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 Thursday, May 28, 2020:

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

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

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

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

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

Also in the news:

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

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

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

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

Bulletin for Wednesday, May 27, 2020:

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

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

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

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

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

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

Also in the news:

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

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

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

Bulletin for Friday, May 22 – Monday, May 25

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

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

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

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

Also in the news:

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

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

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

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

Bulletin for Thursday, May 14, 2020:

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

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

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

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

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

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

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

Also in the news:

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

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

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

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

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

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

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

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

Bulletin for Monday, May 11, 2020:

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

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

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

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

Also in the news:

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

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

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

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

Bulletin for Thursday, May 7, 2020:

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

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

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

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

Also in the news:

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

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

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

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

Bulletin for Tuesday, May 5, 2020:

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

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

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

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

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

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

Also in the news:

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

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

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

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

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

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

Bulletin for Tuesday, April 28

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

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

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

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

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

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

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

Also in the news:

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

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

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

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

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

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

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

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

Bulletin for Monday, April 27

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

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

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

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

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

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

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

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

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

Also in the news:

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

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

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

Bulletin for Friday, April 24 – Sunday, April 26

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

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

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

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

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

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

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

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

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

Some other notable findings from the survey:

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

Also in the news:

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

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

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

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

Bulletin for Thursday, April 23, 2020:

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

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

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

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

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

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

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

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

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

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

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

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

Also in the news:

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

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

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

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

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

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

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

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

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

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

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

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

News for Wednesday, April 22, 2020:

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

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

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

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

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

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

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

Also in the news:

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

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

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

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

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

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

Bulletin for Tuesday, April 22, 2020:

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

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

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

“We feel we are alone in a war zone.”

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

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

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

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

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

Also in the news:

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

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

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

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

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

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

— Confirmed Covid-19 cases in California assisted living communities