survey included positive findings related to the availability of PPE and Covid-19 testing. Nearly 60% of respondents said they are having little difficulty obtaining PPE — up from 27% in Wave 10. And progress continues to be made on getting test results back more quickly, with 43% saying their results were arriving within two days. And although 57% of respondents said that results are taking three or more days, that is a decline from 87% who reported this timeframe in Wave 10.
— The latest version of federal Heroes Act legislation, introduced this week, does not include funding for health care worker premium pay. This is an “unfortunate” omission, LeadingAge stated in its response to the bill. The provider group did praise some components, such as $500 million for an affordable housing provision, but President and CEO Katie Smith Sloan pleaded to lawmakers, “Please, reach a deal that should have been made months ago.”
— NIC is partnering with NORC at the University of Chicago on a research project to study how Covid-19 affected older adults in various senior housing and care settings, and in traditional residential settings.
“The health and housing sectors must better understand the incremental impact of Covid-19 in senior housing and care relative to a similar population in traditional residential settings in the context of what was known about the spread of the disease, local regulations, testing, and other factors,” stated NIC President and CEO Brian Jurutka. “This study will seek to understand the impact of the disease by care setting and identify lessons learned to ultimately benefit older Americans by informing operators, investors, and policy makers.”
— The Centers for Medicare & Medicaid Services (CMS) has created a quick-start guide for how providers can gain Clinical Laboratory Improvement Amendments (CLIA) certification. CLIA certification is needed to administer the Abbott BinaxNOW rapid test that the federal government is distributing to assisted living providers.
— Rendever has launched a platform — called EnvisionHome — to enable senior living providers to offer community tours using virtual reality.
“Staff are equipped with a touchscreen tablet and a set of VR headsets – all of which are networked together so the staff member is in full control of the tour,” a press release stated. “Rendever’s platform also allows staff to see where family members or patients are looking in real time in order to tailor discussions toward features they find most interesting, according to the company.”
Bulletin for Friday, Sept. 18 – Sunday, Sept. 20:
The U.S. Department of Health and Human Services (HHS) shipped Covid-19 rapid antigen testing kits to assisted living and skilled nursing facilities this week, the department announced during a webinar on Friday, September 18.
The kits, developed by Abbott Laboratories, were sent to 12,000 sites across the country. There are about 5,400 assisted living communities in the country that have the CLIA waivers needed to receive the tests, LeadingAge noted in a Sept. 18 brief.
Pharmaceutical giant Abbott last month received a $760 million contract to deliver 150 million rapid, Abbott BinaxNOW COVID-19 Ag Card Point of Care (POC) SARS-CoV-2 diagnostic tests to long-term care facilities, schools and home health care providers caring for seniors and others with special needs.
The kits provide results in 15 minutes, and are authorized for emergency use by the Food and Drug Administration (FDA).
HHS prioritized nursing homes in counties where Covid-19 positivity rates are 10% or higher, and between 5% and 10%. Facilities in the former were sent enough kits to test staff twice a week, while providers with lower positivity rates were sent enough to test weekly. Additionally, assisted living facilities in counties where positivity rates are less than 5% were sent kits. HHS plans to send replacement kits to communities through December.
Also in the news:
— Kaiser Health News reports on older adults who are reconsidering moves to senior living communities due to Covid-19: “Kim Beckman, 64, and her husband, Mike, were ready to give up being homeowners in Victoria, Texas, and join a 55-plus community or rent in an independent living apartment building in northern Texas before COVID-19 hit. Now, they’re considering buying an even bigger home because ‘if you’re going to be in the house all the time, you might as well be comfortable,’ Beckman said.”
— Capital Senior Living (NYSE: CSU) is distributing tablets across its portfolio of about 120 communities, in an initiative coinciding with National Assisted Living Week and furthering virtual programming developed during the pandemic.
“We could not think of a better way to honor our residents, hard-working staff and communities than to help facilitate better communication during Covid-19 and into the future,” stated COO Brandon Ribar. “While we had already been facilitating virtual communication between our residents and their families as well as amongst potential future residents, additional tablets will increase opportunities for our residents to stay close to their loved ones. And, it helps our staff ensure a connection for our residents.”
— Sanitizer dispenser mats, touchless visitor management systems, and smart surfaces incorporating antimicrobial materials are among the potential infection mitigation tools highlighted in a new report on retrofitting senior living communities for better infection control, from Erdman Insights and Charter Senior Living.
Bulletin for Wednesday, Sept. 16:
National Health Investors (NYSE: NHI) in September collected 96.6% of rent owed by tenants, while deferring 2.9% — including 2.6% related to a previously disclosed deferral — to its largest tenant, Olathe, Kansas-based Bickford Senior Living. The remaining balance relates to forecasted revenue that NHI expected to get from properties transitioned before the pandemic, the company said in a business update Wednesday.
