Last year, the Covid-19 pandemic threw a wrench in the best-laid plans of senior living operators across the United States. But the providers to watch in 2021 all continued to innovate and devise interesting strategies for the future, even while responding to the public health crisis.
Going into 2021, the providers on this list are worth watching for a variety of reasons. They will be opening noteworthy communities, executing on strategies under new leadership, leveraging creative partnerships, and trying to prove out business models and operational approaches that are uncommon in the industry.
Some of these plays are risky, but they all are forward-thinking and trying to meet the demands of a more competitive and complex market.
Cedarhurst Senior Living
Cedarhurst Senior Living has been steadily growing for years and is poised to pass the 50-community mark in 2021. And Cedarhurst is not only expanding its footprint throughout the Midwest, Mid-South and Southeast, but could be well-positioned for even more growth and success in the post-pandemic era.
One of Cedarhurst’s advantages could be that it is the operating arm of St. Louis-based The Dover Companies, which is an integrated developer, builder, owner and investor. Having tight alignment across all these aspects of the business could be increasingly valuable as the senior living industry becomes more complex and competitive, according to panelists at Senior Housing News’ 2020 BUILD event. Certainly, Cedarhurst CFO Stephen Wertman believes that this is the case: “First and foremost, alignment that allows us to not only develop and build in cost-conscious ways from an owner’s perspective, but also design a building with a feedback loop that comes from the operations,” he told SHN in August.
Being able to coordinate development, construction, financing and operations also could be key to serving the middle market. It’s the approach that other companies such as Clover Management have taken, because serving the middle market demands efficiency and alignment across all aspects of a project. Currently, Cedarhurst communities tend to be located in secondary and suburban locations, where the provider aims to serve the “very high end” of the middle market. This could position it well should the company decide to pursue an even lower price point and make a play for the heart of the growing middle market.
Furthermore, the company’s strategy to target smaller markets like Owensboro, Kentucky — where a community is scheduled to open in early spring — could pay off in a post-Covid world. Small and mid-size cities like Tupelo, Mississippi, and Boise, Idaho, have gained new luster as more people are able to work remotely and are fleeing the density and costs of urban cores.
And, Cedarhurst has a strong health care focus, with about 55% of its units being assisted living, 30% memory care and 15% independent living. The pandemic made consumers more concerned than ever about the health care capabilities of senior living providers and accelerated the ongoing integration of senior living within the broader health care system, and Cedarhurst is leaning in.
“We’re seeing a lot of opportunity because of our clinical backbone,” Wertman said. “We have really, really strong clinical teams, really strong operational teams that work in concert together, and that allows us to fully believe and embrace that we can handle that challenge.”
PARC Retirement Living
In recent years, U.S.-based senior living owners and operators have been paying more attention to what is happening north of the border — with innovative companies based in Montreal being especially noteworthy. Welltower (NYSE: WELL) has made a play with Cogir, and Ventas (NYSE: VTR) has invested in Le Groupe Maurice. Both these companies operate large independent living communities with high occupancy rates in Quebec, and are active in the United States or eyeing the potential for U.S. expansion.
But Quebec is not the only hotbed for senior housing innovation in Canada, as a smaller company in British Columbia proves.
PARC Retirement Living operates five communities in and around Vancouver, with three more in development. The company was founded in 1994 by Rainer Müller, an architect who devoted himself to the senior living space after seeing the benefits his mother enjoyed after moving into a community.
As might be expected with this backstory, architecture and design are strengths of the company. And from the very first project that PARC did, Müller bucked conventional wisdom.
“Everyone told us that highrises didn’t work for seniors,” he told SHN.
But, from his experience developing rental apartments in Switzerland, he was used to building highrises in dense, amenity-rich urban areas, and saw no reason why this model would not work for older adults. PARC went on to build a successful highrise and has continued to pursue projects in high-density areas. Take its recently opened Oceana PARC community in White Rock, British Columbia. This is a 23-story tower on White Rock’s main commercial street; a breezeway connects the tower to a rooftop space above retail storefronts, overlooking the street.
