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 Tuesday, April 7, 2020:
March 2020 move-ins were down 50% compared to March 2019 for the Senior housing operating and continuing care retirement community (CCRC) portfolios of Healthpeak Properties (NYSE: PEAK).
Compared to February 2020, SHOP and CCRC move-ins were down 41% last month, the Irvine, California-based real estate investment trust reported Tuesday. Together, SHOP and the CCRC portfolio represent 27% of net operating income for the company.
As of March 31, total blended occupancy in the SHOP/CCRC portfolio was 83.4%. That was down from 83.8% on Feb. 29.
“Move-ins were in line with our expectations through mid-March,” Healthpeak stated in its April 7 Covid-19 update. “Thereafter, move-ins declined in response to COVID-19 protocols, sheltering in place, and reduced in-person tours.”
Leads for March 2020 declined by 32% compared to March 2019. However, the REIT’s month-over-month conversion ratios improved, suggesting that inquiries are coming from people with a more urgent desire or need to move.
Other REITs have also reported a slowdown in move-ins starting in mid-March, as the Covid-19 crisis escalated in the United States. Financial analysts watching the space have warned that the pandemic could lead to historically low occupancy rates. However, occupancy appears to have held up reasonably well over the last month, according to data compiled by the National Investment Center for Seniors Housing & Care (NIC).
Even as move-ins have slowed and occupancy has ticked down, REITs are also reporting fewer voluntary move-outs. Healthpeak anticipates a reduction in voluntary move-outs, although the company is not yet predicting how much Covid-19 will affect these numbers. Voluntary move-outs account for roughly a third of Healthpeak’s total move-outs.
Going forward, Healthpeak anticipates that SHOP occupancy will drop roughly 2% to 4% a month and CCRC occupancy will drop about 1% a month due to Covid-19. The REIT may consider rent deferrals for its triple-net lease operators.
Operators are also facing increased costs due to the coronavirus situation. Labor costs are likely to rise between 5% and 15% during the pandemic, Healthpeak stated. Purchases of personal protective equipment typically account for 2% of total costs but this is likely to increase by two to five times.
Currently, 22 Healthpeak communities managed by nine different operators have confirmed cases of Covid-19 among the resident population, and residents have died from the disease in 11 communities, the REIT reported.
Also in the news:
— Argentum and the American Seniors Housing Association (ASHA) have launched “Senior Living FastMatch,” a tool to help connect laid-off workers with opportunities in Senior Living. Powered by technology from Arena, the tool harnesses artificial intelligence to match job seekers from other industries with senior living positions available in their region. Providers can post job opportunities to FastMatch at no cost through Sept. 30, 2020.
“Hospitality, restaurant, and retail workers are particularly impacted by the current crisis, and Argentum has been working with the American Hotel & Lodging Association to help connect these workers with senior living,” stated Argentum President and CEO James Balda. “They bring skills and experience that are a strong fit for many senior living positions, such as concierges, dining professionals, and housekeepers. This talent-matching tool provides the technology and opportunity to quickly help workers and providers connect in this emergency.”
Also, OnShift has created an expanded toolkit to help providers with recruiting and hiring efforts.
— KARE, a “digital labor marketplace app,” is expanding into new markets and has added features in response to the Covid-19 pandemic. The startup also revealed that its backers include a who’s-who of industry leaders, including NIC founder Bob Kramer.
The app connects caregiver “Heroes” to work unfilled shifts in senior living and care communities, offering providers a better rate than a typical staffing agency while giving workers more autonomy and ready access to income. The app launched in October 2019 in Houston and Austin and now is rolling out to other Texas markets, including Dallas/Fort Worth and San Antonio. Atlanta, Georgia is on tap for next month.
“Because of the desperate need for caregivers in this time of crisis, we are grateful that KARE is able to quickly help senior care communities quickly find staff to care for their residents,” stated Bridget Kaselak, chief growth officer for KARE, in a press release. “And because of the concerns about health care workers contributing to the spread of the virus, we have tweaked our technology to help alleviate that concern in ways that a traditional staffing agency can’t in order to be compliant with state or local restrictions.”
Specifically, no caregiver will be able to check in for a shift without reading and acknowledging the particular infection control procedures at that location, KARE CEO Charles Turner told SHN. In addition, a “switch” has been added for areas in which staff movement between different facilities has been restricted. When the switch is flipped, caregivers in that area will be assigned to a particular facility and will be unable to work in any others, and all local communities will be notified.
In addition to Kramer, KARE is backed by organizations including Bridge Real Estate Group, and leaders with providers such as Frontier Management, Seasons Living, Caraday Healthcare, Principal Senior Living, Benton House, Sodalis Senior Living and others.
— A high school in Chicago has dedicated its 3-D printers to making face masks for senior living providers, starting with Silver Birch.
— MyndVR, a company that specializes in providing virtual reality technology to senior living and care providers, will be giving away a free VR headset and one-year content subscription to communities in all 50 states. The program is meant to help reduce social isolation related to Covid-19.