Bickford’s total average occupancy hit 81.7% in August, with a same-store occupancy of 83.3%. Another large NHI tenant, Winter Park, Florida-based Holiday Retirement, logged 79.6% occupancy in the same month.
NHI also announced a newly finalized rent deferral agreement with another tenant that it had previously disclosed as being in negotiations. The deferral represents about $560,000 in each of the third and fourth quarters of this year, and up to about $450,000 in the first quarter of 2021.
NHI does not expect deferral amounts will exceed 1.7% of contractual rent in any month, and the amounts deferred will accrue interest at an initial rate of 8%. Tenants are scheduled to commence repayment in July, 2021, with an expected timeline for repayment of as many as 18 months.
Also in the news:
— Senior living industry association Argentum said Wednesday that the U.S. Dept. of Health and Human Services (HHS) has begun shipping rapid point-of-care antigen tests to senior living communities. Some communities have already received the tests, and Argentum expects shipments will continue through Dec. 20. HHS is prioritizing providers based on epidemiological Covid-19 hotspot data from the CDC, and thus far, only communities with Clinical Laboratory Improvement Amendments (CLIA) waiver certificates are slated to receive them.
Bulletin for Tuesday, Sept. 15:
The occupancy rate for majority assisted living communities hit another record-low level, falling to 79.5% in August across the primary markets tracked by the National Investment Center for Seniors Housing & Care (NIC).
That’s a decline of 5.7 percentage points on a three-month rolling basis, according to the latest intra-quarterly snapshot report from NIC.
Assisted living occupancy has been falling since the Covid-19 pandemic reached the United States in the spring, but August did see a new development: For the first time during the pandemic, assisted living occupancy declined at a slower rate than independent living occupancy. Majority IL properties experienced a 0.8 percentage point decline, versus 0.6 percentage points for majority AL properties.
However, occupancy trends varied from market to market.
For instance, Tampa experienced the steepest drop in independent living census in August, among the NIC primary markets, posting an 82.5% occupancy rate. Sacramento, by contrast, saw IL occupancy tick up slightly to 87.6%.
— Spot occupancy across the senior housing operating portfolio (SHOP) of real estate investment trust Ventas (NYSE: VTR) was 79.8% as of Sept. 10, according to a company presentation. Move-ins and leads trended higher in August than in July, but Ventas still anticipates that sequential same-store occupancy will be lower in Q3 2020 than in Q2 2020. As of August, average monthly operating expenses were trending about 3% lower versus what they were in the second quarter. On the triple-net lease portfolio, the REIT expects to address two additional tenants, at which point the company will have addressed 70% of operators in an effort to improve coverage and respond to pandemic-related challenges.
— Occupancy declined 50 basis points in August to reach 83.9% across the portfolio of New York City-based real estate investment trust New Senior Investment Group (NYSE: SNR). As of Sept. 14, the REIT’s operators reported seven currently active Covid-19 cases across seven communities, according to a presentation posted Tuesday. New Senior’s portfolio consists of 102 independent living assets and one triple-net leased asset.
— The federal government has purchased 150 million Covid-19 antigen tests and within the next two to three weeks will begin distributing them to long-term care providers, including assisted living communities, according to a Tuesday update from Argentum. The industry group also sent a letter to Health and Human Services Secretary Alex Azar outlining recommendations related to testing policies and plans, including the need for providers to have a CLIA certificate of waiver, as well as the potential to test family members of residents.
“Protecting older adults from Covid-19, as well as the employees who care for them, needs to be among the highest priorities in final testing plans, with a number of objectives in mind,” Argentum President and CEO James Balda stated. “We have made clear that these plans should consider not only residents and staff, but also family members, to allow for the opportunity for socialization that has been so critically lacking over the past six months. Final plans should also account for financial reimbursement, utilization guidance, state guidance, and legal protections, among other considerations.”
— OnShift has added OnShift Time to its human capital management platform. The new time and attendance software will give senior living providers the ability to eliminate time clocks, saving labor-related costs while enhancing infection control.
“The pandemic has unfortunately had a devastating impact on healthcare providers, employees and those they serve,” said OnShift CEO Mark Woodka. “With the addition of OnShift Time to our portfolio of workforce solutions, we are giving providers even more capabilities to help them battle Covid-19. We continue to partner with our customers and other providers to keep their communities safe. We are in this together.”
— “We are deeply concerned that there has been no visible progress on negotiations for the next coronavirus legislation, much less an agreed-upon legislative vehicle. For the people we represent – nonprofit aging services providers including nursing homes, home health, assisted living, hospice, home and community-based services providers, and affordable senior housing – this crisis is not over,” LeadingAge President and CEO Katie Smith Sloan wrote in a Sept. 15 letter to Congressional leaders. The letter also lays out the organization’s key requests, including that the next Covid-19 relief package includes funds for “premium pay” for essential workers, and expanding the Paycheck Protection Program (PPP) to organizations of all sizes.