“Visually, seniors can look down, and people on Johnston Road can look up, and they are linked to the street and to the community,” Helen Besharat, a principal at BFA Studio Architects who served as the project’s architect, told SHN.
The community is eco-friendly, including landscaping and green roofs. And, thanks to universal design features, the building is not distinguishable as a retirement community versus a multifamily building.
Even more creative is a project in the works in the British Columbia capital of Victoria. This community involves a 200-unit building and an adjacent 80-unit building. For the first four years after opening, the 80-unit building will be student housing, through a partnership with Camosun College.
This arrangement should facilitate intergenerational interactions, and also gives PARC a ready-made resident population at opening; the company will have more lead time than usual to line up occupants when the building eventually transitions over to senior living. When that happens, it’s possible that the 80-unit building will offer lighter services, perhaps on an a la carte basis, on a model that in Quebec is called “active living.”
From an operational standpoint, the provider also has proven itself to be innovative. Early on in the pandemic, it moved swiftly to create Family Meetup Centres by repurposing modular containers, like the ones used as offices on construction sites. Other innovations during Covid-19 have focused on dining, including the creation of farmer’s market-style PARC Markets that offer fresh local produce and the launch of the PARC Family Eatery. Located at Westerleigh PARC, this is a specially designed dining room with separate entrances for residents and visitors, with physical distancing and other Covid-19 safety measures observed.
While PARC has considered other markets, Müller does not have any imminent plans to expand beyond British Columbia into other parts of Canada or the United States.
“We consider ourselves a niche player,” he told SHN. “A little like the story of Porsche, just building little sports cars, we just build independent living residences.”
But by building little sports cars, Porsche helped shape the automotive industry, and it’s possible that PARC could exert an outsized influence for a provider of its size, as well.
CHI Living Communities
In 2020, CHI Living Communities named a new CEO, who laid out an ambitious set of goals that make this nonprofit a provider to watch in the year ahead. And as the organization grows in new directions, it will provide another example of senior living integrated within a larger health care system — in this case, CommonSpirit Health, a $30 billion system created through the 2019 merger Dignity Health and Catholic Health Initiatives (CHI).
CHI Living’s 13 continuing care retirement communities are part of the system that encompasses more than 1,000 care centers and 137 hospitals, as well as home health programs and other services. Other senior living providers, such as Arden Courts (part of the ProMedica system) and the Evangelical Lutheran Good Samaritan Society (part of Sanford Health), have touted the benefits of health system integration. CHI Living’s new CEO, Aaron Webb, is aiming to maximize those benefits for his organization.
“As I have residents who need acute care, home health, hospice care, or even in some cases, pharmacy services, I’m not having to go out and … form partnerships with third parties who don’t know us,” Webb told SHN in July 2020. “I’m able to handle some of those relationships in-house, and over time, those synergies are only going to become stronger.”
Webb also is looking for opportunities to grow CHI Living, starting with filling in the continuum of care in markets where CommonSpirit already has a presence. Given that the health system operates across 21 states, the potential scope is national.
“We’re striving to become a national player in every way,” Webb said. “This is not business as usual.”
Operationally, Webb has a focus on driving technological innovation, and talking with current and prospective residents in order to gauge their needs and desires. Based on that, he believes that CHI Living can build “senior living communities of the future.”
And, Webb aims to make CHI Living an industry leader in racial justice and diversity; soon after taking the helm, he requested data on the organization’s workforce, and sees room for much improvement.
“Unless we are intentional about seeking out historically underrepresented classes, I don’t think we can move the needle in any positive direction,” Webb said. “So, I plan to generate larger amounts of leads of diverse talent through very intentional efforts.”