Bulletin for Monday, April 6, 2020:
The Department of Health and Human Services (HHS) should confirm that senior living providers have been granted certain legal protections during the Covid-19 pandemic, Argentum and the American Seniors Housing Association (ASHA) said in an April 3 letter to HHS Secretary Alex Azar.
On March 17, HHS published a declaration under the Public Readiness and Emergency Preparedness (PREP) Act. The declaration provides liability immunity — except in cases of “willful misconduct” — to “certain individuals and entities” related to their undertaking “critical countermeasures” to fight the Covid-19 pandemic.
“For senior living communities to respond to Covid-19 in a way that best serves the interests of the elderly adults residing in their communities, the protection from liability provided to Covered Persons by the PREP Act should apply to senior living communities and their employees,” the letter to Azar stated. “We urge the Secretary to confirm this interpretation in an expedited manner to remove current and anticipated barriers to care for the nation’s elderly adults.”
Such a confirmation would provide confidence that senior living providers have liability protection related to such services as administering drugs to residents with Covid-19. If HHS determines that senior living providers are not covered under the declaration as it currently exists, Argentum and ASHA are urging the agency to amend the declaration.
Also in the news:
— Strategic Student Housing & Senior Housing Trust (SSSHT), a public, non-traded real estate investment trust sponsored by SmartStop Asset Management, has stopped selling shares to the public due to changing market conditions caused by Covid-19, CoStar reported Monday.
SmartStop has about $1.9 billion of real estate assets in its portfolio, including 117 self-storage facilities in the U.S. and in Toronto, and saw an opportunity in senior housing.
“Like self-storage 15 years ago, student and senior asset classes are a little bit below the radar,” John Strockis, president and chief investment officer for SSSHT, told Senior Housing News in October 2019. “We really want to parallel what we did with self-storage 15 years ago … acquire them, understand them, brand them.”
As of October, SSSHT had acquired four senior living properties, operated by Integral Senior Living (ISL) and MBK Senior Living. At that time, the firm was raising additional equity and contemplating a brand name for its senior housing portfolio.
— Hospitals have encountered problems in discharging patients to certain post-acute facilities, including both skilled nursing facilities and those providing “lower-level care,” according to a Government Accountability Office (GAO) report.
“One hospital reported a case in which a post-acute-care facility refused to take a patient unless the hospital sent them a week’s worth of masks for the patient and for the staff who would care for the patient, even though the patient was not positive for Covid-19,” the report stated. “Delays in receiving test results contributed to delays in transferring patients to these lower level facilities and in freeing beds in the hospitals for incoming Covid-19 patients.”
Not all senior living communities are hesitant to accept hospital patients. Some providers, such as Phoenix Senior Living, are working with local health systems to proactively manage capacity by taking on lower-acuity patients.
— Due in part to lower valuations for senior housing, the Green Street Commercial Property Price Index fell 1.3% in March. The index is a time series of unleveraged U.S. commercial property values that reflects pricing for commercial property transactions — including some that have not yet closed — across a range of asset types. The March decline is attributable primarily to lower valuations for lodging, malls and senior housing, due to Covid-19 concerns, according to a Green Street press release.
“The property markets are in an adjustment period; it’s going to take some time for buyers and sellers to figure out what a new fair price is,” said Peter Rothemund, managing director at Green Street Advisors. “Most everybody acknowledges pricing will be lower, but the question is how much. There is no one right answer. Prices of some property types should hold up relatively well, while those most affected could see 30% declines.”
— Bloom Senior Living and Assured Assisted Living have joined the ranks of providers that are offering Covid-19 tests. Family-owned and operated Bloom has partnered with Alabama-based Assurance Scientific Laboratories to perform tests for residents and associates at all of the company’s locations. Bloom is based in Birmingham, Mississippi, and operates nine communities across Indiana, Ohio, South Carolina, Louisiana and Florida.
Assured Assisted Living operates 10 memory care communities in and around Denver and Castle Rock, Colorado. The company is working with Centennial State Lab to begin testing all incoming residents for Covid-19 starting this week. Potential residents will be tested in their own homes as part of an initial care assessment. Individuals needing immediate placement will go to a specialty care home for a period of quarantine.
“When we receive negative test results we can move residents in immediately and provide peace of mind to our current families and staff,” said Francis LeGasse, in a Monday press release. “We are 100% committed to providing the safest environment possible while still helping those who need care and want to transition to an assisted living environment with memory support.”
— In brighter news during the pandemic, residents at The Enclave at Round Rock — a Spectrum Retirement Communities building in Austin, Texas — held a virtual bingo night with a special host: Oscar-winning actor Matthew McConaughey.
“Last September, the residents and team members at The Enclave posted a video on social media requesting McConaughey to join them for bingo,” CBS affiliate KEYE reported. “Amid the Covid-19 pandemic, McConaughey had the time and ability to answer this call.”
Bulletin for Saturday, April 4, and Sunday, April 5:
Welltower (NYSE:WELL) has reportedly backed off a years-long bid to buy a London-based firm with more than 200 care homes in the United Kingdom.