Bulletin for Monday, Sept. 14:
The Covid-19 pandemic has had a mixed effect on senior housing construction costs, with labor still tight but reductions in some material costs and subcontractor pricing.
That’s according to the Summer 2020 Senior Living Cost Brief that general contractor, construction and design firm The Weitz Company prepared for the American Seniors Housing Association (ASHA).
Despite massive layoffs in other industries, Weitz has not seen an influx of new workers into the construction trades. Labor costs therefore have not moderated due to the pandemic; most union contracts cover multiple years and have set increases, and a recent survey showed two-thirds of construction companies plan to give raises in 2020, the brief stated.
Lumber and steel prices have substantially fallen in the last 18 months, but managing deliveries to job sites has become more complicated due to the pandemic, creating longer lead times. Subcontractors appear to be “nervous about the future” and therefore filling their backlogs.
“Pricing varies depending on location. Some areas have seen inflation go flat while others are still seeing increases, however at a lower rate than previous years,” the Weitz report stated. “ … Over the past several years we have seen the annual inflation rate in the 4-7% range depending on the market area, however now we are seeing rates in the 2-4% range.”
Most construction projects are proceeding and adapting to pandemic working conditions, although renovation projects on active campuses are mostly shut down, according to the brief. New developments are mostly moving forward under the assumption that a vaccine will be available before construction commences, although some projects have been paused or are going to a phased approach.
— Private-pay assisted living providers now have until Monday, Sept. 21 to file for relief funding from the U.S. Department of Health and Human Services (HHS).
“We appreciate HHS’s efforts and working with us to extend the deadline for applications,” Argentum President and CEO James Balda stated. “Argentum requested this extension to be sure all qualified assisted living providers had the opportunity to apply for much-needed funding. The funds will go a long way in helping providers who’ve seen skyrocketing costs as a result of Covid-19.”
— Occupancy in the senior housing operating (SHO) portfolio of real estate investment trust Welltower (NYSE: WELL) declined about 60 basis points in August, to 78.8%, according to a presentation that the company prepared for the Evercore ISI Real Estate Conference. The REIT expects Q3 2020 SHO expenses to be approximately flat with Q2 2020 expenses, as labor costs moderate but costs related to community reopenings, insurance and utilities increase.
Bulletin for Tuesday, Sept. 8:
A new analysis from the National Investment Center for Seniors Housing & Care (NIC) is shedding light on what senior living residents are paying in rates amid the Covid-19 pandemic.
Average initial rates for residents moving into independent living, assisted living and memory care units were largely below average asking rates, NIC reported Tuesday as part of its ongoing Actual Rates Initiative. The initial data set includes 25 to 30 senior living operators representing more than 2,500 properties and 300,000 units.
NIC found that, among providers in three metropolitan markets the NIC Map Data Service covers — Atlanta, Philadelphia, and Phoenix — Atlanta saw the highest discount for memory care segment units in initial rates relative to asking rates, with a discount in April 2020 equalling 2.7 months at an annualized basis. That represents the largest recorded discount of initial memory care rates in Atlanta since the beginning of 2017, according to NIC.
In Phoenix, memory care units also reached their highest recorded discount for initial rates, hitting 2.6 months in June on an annualized basis. In Philadelphia, providers ended the quarter with a 0.4-month annualized discount.
Click here to access more highlights from the new analysis.
Also in the news:
— A new report from national research organization PHI found that the residential care aide workforce — including those who help older adults in small group homes, assisted living communities and other residential care settings — are continuing to struggle with low wages, making on average just 42 cents more than they did one decade ago. The new report comes as direct care workers throughout the U.S. deal with Covid-19 in their places of business.
— NIC is also now offering a limited number of complimentary seats to its all-virtual 2020 Fall Conference. The benefit is currently available for senior housing and care workers who are unemployed, and those interested can apply for tickets here before Sept. 14.
Bulletin for Sept. 3, 2020:
As senior living communities increasingly move toward operating models that prioritize residents’ holistic wellness, architectural and design elements can play an important role.
Such are the findings from architecture firm Perkins Eastman, which surveyed more than 540 residents of three nonprofit communities that recently underwent construction and/or renovation projects with wellness goals in mind.
“As we fight through the pandemic and enter a post-COVID world, we will continue to seek to understand how design impacts wellness, and how we can affirm why older adults would choose a senior living community over staying at home,” Perkins Eastman researchers wrote in a new white paper with the survey findings. “It is clear that some design strategies may alter or be temporarily altered in times of infection, but it is also clear how valuable these strategies are for creating a path for healthy aging.”
The white paper highlights several design strategies that are meant to promote wellness. One example is “patterns of movement.” Designs can strategically mix “targeted routes” that enable residents to travel from Point A to Point B in an efficient manner, as well as “pleasant routes” that encourage enjoying views or facilitate spontaneous social engagement. At one community involved in the study — MonteCedro in Altadena, California — the auditorium and theater anchor either side of an open dining area and lobby, making it easier and more natural for residents to congregate and socialize after attending an event.
