After a slower start than many operators had hoped in 2023, the senior living industry is poised to regain pre-pandemic occupancy in 2024 – but many of the pandemic era’s challenges still remain.
Challenges for the year ahead include finding ways to grow as new development remains tough, navigating lingering high expenses, staffing communities with enough workers to keep operations moving smoothly and managing the perceptions of prospective customers.
At the same time, senior living companies are evolving and growing into new product types. The stakes that investors and owners lay today may very well help reshape the industry in the coming year and beyond.
These and other trends were apparent in executives’ own words in our coverage throughout the year. The following quotes show the progress the industry made in 2023, where the focus lies for many companies and what they are planning in 2024.
“That market is about to explode.” – Michael Levine, Senior Managing Director of Real Estate, Active Adult, Greystar
The active adult trend is ready to “explode” in the U.S. — and Charleston, South Carolina-based Greystar is at the forefront of it with 110 owned or operated communities in 28 states and 90 different markets.
Greystar, which is already the largest operator of multifamily apartments in the U.S., is making a play to grow “significantly” in the active adult space in the coming year, according to Levine. If those plans hold true, the company will expand into new states including Missouri and Indiana, with further expansion to come in the Pacific Northwest and Northeast.
Greystar is also involved in some forward-thinking active adult projects. For example, the company was recently publicized as the manager for Viva Bene, a new senior housing brand from developer Avenue Development that pairs active adult dwellings with access to primary care services.
With in-house development and other resources behind it, the company has the “pieces in place to grow a lot more, and to be able to handle a lot more without faltering at all,” Levine said.
And Greystar is not the only company with ambitions in the active adult sector, either. Others include Liv Communities, which this year launched a dedicated active adult brand; GSI, Chapters Living and Grace Management. Even if just some of these companies execute on their plans, the sector will remain red-hot in 2024.
“Incremental change is not going to cut it in this business anymore. You don’t need fancy, you need common sense.” – Shankh Mitra, CEO, Welltower
Given all the challenges and opportunities ahead of the industry, “good enough” is no longer a good enough result for senior living operations.
That is the philosophy of Welltower (NYSE: WELL) CEO Shankh Mitra, who believes that the industry today requires a truly new way of thinking about the business. To Mitra, operational success is a math equation that must be solved through cold rationality. He believes that senior living operators must start with a “blank slate” and build a new customer journey for the post-Covid era.
“We have got to think about a complete business process reengineering and think what needs to be done by people and what can be done better by software, technology, systems, infrastructure, so we can have our precious human capital focus on what they signed up to do,” Mitra said during a panel discussion at the NIC Fall Conference in Chicago earlier this year.
He added in an interview with Senior Housing News: “We want to show the industry that if you start from the beginning with a fresh approach — nothing fancy, just common sense — you can get to a viable model.”
That worldview is informing how Welltower is working with operating partner Cogir on a new operating platform in parts of Canada previously known as “Project Transformer.” Through that arrangement, Cogir is slated to manage about 75 properties in Canada, with the REIT serving a more “hands-off” strategic role.
Cogir is operating the communities with a tech- and data-forward view, with ambitions to one day collect passive biometric info and other data that can improve the resident experience. And depending on the outcome, what the companies achieve together could very well create a new blueprint for owner-operator alignment in the years to come.
“Development is like a big locomotive. It just doesn’t start and stop on a dime. You have to lean in when it’s a little uncomfortable so that you can be rewarded on the other side,” – Matt Derrick, Development Managing Director, Confluent Development
The senior living development locomotive ran into an economic “slow-moving trainwreck” this year – and the red signals are still flashing as the industry heads into a new year.
High interest rates and construction costs have effectively stymied capital for new projects as lenders look for more visibility ahead. For senior living operators basing their future on fast growth in the form of new builds, this has presented a big challenge.
With larger plans on hold, some senior living developers are teeing up projects and getting preparations in place now “to strike fast and be first” whenever conditions loosen up from where they are today.
Companies like Confluent Development are doing so with the belief that the current era could resemble the aftermath of the Great Recession in the sense that very good opportunities are right around the corner for those willing to seize them. The challenge for Confluent and other developers is which projects to get ready now, and when to execute on them.