The Toledo, Ohio-based real estate investment trust (REIT) was previously interested in acquiring Barchester Healthcare for a sale price of at least £2.5 billion, or roughly $3.1 billion. But the company has now dropped its bid, according to a new report in The Sunday Times.
It wasn’t immediately clear why Welltower dropped its bid now, and the REIT declined to comment when reached by Senior Housing News Saturday. But the company has focused its fire in recent weeks on slowing the spread of Covid-19 as its properties. As of April 1, Covid-19 had affected 116 residents in 45 of Welltower’s communities across the United States. Occupancy for Welltower’s senior housing operating portfolio (SHOP) was 85.4% as of March 27, a decrease compared to the 85.6% occupancy rate the company reported on March 13, 2020.
Meanwhile, Welltower is bulking up on its supplies of personal protective equipment (PPE). The company last Wednesday said it had procured or was working to procure 400,000 pairs of gloves, 250,000 facemasks, and 120,000 isolation gowns in addition to hand sanitizer, disinfectants and no-touch thermometers. The REIT plans to distribute the supplies from a newly established center in Dallas.
Welltower wasn’t the only U.S. senior housing company interested in buying the U.K. nursing home company. U.S. investment bank JP Morgan has also shopped the company around to a lineup of different potential buyers, including Chicago-based Ventas (NYSE: VTR) and Seattle-based investment firm Columbia Pacific Advisors.
Australian investment bank Macquarie then took the lead in the bidding process, but ultimately dropped out of the process last year over uncertainty regarding the Brexit process, the Sunday Times reported.
SHN wasn’t able to reach a representative for either Ventas or Columbia Pacific as of Sunday afternoon.
Also in the news:
— If move-ins grind to a halt due to Covid-19, senior housing occupancy could be cut in half, falling below the 70% mark, BMO Capital Markets Analyst John Kim told Bloomberg. (Editor’s Note: Senior Housing News spoke with Kim about his projections Monday morning. Click here to learn more.)
Last Tuesday, on an earnings call for Capital Senior Living (NYSE: CSU), Barclays Managing Director Steven Valiquette noted that a 2,500 basis point decline in occupancy is being floated among the investment community as a potential Covid-19 scenario. Capital CEO Kim Lody and COO Brandon Ribar said they do not see any indications so far of such a dramatic decline.
And occupancy appears to have remained stable in the early weeks of the U.S. Covid-19 outbreak. Occupancy did not change or increased over the last month, according to three-quarters of senior housing executives who responded to a National Investment Center for Seniors Housing & Care survey conducted between March 24 and March 31.
But analysts are gaming out worst-case scenarios and responding to sharp drops in the market caps of publicly traded owners and operators. Senior housing REITS are essentially “uninvestable” given current uncertainties, Jeffries analyst Jonathan Petersen told Bloomberg.
— March move-ins were down 30% compared to January and February averages for New Senior (NYSE: SNR). The New York City-based real estate investment trust has a portfolio of 102 independent living communities in management contracts and one asset in a triple-net lease, with Holiday Retirement its primary operating partner.
Move-ins began to decline in mid-March as the U.S. Covid-19 outbreak escalated, putting the brakes on physical tours and new move-ins, the REIT reported on Friday in an updated presentation on how the pandemic is affecting its portfolio.
There is some good news as well, in the form of fewer move-outs. April move-out notices are 20% lower versus the comparable March metric. And tour volume increased in the final week of March due to the rollout of virtual tours.
As of April 2, eight communities managed by three different operators had confirmed Covid-19 cases, affecting 18 residents and one employee. More than 120 residents and staff members have been tested for Covid-19. So far, 84% of tests have come back negative, but New Senior expects confirmed cases to increase as testing becomes “more widely and easily available.”
“We would like to again thank and commend all of our operators and the staff at our communities, who continue to serve our residents with exceptional care and purpose, in spite of the ongoing crisis,” the REIT’s presentation stated.
— Juniper Communities and LTC Properties (NYSE: LTC) have launched Virtual Connections, a hub of free digital resources for senior living providers and residents. The website SLvirtual.com includes hundreds of activities, games, exercise videos, live webcams of zoos and aquariums and other digital resources to aid in resident engagement and entertainment while social distancing is in effect.
“As aging adults are isolated around the world and in our senior care communities, we wanted to be able to provide relief for those working in the communities and entertainment to help make these days a little brighter for residents and staff,” Lynne Katzmann, president of Juniper Communities, said in a press release. “Virtual Connections is a way to give back to our industry and show encouragement to those working tirelessly to serve seniors while honoring social distancing policies.”
In addition to working with Juniper to launch SLvirtual, LTC has started an online forum for its operating partners and other trusted industry partners.
“During these challenging times, we seek creative ways to help our partners and the industry as a whole,” Wendy Simpson, CEO and President, LTC Properties said.
— Industry associations ASHA and Argentum pushed back against an April 5 Wall Street Journal article.