In the survey, 88% of residents said a casual dining area provided “good” to “very good” opportunities for socializing, and 92% of respondents said the built environment overall provides “good” to “excellent” support of social/emotional wellness.
“Overall, across the three communities we evaluated, residents’ perceptions of their physical, social/emotional, and intellectual wellness positively increased or held steady after they began using the new or newly renovated spaces at their community,” the white paper authors wrote.
Also in the news:
— While senior living providers reported little change in the pace of move-ins and move-outs in the past 30 days, they also reported a notable spike in resident or family member concerns as an impediment to move-ins, according to the latest Executive Insights survey findings from the National Investment Center for Seniors Housing & Care (NIC).
Bulletin for Sept. 1, 2020:
Covid-19 infections and deaths in assisted living communities increased between June and August, according to data analyzed by the Kaiser Family Foundation.
A minority of states report on Covid-19 infections and deaths in assisted living, with less than half of all states reporting cases and fewer reporting deaths, KFF noted. However, the 18 states that do report on Covid-19 in assisted living had logged a total of 22,080 cases among AL residents and staff members as of early August.
Out of this group of states, 14 had reported this information in June as well as August. Comparing those months revealed the number of cases among residents and staff increased 66%.
The increase in staff infections is linked to the general spread of Covid-19 in a given geography. Four of five states with the largest increases in staff infections — California, Florida, Nevada and South Carolina — have also been hotspots for community spread.
The data related to deaths also showed an increase.
“Among the 10 states that reported deaths in both June and August, the total number of deaths increased by 59% from 1,483 to 2,356 deaths in early August,” KFF reported. “The majority of reported COVID-19 deaths are among assisted living facility residents (2,257); a relatively small number represent deaths among staff (99).”
Also in the news:
— Assisted living communities will be among the recipients of point-of-care Covid-19 antigen tests being distributed by the federal government, HHS Assistant Secretary for Health Brett P. Giroir said Tuesday during a call with press. The Trump Administration recently announced an initiative to distribute 150 million rapid tests across the country, with a major goal to support school reopenings.
— Sabra Health Care REIT (Nasdaq: SBRA) saw occupancy decline 117 basis points in its leased senior living portfolio and 479 basis points in its managed senior living portfolio between February 2020 and August 15, 2020, according to an investor presentation filed Tuesday. The REIT collected all its forecasted rents through August.
Bulletin for August 18, 2020:
In the second quarter of 2020, occupancy declined to 76% for the 55 assisted living communities in the portfolio of Toledo, Ohio-based health system ProMedica.
That compares to occupancy of 80% at this time last year, according to financial disclosure documents filed on Aug. 13.
The assisted living communities are part of a larger portfolio of skilled nursing, home health and hospice services formerly operated by HCR ManorCare. ProMedica acquired the portfolio in 2018 as part of a joint venture with real estate investment trust Welltower (NYSE: WELL), also based in Toledo.
Skilled nursing occupancy took a bigger hit in Q2, dropping to 76% from 80% a year ago.
The entire ProMedica system — which includes 13 hospitals and employs more than 49,000 staff — took a hit from Covid-19. However, government financial support helped buoy its results, including an operating margin of 10.8%, as the Toledo Blade first reported. The system also posted quarterly operating income of $189.4 million, compared to an $18.1 million loss in Q2 2019.
Other senior living companies also took pandemic-related hits to occupancy last quarter. The nation’s largest provider, Brookdale Senior Living (NYSE: BKD), reported second quarter occupancy of 76.6%.
Also in the news:
— Murfreesboro, Tennessee-based real estate investment trust National Health Investors (NYSE: NHI) collected 95.3% of contractual rent in August, with 4.2% deferred and the balance related to forecasted revenue that the REIT expected to glean from transitioned properties prior to Covid-19. A previously announced deferral for tenant Bickford Senior Living accounted for 2.5% of the August deferred rent, according to a business update issued Tuesday.
— Connecticut’s long-term care facilities were hard hit by Covid-19, but assisted living fared notably better than nursing homes. Only 3% of assisted living communities had outbreaks affecting more than 50% of residents, and 37% of assisted living communities had zero cases and deaths, according to a newly released interim study commissioned by the state. About 26% of Connecticut nursing homes had outbreaks affecting at least 50% of residents.
Bulletin for July 31:
Industry associations ASHA, Argentum, AHCA/NCAL and LeadingAge are assisting the U.S. Department of Health and Human Services (HHS) in collecting information for a possible financial relief package for senior living providers.
The groups are encouraging all private-pay assisted living and memory care providers — either standalones or part of CCRCs, members of the organizations or not — to submit information through a private, secure data collection portal by 5 p.m., eastern, on Monday, Aug. 3.