“Some of the best deals we’ve done we’re coming right after the Great Recession,” Derrick told SHN this summer. “And we find ourselves in a similar place.”
“There are going to be huge opportunities in 2024, probably into 2025, to buy troubled assets, and you’re going to get relatively newer stuff.” -Jon DeLuca, CEO, Senior Lifestyle
Companies looking to expand through acquisitions in senior living are excited about the prospects that 2024 could bring.
It’s no secret as to why: Billions of dollars of debt maturity are coming due in 2024, and some communities that are struggling will simply change hands as owners and operators are forced to make tough decisions. Companies with deep pockets, like private equity and REITs, stand to gain.
In fact, Welltower CEO Shankh Mitra said this year that now is “the best environment for investments that we have ever seen.” To Ventas’ Debra Cafaro, it’s “the most favorable supply-demand fundamentals the industry has ever experienced.”
Operators that align themselves with those companies also stand to gain, in the form of fast growth with a large established partner. That is why DeLuca said Senior Lifestyle is looking to link up with a partner that can help facilitate the Chicago-based operator’s growth in the next 12 to 18 months through acquisitions.
“We’re going to continue to focus on buying market-rate communities, and developing market-rate communities when it’s right,” he said at this year’s BUILD conference in Orlando.
“The era of the single-site and small-system organization is coming to a close.” – Steve Lindsey, CEO, Garden Spot Communities
It’s tough to be a senior living operator in 2023 – even tougher if you only have a single location or a very small number of them.
For small- and single-site organizations that have trouble accessing resources, the Covid-19 period has been one of constant challenges. At the same time, forces such as value-based care and the middle-market present big opportunities for companies that can muster the creativity and scale to seize them.
Organizations including Garden Spot Communities and Frederick Living have sought to join forces in recent years, both to help vault over the challenges of today and prepare for a new and changing world at their doorstep.
Lindsey compared the current period to a quote from futurist Bob Johansen, who has said that “the future will be a scramble: An asymmetrical patchwork of urgency, panic, imbalance, and hope.”
“That feels a little bit like the current reality of senior living, and we don’t see it changing as we go forward,” Lindsey said earlier this year.
According to a mid-year 2023 M&A report from Ziegler, 846 nonprofit senior living providers have consolidated operations since 2015, representing around 17% of all communities. No doubt, leaders like Lindsey and others will drive more such transactions in the new year as they seek to evolve for a new generation of older adults.
“The high acuity trend that is taking place in the market is in favor of majority assisted living properties, for now.” – Omar Zahraoui, Principal, NIC
If current supply and demand trends hold, the senior living industry will reach pre-pandemic occupancy toward the end of 2024, according to a NIC analysis from October.
Taking a closer look at the different product types, assisted living is recovering at a faster rate than independent living in the NIC MAP Primary Markets, with occupancy in the third quarter of 2023 improving by 0.9 percentage points to 82.6%. Occupancy has also recovered to pre-pandemic levels for assisted living operators in secondary markets, which as of 3Q carried occupancy rates of 84.3%
The trends suggest that operators of higher-acuity communities are better-positioned to grow census in 2024 – at least for now, according to Zahraoui.
“We don’t know where the market is heading, but for now, this is the situation that we’re in,” he told SHN in September.
Companies including the nation’s largest operator, Brookdale Senior Living (NYSE: BKD), are preparing the rollout of offerings aimed at residents with higher care needs. In fact, the company’s HealthPlus program – which helps manage chronic conditions among residents living in assisted living communities – has laid the foundation for a “great year” in 2024, according to CEO Cindy Baier.
“We have a multi-year period where the supply/demand and macroeconomic conditions are so very favorable, and at the same time, we invested early in health care,” Baier said. “So we’re right where the market needs us to be at the time when it needs us most.”
“The world I came from, which was OpCo/PropCo, now goes OpCo/PropCo/health care.” – Arnie Whitman, Executive Chairman, Formation Capital
Arnie Whitman has had his eye on the future of senior living since he first joined the industry in the 1980s. In 2023 he helped unveil a new vision for the future: A tech-enabled, data-driven senior housing model where operating companies and properties are integrated with value-based care payment frameworks.