“Assisted-living facilities, a booming but lightly regulated industry that houses roughly a million elderly patients in Florida and across the nation, are ill-prepared for the novel coronavirus, some health authorities say,” the article began.
The industry groups took issue with the idea that assisted living communities are less prepared than other settings for Covid-19, and pointed out the systemic challenges related to a lack of supplies and testing.
“As with most every other operator across myriad industries, if assisted living had access to quick-acting testing kits and PPE, we could further protect our vulnerable population and continue to keep most of our residents out of the hospital, allowing our health care system to focus on those with life threatening conditions,” the associations stated. “The fact of the matter is that assisted living residents are much safer living in our communities than they would be living by themselves with the physical and cognitive impairments that characterize most of those we care for.”
— A Place for Mom is launching a new ad campaign in light of Covid-19. “As the national healthcare system becomes increasingly burdened, APFM has received a myriad of inquiries from families facing pressing and difficult decisions,” the company stated in a press release. “They need access to the latest information available and support as they seek to keep their loved ones safe amid quarantines and expedited hospital discharges.”
A Place for Mom also is adding its voice in calling for more Covid-19 tests, supplies and other resources for senior living providers. A recent APFM survey found that more than 90% of the 17,000 senior living communities in its network are accepting move-ins, and about 450 of their community partners is capable of doing Covid-19 testing on site.
— Carlsbad, California-based Integral Senior Living (ISL) and the independent living brand the company created, Solstice Senior Living, plan to hire 300 new associates for a range of positions.
“We know that there are a lot of displaced workers out there right now, and we want to do our part to help by offering employment opportunities to those who have lost their jobs,” said Collette Gray, president and CEO of ISL and Solstice, in a press release issued Friday. “The health and well-being of our residents is our top priority, and our associates are at the heart of caring for our country’s most vulnerable population. Because of Covid-19, we’re in need of passionate, hardworking people more than ever.”
ISL manages independent living, assisted living and memory care communities across 20 states and is one of the 20 largest operators nationally.
Many other senior living providers — including Avamere and Solera — are making an aggressive hiring push, as they have elevated labor needs due to Covid-19 at a time when many other industries have experienced mass layoffs.
— Funding has exploded for tech startups that could address challenges related to Covid-19.
“In particular, telemedicine startups saw a 1818% YoY increase in funding. And mental health, an otherwise underfunded health sector, saw a 65% increase in funding, suggesting the pandemic could shine a light on previously overlooked areas for health innovation,” StartUp Health stated in an email on Friday, drawing on its Q1 Insight report.
Senior housing providers are among those driving the strong demand for these types of tech solutions.
Bulletin for Thursday, April 2, 2020:
Juniper Communities today began offering Covid-19 tests to all of its residents and employees as a preventative measure to stop the spread of the disease.
The Bloomfield, New Jersey-based senior living provider procured the nasal swab tests through private/commercial vendors using CDC-qualified reagents and operating under the FDA’s Emergency Use Authorization.
The lack of tests has been a major pain point in the national response to the coronavirus pandemic, and has hampered senior living providers in their efforts to create strategic mitigation efforts. As for how Juniper was able to secure tests, CEO Lynne Katzmann has a simple answer: cold calling labs.
“We smiled and dialed until we found someone we could work with,” she told Senior Housing News.
Testing has now become more widely available than in the early days of the U.S. outbreak, and Juniper is not the only provider to make tests available to residents and staff. Atlas Senior Living may have been the first to do so, announcing its partnership with a testing lab on March 22.
Juniper is not taking tests away from other medical providers or hospitals, the company stated in a press release on Thursday.
Ramping up testing is necessary, as Juniper needs actionable data in its plan to prevent the spread of Covid-19, according to Katzmann. Based on the results of the tests, the company will be able to take several actions, including:
— Confirm symptomatic individuals for isolation
— Identify asymptomatic individuals for segregation
— Change staffing patterns to limit cross-contamination
Juniper is going through a “rigorous stratification process,” which will be further accelerated by the testing, in which residents who test positive for Covid-19 but are healthy enough to stay in the senior living setting receive care in particular parts of buildings, from dedicated staff members fully equipped with protective equipment, Katzmann told SHN. While the availability of PPE has been a tremendous concern for senior living providers, Juniper’s inventory is adequate and being distributed via three central stockpile locations, she added.
Although she declined to share the cost of testing, Katzmann said it is not expensive, particularly when considered in light of the enormous costs that can be avoided through better Covid-19 detection.
The tests are not accurate in every single case, but Juniper believes that accuracy in the 70% to 80% range will be a major step forward in how the company can respond to the pandemic. Initially, test results will take a few days, but Katzmann hopes that more rapid tests will become available soon.
“We’ve successfully cared for residents through natural disasters such as Hurricane
Irma without loss of life. This is the greatest challenge we have ever faced,” she stated in Thursday’s press release. “Full testing is clearly the correct next step.”
Also in the news:
— The $2 trillion CARES Act contains a provision that could help infuse more cash into the senior living industry — but there are new questions regarding whether the program will be ready by the time it officially launches.