The groups stressed there is no guarantee the government will ultimately distribute funds to the senior living industry, and providers that submit information are not guaranteed to receive assistance. The call for information from senior living providers comes just one week after HHS announced plans to send an additional $5 billion to skilled nursing facilities in the U.S.
Also in the news:
— A new study from The Green House Project and University of North Carolina researcher Sheryl Zimmerman found that 95% of Green House homes reported no cases Covid-19 among residents or staff between February and June. The study lends hard evidence to the fact that Green House homes have had better clinical outcomes than their skilled nursing counterparts.
— New executive survey data from the National Investment Center for Seniors Housing & Care (NIC) found that surveyed operators, on average, have tested 18.5% of their independent living residents, 41.7% of their assisted living residents and 45.7% of their memory care residents. The results are based on responses from 52 senior housing and care operators between July 6 and July 19.
— Senior living software firm PointClickCare has partnered with DrFirst to bring the Backline communications platform, which includes telehealth, to long-term care providers across North America.
— Allbridge is teaming up with K4Connect to deliver the senior living software firm’s K4Community solution to senior living operators, and give its customers access to the K4Community Team Hub management tool.
Bulletin for July 23:
A majority of like voters in the 2020 U.S. elections are in favor of federal financial assistance to support senior living providers during Covid-19.
A national survey of likely voters revealed that 80% approve of emergency funds flowing to senior living, according to the findings released Thursday by industry association Argentum. The survey was conducted by McLaughlin & Associates.
The support for senior living financial relief was largely consistent across party lines, with 83% of Republican voters in favor, 81% of Democatic voters in favor and 77% of independent voters in favor.
Nearly 60% of voters disapprove of the fact that senior living communities have not received provider relief funds, and 76% said they would be more likely to vote for a candidate who supports increased funding.
Furthermore, 71% of survey respondents said they have a favorable opinion of senior living communities, and 48% said they had or have a loved one who resides in senior living.
“These past few months, Covid-19 has significantly impacted the residents and staff of our nation’s senior living communities, with many communities having to scramble to procure supplies and protective equipment and support increasing staffing needs, costs, and operational changes — all without federal funding,” said James Balda, president and CEO of Argentum.
The survey results were released one day after the federal government announced a $5 billion round of funding for nursing homes.
Also in the news:
— Nearly 79% of in-place staff had been tested for Covid-19 as of June 30, with a confirmed positive test rate of 5.2%, according to NIC survey data from 52 senior housing and skilled nursing providers.
— “After seeing the heart wrenching images of nursing home residents desperately trying to connect with their families perched outside their windows during Covid-19 and learning about the many deaths in those facilities, it’s quite likely that there will be a sea change in how and where the oldest Americans will live out their lives once the pandemic subsides,” Next Avenue contributor Bart Astor wrote in “After Covid-19: What Housing For America’s Oldest Could Look Like.”
— Dedicated “Skype rooms,” concierge wings, more compartmentalized layouts and Passive House principles are likely senior living community design trends likely to take hold as a result of Covid-19, according to architects interviewed by Archinect.
— A group of senior living design professionals has founded the Ageless Living Collaborative, dedicated to creating “optimal outcomes” for residents of senior living communities and other types of housing. “The first initiative of ALC is a webinar discussion on isolation, and how we can do better in combating that feeling that is challenging seniors every day, and especially during this time of COVID/post-COVID,” said Phoebe Stein, president of Olive Presents and a founding collaborator.
Bulletin for July 22:
The Department of Health and Human Services (HHS) plans to send an additional $5 billion to skilled nursing facilities in the U.S.
The funding will go to Medicare-certified long-term care facilities and state veterans’ homes, according to the Centers for Medicare & Medicaid Services (CMS). Providers could use the money for things like hiring additional staff, increasing testing, and implementing technology that virtually connects residents to their loved ones.
The new $5 billion in relief funds come after other rounds of help for nursing homes authorized under the $2 trillion CARES Act coronavirus stimulus package. Past assistance has included relief based on Medicare and Medicaid reimbursements and a prior $4.9 billion disbursement that was also dedicated exclusively to skilled nursing facilities.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) applauded the move, but noted that the latest relief package fell short of the industry organization’s request to add $100 billion to industry relief efforts.
“While this funding is a significant step forward, it is equally important for Congress to provide an additional $100 billion for the HHS Provider Relief Fund, which is accessible to all health care providers impacted by Covid-19,” stated Mark Parkinson, president and CEO of AHCA/NCAL. “And, that a sizeable portion of the fund be dedicated to helping both nursing homes and assisted living communities to cover the enormous costs associated with protecting vulnerable residents and staff from the virus.”
Read more about the new relief package on Skilled Nursing News.
Also in the news:
— The National Investment Center for Seniors Housing & Care (NIC) has issued a request for proposal for a national study that would focus on the impact of the pandemic on older adults.