In recent years, some nonprofit leaders have called for swifter innovation and growth, in order to maintain competitiveness with for-profit senior living companies. CHI Living could emerge as an example of how a nonprofit organization can achieve these goals.
Residential care homes are a significant part of the senior living market — in the state of California alone, there are 8,100 licensed residential care facilities for the elderly, and more than 90% are licensed for six or fewer beds. Small-home senior living might gain even more popularity in the wake of Covid-19, and Majestic Residences wants to be able meet that demand.
Phoenix-based Majestic was founded in 2020 by Gene Guarino, who runs the Residential Assisted Living Academy, and Chuck Bongiovanni, founder and former CEO of senior living and care placement service CarePatrol.
“We want to organize our homes on one page and under one brand to be a force in the market, and get residential care homes recognized,” Bongiovanni told SHN. “They’ve been around forever, but they’re not always recognized as part of the senior care continuum.”
Small-format senior living has been gaining steam in recent years, through efforts like Bill Thomas’ Minka model and the rise of pocket neighborhood communities. And Covid-19 might supercharge interest in small-home senior living, which is easier to manage from an infection control standpoint than a large building.
What distinguishes Majestic from other providers pursuing small homes is that the company operates on a franchise model. Going the franchise route is an attempt at preserving the entrepreneurial spirit of small-home senior living owners and operators while giving them access to more resources and other benefits of scale.
And Bongiovanni has significant franchise experience. CarePatrol is a franchise company that was acquired by private equity firm The Riverside Company and is now part of the Best Life Brands platform of integrated companies serving older adults, including home care and estate sales. Franchise-based senior living is a growing trend, and one that could push the industry in new directions.
There are several options for how to join the Majestic Residences brand, including converting an existing small-home operation into a franchise, or operating a small-home business under a lease arrangement with a separate owner.
And so far, the company appears to be attracting interest: In its first month, the company awarded 12 franchises, it has more than 40 franchises in the pipeline, and expects to hit 200 by the end of 2022, Bongiovanni told me recently.
Five years after Chris Guay founded Vitality Living, the company appears to be hitting its stride and is making plays related to a few different industry trends. In 2021, it will be worth watching how Vitality approaches these projects and whether the company notches any early successes or experiences challenges.
Guay started Vitality after coming up the ranks with Emeritus and Brookdale, and he intended to leverage that experience while pushing the envelope on innovation. But after his original capital partner went in a different direction, Guay had to essentially “re-launch” Vitality in 2018.
Now, Guay has aligned with several ownership groups and is pursuing a slate of interesting development and adaptive reuse projects. Vitality and hospitality developer Fusion are launching a brand called Landmark Lifestyles, with their first project in Tupelo, Mississippi. That project exemplifies both the mixed-use trend that has gained momentum in recent years, and the pandemic-related trend toward developing in smaller markets.
Another rising trend could be adaptive reuse of hotel properties to senior living, given how hard Covid-19 hit the hospitality industry. Vitality is working on a hotel conversion with Fusion in Jackson, Mississippi.
Vitality also is working with Al Copeland Investments to transform Louisiana’s 17-story Copeland Tower — a landmark of Metairie, near New Orleans — into an active adult community. Formerly a hotel, the building will be renovated and could welcome its first senior living residents this summer, at rents starting around $3,400.
And Vitality is making inroads into the fast-growing active adult space through other projects as well, notably a recently opened community in Madison, Georgia. This community features detached patio homes, including some designed with private living quarters but shared common space for residents, to enable lower price points.
A second phase of the project could add communal assisted living and memory care, but the “focal point” is the active adult component, and there could be 200 patio homes when all is said and done, Guay told SHN. The concept could test a continuum of care that goes big on active adult and forgoes traditional independent living, banking on residents being able to age in place unless they develop the need for more robust care.
“We’re really excited to see how this concept works in the market,” Guay said — and no doubt others in the industry will be watching this concept, and Vitality’s other projects, with interest.