The provision, known as paycheck protection program (PPP), is meant to help small businesses retain their workforce with forgivable loans. Companies harmed by Covid-19 as early as Feb. 15 and with 500 or fewer workers can apply for up to a $10 million Small Business Administration (SBA) 7(a) loan under the program to be used for payroll and some other expenses, including mortgage payments and utilities. The only catch for loan forgiveness is that the businesses must keep or quickly rehire their employees while maintaining salary levels throughout the pandemic’s duration.
But now there are questions as to whether the government-backed loan program will launch April 3 as originally planned. Specifically, lenders say Friday’s deadline is unrealistic and the program is fraught with unworkable guidelines and requirements, according to an April 2 story on Politico. These issues may delay the program’s implementation by weeks or more.
—- Diversified Healthcare Trust’s (Nasdaq: DHC) board of trustees has reduced the company’s regular quarterly cash dividend on its common shares for the first quarter to $0.01 per share, a move they expect will conserve about $33.3 million per quarter this year.
The dividend will be paid to the company’s shareholders on April 13 and distributed on or about May 21, the company said.
Diversified Healthcare Trust also deferred some previously planned capital investments that are expected to save up to $150 million in 2020. The company said it will later this year reevaluate all of the capital projects it deferred.
And although the company closed on the sale of four assets for approximately $56 million since the fourth quarter of 2019, it expects the pace of sales will slow considerably in the future.
The moves were made in response to the operating challenges and uncertainty of the Covid-19 pandemic. The company reported 41 confirmed cases of Covid-19 in its managed and leased properties, including 31 residents and tenants and 10 employees across 23 properties, primarily in its SHOP portfolio.
“We continue to carefully monitor developments related to the virus and support our senior living manager, Five Star Senior Living, and tenants following recommendations provided by the CDC and federal, state and local regulatory authorities,” Diversified Healthcare Trust President and COO Jennifer Francis said in a statement. “From a financial perspective, we believe we are taking all of the appropriate steps to preserve capital, maintain liquidity, and meet our debt obligations during this crisis.”
— The senior living and long-term care industries’ top associations on Thursday released a joint statement calling for more actions to protect frontline caregivers during the Covid-19 pandemic.
The leaders of ASHA, LeadingAge, NIC, Argentum, ASHA/NCAL all co-signed a statement emphasizing there is more to do to protect frontline health care workers caring for people affected by Covid-19 IN senior housing and skilled nursing communities across the U.S.
Specifically, the industry leaders called for the prioritization of testing for frontline caregivers, an increased availability of personal protective equipment (PPE) and more creative solutions to help meet workers’ personal and family obligations.
— Humana Inc. (NYSE: HUM) has announced it’s implementing more streamlined claims processing to get reimbursement payments to providers as quickly as possible and help ease their financial concerns as the Covid-19 pandemic rages on.
The company also said it’s expanding its policy of suspending prior authorization and referral requirements. The company is now requesting notification within 24 hours of inpatient and outpatient care. The move is applicable for all providers, regardless of network affiliation, for patient care related to Covid-19; and applicable for in-network provider for patient care not directly related to Covid-19. The move will allow for easier transfer of hospital patients to alternative sites of care, including senior care communities.
The policies are applicable for covered plan benefits under individual and group Humana Medicare Advantage, Medicaid and employer-sponsored plans.
— Compass Senior Living is paying its employees extra this month to show appreciation for their efforts amid the Covid-19 pandemic.
The Eugene, Oregon-based provider is paying all of its team members a bonus equal to 10% of earned wages for the month of April. The bonus applies all wages earned, including regular and overtime hours.
Compass said it will pay out the bonus on May 8.
Bulletin for Wednesday, April 1, 2020:
Welltower (NYSE: WELL) reported Wednesday that 116 of its residents in 45 of its communities were affected by Covid-19. The Toledo, Ohio-based REIT has also made headway on procuring PPE and is opening a new distribution center in Dallas.
Occupancy for the company’s senior housing operating portfolio (SHOP) was 85.4% as of March 27, a decrease compared to the 85.6% occupancy rate the company reported on March 13, 2020, and the 85.8% rate it reported on February 28.
Looking forward, Welltower expects more declines due to the limitation of tours at many of its communities and restrictions on resident move-ins. The portfolio’s operating expenses also rose in recent weeks, as the Toledo, Ohio-based real estate investment trust (REIT) has seen an increase in labor costs as well as an uptick in costs related to personal protective equipment (PPE) and medical supplies.
But Welltower said it’s making good progress on amassing a stockpile of PPE for use by its operators’ workers.
On Wednesday, the company said it had already procured or is working to procure 400,000 pairs of gloves, 250,000 facemasks, and 120,000 isolation gowns. The company also reported stocking up on hand sanitizer, disinfectants and no-touch thermometers. The REIT will distribute these supplies from a newly established center in Dallas. There, the company will receive bulk orders from suppliers and group purchasing organizations, along with new supply chains.