The study’s purpose is to analyze how Covid-19 impacts deaths, mental health, mobility and functional impairment among senior housing and skilled nursing residents, and then compare the findings to people of similar age and health in non-senior housing settings.
NIC expects to award the research contract in September, with results as early as next March.
Bulletin for July 20:
Senior housing and care providers in Florida are reporting monthly operating losses in the range of $100,000 a month to as high as $3 million a month, according to a situation report released Monday by LeadingAge Florida.
“Many aging care providers are struggling to keep up, and they’re hurtling towards a fiscal cliff,” said Steve Bahmer, president and CEO of LeadingAge Florida. “The only hope we have of getting ahead of this is repeat, rapid, routine testing. The need is not going down and costs are not coming down, so federal resources are absolutely necessary.”
The provider association sounded the alarm as Covid-19 cases have surged of late in the Sunshine State. Currently, new cases are being reported at a rate of 12,000 a day, compared with about 2,000 new cases per day in June. Over 3% of nursing home and assisted living residents — representing more than 4,500 individuals — have been infected. And, 3.5% of nursing home and assisted living staff have been infected.
There have been 2,343 deaths of long-term care residents and staff in Florida, according to the report.
LeadingAge Florida sent a letter to the state’s U.S. Senators Marco Rubio and Rick Scott, urging them to “harness federal resources” to aid the state’s long-term care providers. At the national level, LeadingAge and a group of industry associations sent letters to the White House and Congress, saying they should prioritize support to senior living providers.
“Senior living operators are proud to be playing a critical role in helping to ‘flatten the curve’ and avoid further burdening our nation’s hospitals during this crisis,” the letter states. “However, these extraordinary efforts are leading to significant financial stress, largely due to enhanced infection control measures, acquiring personal protection equipment (PPE) and related supplies, COVID-19 testing, additional staffing and incentives, and loss of revenue associated with halting new residents moving into the communities.”
Leaders with Argentum, LeadingAge, the National Center for Assisted Living (NCAL) and the American Seniors Housing Association (ASHA) co-signed the letter. They requested several specific actions, including:
— Increased funding through Public Health and Social Services Emergency Fund
— An expansion of the Paycheck Protection Program (PPP) to allow more senior living providers to access these forgivable loans to meet labor-related costs
— Including senior living workers in any proposal to increase essential worker compensation through “hero pay” allocations
The associations also pressed for priority access to PPE, rapid diagnostic and non-diagnostic Covid-19 test, and priority access to a vaccine when one becomes available.
These associations have been pushing federal policymakers for months to increase support to private-pay senior living providers, but such support has been scarce compared to other health care sectors such as nursing homes and hospitals.
Senior living providers are continuing to face “skyrocketing costs” and “disrupted operations,” Argentum President and CEO James Balda said in an emailed statement to Senior Housing News.
“Lives and livelihoods are depending on this essential federal support,” he said.
Also in the news:
— With the Covid-19 pandemic casting uncertainty over operations and seizing up the capital markets, the number of publicly announced senior housing and care deals dropped to seven-year low of 59 in Q2 2020, according to data released Monday by Irving Levin Associates. That’s a 50% year-over-year decline. Two large Welltower (NYSE: WELL) transactions accounted for about 60% of the quarter’s spending total of $1.35 billion. Private senior care providers accounted for about 50% of Q2 buyers, with REITs representing 25% and private equity firms making up 14%. About 44% of deal volume was related to skilled nursing transactions.
— Brookdale Senior Living (NYSE: BKD) touted the efficacy of consistent assignment in helping to manage Covid-19 in memory care settings. “Consistent assignment and the continued development of care partnerships between our associates and residents is the magic that enables us so often to identify early, very subtle symptoms of this horrible virus,” Juliet Holt Klinger, senior director of dementia care and programs, wrote in a blog post. “We are able to notice signs unique to that person that tell us when things may be just a little off, when their eyes reflect a change, when the smile is a little less robust, the handhold a little more weak.”
— Demand for robots to aid with service and cleaning tasks is up in a variety of industries, including senior living, due to Covid-19, Bisnow reported.
— Penn Medicine will receive funding to help long-term care communities in Pennsylvania with Covid-19 readiness and response planning, the Daily Pennsylvanian reported. “Selected facilities will be collectively awarded $175 million and will focus on improving quality and continuity of care, as well as on expanding COVID-19 testing to asymptomatic staff and residents and continuing services in an attempt to mitigate the spread of the virus,” the article stated.
Bulletin for July 17 – 19
Artis Senior Living has partnered with Johns Hopkins physicians and others to launch the Artis Safety Council, to enhance Covid-19 response and take proactive steps to meet other potential community health issues.
“We are proud of this exciting partnership with a truly world-class organization like Johns Hopkins,” Donald E. Feltman, Artis Senior Living President and CEO, said in a July 16 press release. “Our commitment to our residents, their families and our staff is at the heart of what we do. Their safety today, and always, is a top priority.”