In September, Whitman – along with partners Chip Gabriel of Generations, LLC, Omega Healthcare Investors (NYSE: OHI), and a newly launched operator called Kalven Senior Living – announced the acquisition of a 113-bed assisted living and memory care community in Brentwood, Tennessee.
Together, they will endeavor to transform the community into a “Senior Living Transformation Center” where residents will live and benefit from the new model.
“We absolutely see the potential of senior living becoming a partner in the value-based care ecosystem,” said project partner Joelle Poe, who has led product design and management at health care-focused technology and managed care companies such as Alignment Healthcare and SkyPoint Cloud. “We see this as a journey to getting to value-based care, and that this is an opportunity to deliver a tremendous amount of value to our stake stakeholders along that journey.”
If things go as planned, the concept has the potential to blaze a new trail in value-based care in senior living. And it potentially could be a blueprint for other such arrangements in the future, given the cross-section of financial, real estate, operational, technological, and managed care experience involved.
And that seems to be the intent, according to Gabriel.
“As we grow and work with other operators, we will have established systems that we will want them to implement in communities that we own. That is what will drive the data and analysis to implement our care model and work with payers,” he said.
“Data is going to be what we need to make sure people are happier and healthier in the future.” – Sevy Petras, CEO, Priority Life Care
From resident health to operational metrics, the senior industry’s future increasingly lies in the use of data.
Senior living operators including Priority Life Care have built out complicated data models to hit middle-market price points and make better business decisions. The Fort Wayne, Indiana-based company works with REIT Ventas (NYSE: VTR), which launched a data analytics and asset management platform called Ventas Operational Insights.
For Priority, that collaboration resulted in new capital investments, improved occupancy and better financial performance for its “Celebration” portfolio made up of former Eclipse properties. And looking ahead, data will continue to be an important part of what the operator does.
“My mission in life is to find paths and technology to make the jobs of our staff members easier,” Petras told SHN. “There’s a wealth of data, we just haven’t been able to really tap into it.”
Welltower is similarly leveraging a data analytics platform as it builds its new platform with Cogir. The REIT’s management noted earlier this year that the level of data it can collect is so precise that it can accurately predict resident rates at a multifamily or senior housing property within a range of error of just $10.
New operators including Evolve Senior Living from former Anthology Senior Living executives Andrew Agins and Justin Dickinson are launching with data collection as a competitive differentiator. All the while, senior living companies are adopting an ever-growing array of technology to usher them into their next chapters.
One challenge for operators is standardization across multiple platforms. But Belmont Village President Mercedes Kerr said earlier this year that she is “optimistic for the first time ever” that operators can better agree on the kinds of data they track and analyze.
“I believe that the industry will have to come to terms with some level of standardization, whether it’s quality of care, whether it’s reporting or financial metrics,” she said during a panel discussion at the 2023 Argentum Senior Living Executive Conference in New Orleans. “It’s going to be a very heavy lift, but one that I think everybody is going to somehow eventually come into.”
“Assisted living and memory care will be reimbursed, they will not remain private-pay.” – Adam Kaplan, Founder and CEO, Solera Senior Living
That bold prediction also came during a panel discussion at the 2023 Argentum Senior Living Executive Conference in New Orleans.
Kaplan’s point was that operators are in a prime spot to improve outcomes among older adults and deliver services at a lower cost relative to other options. So, why not get reimbursed for those efforts?
Reimbursements can also help operators make their services affordable for the middle-market of consumers, which make up a large and growing number of their prospective resident base in the years to come.
Operators have long resisted bringing more government payments into private-pay assisted living and memory care, as they are wary of federal oversight. But with expenses high and margins compressed, Kaplan is left wondering “whether we’re going to be a private-pay industry long-term.”
As more senior living operators flirt with the middle market – along with new payment sources, such as those in value-based care – they will no doubt ask many of the same questions that Kaplan has asked himself.
Companies featured in this article:
Confluent Senior Living, Formation Capital, Garden Spot Communities, Generations, Greystar, Priority Life Care, Senior Lifestyle, Solera Senior Living, Welltower