Welltower has also bulked up on Covid-19 testing kits, and has begun building new relationships with regional and national lab providers for testing capabilities. And, through an existing relationship with the University of California San Francisco’s (UCSF) Clinical Innovation Center, the REIT has connected its operating partners with experts who can provide guidance on interfacility transfers, staff screening and safety, and testing protocols.
“Amongst a host of other initiatives, we have provided resources designed to support telemedicine solutions to avoid subjecting residents to unnecessary risk of infection and to triage in-place residents,” the REIT wrote in a business update Wednesday. “Welltower is committed to further engagement with parties across the health care sector to explore any and all solutions which will benefit our operating partners.”
Also in the news:
— Brookdale Senior Living (NYSE: BKD) announced Wednesday that it completed three financing transactions totaling $208.5 million. The deals allow the Brentwood, Tennessee-based operator to refinance the majority of its near-term debt maturities, as well as partially fund recent acquisitions.
On March 31, Brookdale received $149.3 million in mortgage financing from Capital One. The refinancing took the form of ten-year nonrecourse fixed and variable rate loans of $76.2 million and $73.1 million, respectively, resulting in proceeds of $13 million.
The operator also completed a $30 million refinancing package with BBVA USA, and a $29.2 million package from Berkadia under the Fannie Mae DUS program. The collateral used to secure these loans were communities acquired from National Health Investors (NYSE: NHI) and Healthpeak Properties (NYSE: PEAK).
— Georgia Governor Brian Kemp announced the deployment of 100 National Guardsmen to assisted living facilities and nursing homes across the state to help contain the spread of the coronavirus, according to the Atlanta Journal-Constitution. The move comes as Kemp is preparing a shelter-in-place order for the state.
The Georgia Health Care Association estimates more than 30 facilities across the state with residents who have tested positive for the virus. The Guardsmen will be used to audit sanitation methods, train staff on stricter infectious disease control protocols and clean facilities.
The Georgia Department of Public Health reports 4,638 confirmed cases of COVID-19. Of those, 139 have died.
— Juniper Communities and the American Seniors Housing Association (ASHA) have partnered with Music Theatre International to launch “Send in the Gowns,” an initiative encouraging the public to gather or make personal protective equipment (PPE) and donate them to local senior housing communities across the country.
The initiative is specifically geared toward theater groups and costumers that would have access to materials and manpower to make facemasks, gowns and face shields for front line staff responding to the coronavirus pandemic. But anyone can participate.
Juniper and Music Theatre International have an existing relationship. The Bloomfield, New Jersey-based operator was among the first to pilot Music Theatre International’s “Broadway Senior” program, which gives seniors the opportunity to star in Broadway plays adapted especially for them.
“These costumes may not be glamorous, but they’re necessary to keep our residents and those who care for them safe during COVID-19,” Juniper CEO Lynne Katzmann said in a statement announcing the initiative.
The initiative comes as Department of Homeland Security officials told the Washington Post that the country’s emergency stockpile of PPE is critically low and close to being exhausted, despite assurances from the Trump administration that plenty of stock remains available.
Bulletin for Tuesday, March 31, 2020:
Atria Senior Living CEO John Moore says he is pleased with how the company is responding to the Covid-19 crisis.
“I couldn’t be prouder of how everybody at Atria is rising to the occasion,” Moore said in an interview with Louisville Business First (subscription). “We have resources and talent aimed at supporting all the communities everywhere. It’s going to sound overly simplistic, but I think, as a company we’re reacting smartly and working together. I’m confident that this is going to make us better at what we do.”
Louisville, Kentucky-based Atria is one of the largest senior living providers in the United States, operating more than 200 communities across the U.S. and Canada. Its Atria Willow Wood community in Fort Lauderdale has been particularly hard hit by the coronavirus, with six deaths, according to media reports. Florida Gov. Ron DeSantis criticized Atria for not going far enough in screening staff; in a statement, Atria said those comments from the governor were “inaccurate and unproductive.”
Moore did not tell Louisville Business First how many Atria residents have been diagnosed with or died due to Covid-19, but said that a “handful of communities” have confirmed cases.
“We’re worrying about it (the coronavirus) everywhere,” Moore told Louisville Business First. “We’re tracking anyone anywhere with symptoms.”
Also in the news:
— Hunt Valley, Maryland-based Omega Healthcare Investors (NYSE: OHI) has identified 57 confirmed Covid-19 cases across its portfolio, with 28 facilities impacted — all but one of those are skilled nursing facilities. Like other real estate investment trusts, Omega noted that its operators are experiencing cost increases. Some increases are related to labor — including overtime and bonus pay — as well as a “significant increase” in the cost and usage of personal protective equipment and supplies. The REIT has taken steps to shore up its liquidity and expects to update its earnings guidance when it releases Q1 2020 results.
— Fitch maintained a BBB- rating and negative outlook for Sabra Health Care REIT (Nasdaq: SBRA). The ratings agency looked favorably upon the REIT’s decision to reduce its upcoming quarterly dividend, made to provide additional liquidity in the face of coronavirus-related uncertainties and challenges.