Members of the council include Michele Bellantoni, M.D., an Associate Professor of Medicine in the Division of Geriatric Medicine and Gerontology at The Johns Hopkins University School of Medicine; Morgan Jane Katz, M.D., an Assistant Professor of Medicine at The Johns Hopkins University School of Medicine and a member of the independent Coronavirus Commission for Safety and Quality in Nursing Homes that will be advising the Centers for Medicare & Medicaid Services; and Ravi Passi, M.D., an attending physician in partnership with Artis at Olney Assisted Living in Maryland.
Artis will also be adding staff as safety officers to oversee matters such as staff training across the portfolio and monitoring safety protocols.
As a leader with ManorCare in the 1980s, Feltman worked with Johns Hopkins to pioneer approaches to memory care. Today, Artis operates a portfolio of about 25 communities, focused on memory care, across 11 states.
Also in the news:
— Murfreesboro, Tennessee-based real estate investment trust National Health Investors (NYSE: NHI) collected 96.9% of July rent, with the remaining 3.1% deferred or uncollected, according to a business update issued Friday. The REIT had collected 99.4% of contractual rent in June. The company also issued an occupancy update for its largest senior living operators:
— Minnesota lawmakers introduced a bill to give assisted living residents the right to a speedy administrative law judge appeal starting in August, should they be facing a situation in which they must leave a community due to increasing heatlh needs.
— Syracuse, New York-based senior living development and management company The Hearth has installed Viking Pure cleaning solution generators across its portfolio of 15 communities, in a program called Total Coverage 360. “The generators produce a natural cleaning product called Pure San Solutions, and they are roughly the size of an average office water cooler but have the capability of producing over 100 gallons of disinfectant a day,” according to a press release.
— Vestra Labs, which is contracted to provide Covid-19 testing across Arizona’s 148 Medicare-certified skilled nursing facilities, will also be conducting tests in assisted living communities, KJZZ reported. “So we’re currently working with the assisted living facilities to get their staff and residents tested. We are in the discussions about whether or not that can be an ongoing thing,” Dr. Cara Christ, head of the Arizona Department of Health Services, told KJZZ. Arizona is facing a surge in Covid-19 cases.
— Covid-19 cases have spiked in Florida’s assisted living communities and nursing homes, according to the Orlando Sentinel. “Three weeks ago, there were roughly 1,400 residents of the state’s long-term care facilities who were positive for COVID-19,” the newspaper reported. “By Thursday, that number had reached 3,652. And for senior-care workers, the rise was even steeper — from about 2,500 to 6,368 — the total dramatically eclipsing that of residents.”
Bulletin for Thursday, July 16:
Chicago-based specialty investment bank Ziegler has released some best practices for disclosing information to investors and bondholders during the Covid-19 pandemic.
Providers should be prepared to offer a range of information, such as a timeline of Covid-19 cases that includes a count of the initial positive cases, peak number of cases and number of recoveries for both residents and staff.
Ziegler also recommended that senior living providers give investors and bondholders information on:
- General operations, including unit count and reimbursements
- Marketing adjustments and the pace of move-ins and sales in light of Covid-19
- Local restrictions and information on local Covid-19 outbreaks
- Covid-19 plans, such as reopening strategies, designated Covid-19 units, and policies for positive caes
- Financial information, such as loans or grants, entrance-fee collections and refunds and Covid-19’s impact on expenses and revenue
- The status of construction projects, whether they’ve hit any delays and the projects’ overall feasibility
While the full list of recommendations may look intimidating to some providers, Ziegler says its intent is not to create more work for management teams.
“On the contrary, the hope is that these recommendations will save time for both you and investors by providing data in a public forum before investors need to ask questions,” the investment bank wrote in an update Thursday. “The goal is to cover as many of the key recommendations as possible without placing significant burden on your organization.”
The full document can be viewed here.
Also in the news:
— The occupancy rate for independent and assisted living communities dropped in June — but not as sharply as in April or May, according to a new intra-quarter occupancy report from the National Investment Center for Seniors Housing & Care (NIC).
Occupancy for assisted living communities dropped 3.2 percentage points between March and June. For independent living communities, occupancy fell 2.4 percentage points in that same time frame. But the sharpest decline in occupancy happened in April, with declines lessening each subsequent month, according to the report.
— Fitch Ratings said in a webinar Thursday that Covid-19 outbreaks have remained limited or well-contained within its rated portfolio of life plan communities. The company also noted that turning over vacant units and generating cash flow from entrance fees is still the biggest risk ahead for those communities.
— Senior living provider Grace Management now offers saliva-based Covid-19 testing for future residents at its communities thanks to a new partnership with Clinical Reference Laboratory. The tests results are typically available within 48 to 72 hours, the company said. Grace Management is based in Maple Grove, Minnesota, and is a subsidiary senior living management company of private equity firm Chicago Pacific Founders.