— Nursing facility care is becoming harder for seniors to access due to Covid-19, according to Dr. Alexander Sasha Rackman, a geriatric medicine physician and assistant professor of medicine at Rush University Medical Center in Chicago. Older adults living at home are beginning to suffer from a lack of home health care services, as these providers curtail visits to prevent the spread of Covid-19, Rackman wrote in The Hill.
— California has postponed activities related to its Master Plan for Aging as the state responds to Covid-19.
Bulletin for Monday, March 30, 2020:
With senior living providers under financial pressure due to Covid-19, one of the largest ownership groups in the country — Chicago-based real estate investment trust Ventas (NYSE: VTR) — has established a rent deferral program for operators in triple-net leases. This group represents about 20% of Ventas’ portfolio by net operating income.
“Under the program, certain senior housing care providers who are Ventas tenants can defer 25% of their April 2020 payment obligation until the earlier of October 1, 2020 or receipt of government assistance,” the REIT stated in a document filed with the SEC on Monday. “All amounts deferred are required to be used for operating expenses to care for seniors at Ventas communities.”
Total April deferrals could be in the $3 million to $9 million range, Ventas estimates. The REIT collected “substantially all” of its March rent.
Government assistance for senior living operators could be coming through the recently signed $2 trillion stimulus package, which included $100 billion for health care providers. The package also included $500 billion in additional business assistance loans, some of which could flow to senior living providers as well.
Average occupancy in Ventas’ senior housing operating portfolio, which accounts for about 30% of the REITs’ overall NOI, has not been materially affected but trended lower in the second half of March, the company noted in Monday’s SEC filing.
“In addition, inquiries and tours have begun to decrease materially and move-ins have begun to slow,” the document states. “While there is not yet a clear trend, move-outs may become elevated as a result of the pandemic. Finally, operating costs have begun to rise as operators take actions to protect caregivers and residents and increase screening and infection control efforts. Each of these trends accelerated in the second half of March, and may accelerate further as the pandemic continues.”
Out of approximately 70,000 residents in its senior housing operating and triple-net portfolio, about 70 have so far received a positive Covid-19 diagnosis, while 25 staff members have been diagnosed. In all, 33 communities in Ventas’ portfolio have had a positive Covid-19 diagnosis.
The pandemic has put senior housing-focused REITs on a wild stock market ride, with their market caps drastically falling and then recovering somewhat last week as the overall market rebounded. Shares in Ventas were down 5.26% at the end of the trading day on Monday. The firm’s CEO, Debbie Cafaro, appeared on the CNBC show “Mad Money” last week and reassured investors of the company’s “solid and stable” financial position.
Also in the news:
— Executive officers with Dallas-based Capital Senior Living (NYSE: CSU) will not receive an increase in their base salaries for 2020, in light of “current economic conditions.” In addition, the CSU board’s compensation committee has enacted a temporary suspension on equity awards for all directors and officers of the company.
The compensation committee approved retention awards for Capital’s named executive officers and certain other executive officers, equal to 100% of current base salary, with 50% of the award contingent on continuous employment through Sept. 15, 2020, and the remainder contingent on continuous employment through March 15, 2021. Certain performance bonuses are also available to some of the executive officers.
— The Centers for Medicare & Medicaid Services (CMS) has further expanded telehealth flexibilities in response to Covid-19. The agency is now allowing more than 80 additional services to be furnished via telehealth. Providers can evaluate beneficiaries via audio only, bill for telehealth visits at in-person rates, and can utilize telehealth for emergency department visits, initial nursing facility and discharge visits, home visits and therapy services furnished by a clinician allowed to provide telehealth. Telehealth also can be used to fulfill many face-to-face visit requirements in home health, hospice and inpatient rehabilitation facilities.
— The Alzheimer’s Association — in conjunction with several senior living providers including industry giants such as Brookdale and LCS — issued an emergency preparedness guide with best practices in dementia care during Covid-19. The document covers topics such as preventing illness and ways to observe and respond to dementia-related behaviors. Many of these best practices hold true at any time, not just in emergency situations, but the guide may be especially helpful for those who are called on to provide dementia care specifically during the pandemic.
“Maintaining operations in long-term and community-based care settings with the expected staffing shortages during any pandemic, epidemic or disaster can be very challenging,” the document states. “During this time, non-clinical staff may be needed to assist with care.”
— Some family members are taking their loved ones out of senior living communities due to Covid-19, but the decision is a hard one and sometimes results in a discharge, CNN reported: “Another concern in bringing someone home: Some facilities are telling residents that if they leave, even temporarily, they can’t return. That happened to a family in western New York, according to Roxanne Sorensen, a geriatric care manager with Elder Care Solutions of WNY. When this family took their elderly parents out of an assisted living facility for a brief ‘stay-with-us’ respite, they were told the parents had been discharged and had to be placed on a waiting list before they could return.”
Bulletin for the weekend of March 28 and March 29:
Senior living providers are considered “health care providers” and therefore are exempt from certain requirements of the Families First Coronavirus Response Act (FFCRA) related to providing paid leave for employees during the Covid-19 outbreak.
President Trump signed the FFCRA on March 18. The act stated that employers with fewer than 500 employees had obligations to offer 10 days of paid sick leave and up to 12 days of paid leave for employees who needed to care for children due to school closures, if certain criteria were met. However, exemptions were available to health care providers; senior living industry groups Argentum and the American Seniors Housing Association (ASHA) pushed for the Department of Labor to clarify the definition of “health care provider” and to include senior living under that definition.
The DOL clarified the definition of “health care provider” in a Q&A document issued Saturday.
“For the purposes of employees who may be exempted from paid sick leave or expanded family and medical leave by their employer under the FFCRA, a health care provider is anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, employer, or entity,” the document states.
Senior living was not the only health care industry to raise concerns over the FFCRA. For instance, some home health industry voices also warned that the child care-related requirements could be financially unsustainable and winnow the ranks of workers at a time when they are needed on the frontlines of caregiving. Argentum and ASHA joined with home health and home care industry groups to make their case in a March 23 letter to U.S. Secretary of Labor Eugene Scalia.
“We are gravely concerned, based on prior experience, that absent an exemption from the requirements … we will lack an available workforce able to deliver much needed home health and residential care,” that letter stated.
Many senior living providers are offering paid sick leave and child care benefits to employees in some form. Wilsonville, Oregon-based Avamere, for instance, is offering full pay for any employee who has to miss work due to a Covid-19 quarantine, and is providing up to $50 a day in child care reimbursement.
Also in the news:
— Policies that require nursing homes or assisted living communities to accept “surge” patients from hospitals to free up beds for Covid-19 patients are “short-sighted” and could end up making the problem worse, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and AMDA the Society for Post-Acute and Long-Term Care Medicine warned in a letter issued Sunday.
The groups specifically cited an order in New York state under which nursing homes are cannot deny admission or readmission based “solely” on a confirmed or suspected Covid-19 diagnosis.
“The question all state officials must consider is whether the risk of introducing a virus with an estimated 30% or higher mortality rate into a nursing home or assisted living community outweighs the risk of hospitals being overcrowded,” the letter states. “Regrettably, this is a difficult decision that many officials will be facing now or in the near future.”
Even more than nursing homes, assisted living communities and CCRCs are not equipped to handle “medically complex surge-related discharges,” the letter noted.
— Debt and equity providers are signaling that they will commit to deploying capital until the pandemic subsides and a clearer picture of the economic landscape emerges, according to a state of the market report from Chicago-based lender, Helios Healthcare Advisors.
Lenders are still moving forward with completing previously committed transactions and will focus on existing clients in the short-term.
“Some sophisticated conventional lenders, specialty finance and non-bank lenders who hold large portfolios of healthcare and healthcare real estate loans still open to new business and intend to ‘cherry pick’ best opportunities, however pricing, advance rates, and credit standards are becoming more conservative,” the report notes.
Helios’ analysis echoes observations from panelists during a Thursday webinar on the market landscape hosted by the National Investment Center for Seniors Housing & Care (NIC). The panelists on that webinar warned of “peak volatility” for the industry, but that senior housing is a more stable real estate product than other commercial sectors, and its need-based, recession-resilient components open it up to available sources of liquidity.
— The House of Representatives passed the $2 trillion coronavirus stimulus package on Friday and President Trump signed it, but it was not without some drama.
The House was set to pass the package in a voice vote Friday morning until Rep. Thomas Massie (R – Kentucky) held up the move in favor of a recorded vote.
Massie’s move forced scores of lawmakers on both sides of the aisle scrambling to return the capital, and he was roundly criticized by members of both parties and President Trump, who signed the bill into law.
Senior living providers dealing with mounting expenses responding to the outbreak will be able to apply for relief through a $100 billion public health and social services emergency fund and a $500 billion stabilization fund. The package also includes tax relief measures that can benefit operators.
— Echoing other senior living executives, Notre Dame Health System President and CEO Wayne Plaisance said that personal protective equipment (PPE) is in short supply and “not available at any price.” The Notre Dame system includes three senior housing and care communities in the New Orleans area, one of which — Chateau de Notre Dame — has been identified as a coronavirus cluster by the Louisiana Department of Health.
— An associate at a Brookdale Senior Living community in West Lake Hills, Texas has tested positive for Covid-19, according to KXAN-TV.
The associate has been placed in quarantine and will not be allowed to return to work until testing negative for the virus. Residents, family members and fellow staff have been informed of the situation, and Brookdale is monitoring residents and working with local public health officials to monitor the community for further signs of an outbreak, Brookdale spokeswoman Heather Hunter told the station.
Many of the nation’s largest senior living providers — including Atria Senior Living, Sunrise Senior Living and Five Star Senior Living — are now responding to positive diagnoses of Covid-19 either a
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