Bulletin for Tuesday, July 14:
Ventas (NYSE: VTR) recently sold a seven-property senior living portfolio for $52 million, dropping the initial $70 million purchase price due to impacts of Covid-19.
That’s according to Austin, Texas-based Kong Capital, which was involved in the deal and issued a press release Tuesday. The transaction previously was announced by Dallas-based MedCore Partners, which worked with Kong and other partners to acquire the portfolio, but the price was not disclosed.
“In January 2020, Kong Capital and MedCore Partners put the off-market portfolio under contract for a $70MM purchase price,” the Kong Capital press released stated. “After receiving 4Q2019 financial statements and seeing a further decline in NOI, the purchase price was renegotiated with Ventas to $52MM.”
Kong is seeing more deals of this type come to market as the Covid-19 pandemic stretches on, Kong Capital Founder and CEO Coe Schlicher said in the release.
The portfolio consists of 593 beds of independent living, assisted living and memory care. The communities are located in Washington State and California; they were previously operated by Senior Services of America, and the Tacoma, Washington-based company will remain the operator.
Also in the news recently:
— Senior living inquiries were 15% higher in June than May, according to new sales and marketing data from Enquire. Move-in averages increased about 32% between May and June, while June move-outs were 20% lower than a year prior, on average.
— Sherpa also recently released new sales and marketing data, showing that new leads increased more than 30% on average in June, compared to March, April and May levels. Time spend on virtual tours decreased slightly, while time spent on in-person tours and home visits ticked up. Other metrics continued to improve from recent months but remained well below 2019 levels; for example, time spent per contact increased in June but was 43% below the 2019 monthly average.
— States should do more to support assisted living communities and nursing homes, given that recent spikes in Covid-19 infections increases the risk of outbreaks in these settings, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) stated in a letter to the National Governors Association (NGA) and state governors. In particular, Covid-19 testing needs to be more rapid; more personal protective equipment is needed; and state public health agencies should work in close conjunction with senior living and care communities that are reopening to visitors, the letter stated.
— A consortium of five nonprofit senior living providers in New York State has worked together to coordinate certain aspects of their Covid-19 response. Details of the Alliance for Senior Care’s response are detailed in WNY Physician Magazine. “What’s best for geriatric care — engagement, involvement — is exactly what’s worst for spread of the virus,” noted Kim Petrone, M.D., medical director of St. Ann’s Community.
— In the two-week period between June 15 and June 26, 79% of assisted living providers in New York state reported having one or more residents leave the community, despite the risks of Covid-19 contraction. That’s according to a survey that the Empire State Association of Assisted Living (ESAAL) did of its 300 member organizations. Of those residents who left the premises, 20% went to a hair salon, 22% went to the home of family or friends, 8% went to a restaurant, and 50% reported going elsewhere, primarily to medical appointments. After continuing advocacy from ESAAL, the New York Department of Health recently began allowing for indoor and outdoor visitation at assisted living communities that meet certain criteria.
Bulletin for July 6, 2020:
Bethesda, Maryland-based Meridian Senior Living has partnered with a testing lab and hired a medical director to support the company’s Covid-19 response efforts and help smooth new admissions.
“Our collaboration with the lab and the appointment of our Medical Director is a vital pivot point in our reopening strategy. We now have the resources and medical expertise to routinely test,” Kacy Kang, president and COO of Meridian Senior Living, said Monday in a press release. “This is an extension of our ongoing commitment to keep our communities as safe as possible, while decreasing the risk of issues that arise from long periods of isolation, both with our residents and seniors in the towns and cities in which we operate.”
Meridian operates more than 75 communities across 21 states.
The new testing partnership should be able to reduce the amount of time that new residents spend in self-isolation, according to the company’s press release. Multiple negative tests could shorten the standard 14-day quarantine period.
Current residents and staff also will be tested more frequently going forward.
Also in the news:
— As of June 30, occupancy in the senior housing operating portfolio of Diversified Healthcare Trust (Nasdaq: DHC) was 77.4%. That marks a decline from 78.2% as of May 31. The Newton, Massachusetts-based real estate investment trust (REIT) primarily works with operator Five Star Senior Living (NYSE: FVE).
DHC also has amended agreements governing a $1 billion unsecured revolving credit facility and $200 million unsecured term loan. Among other conditions, the company will be required to maintain unrestricted cash liquidity of at least $200 million and will be limited a cash dividend of $0.01 per common share per quarter, plus amounts required to maintain REIT status and avoid certain tax payments.
— Touchless doors and water fountains, floor markings in dining areas, and enhancing acoustics to help people hear despite masks are among the recommendations in a new report from The American Institute of Architects, “Strategies for Safer Senior Living Communities.”
— The Covid-19 pandemic has worsened the legal guardianship situation in the United States, in which older adults are placed against their will in assisted living or other facilities, The Intercept reported.
To read previous Bulletin entries, click here.