“Organizations reporting an increase in the pace of move-ins has held steady now for several consecutive waves. When the BA.4 and BA.5 variant surge occurred in summer of 2022, the rate dropped from more than 50% of operators reporting an increase in the pace of move-ins to the current ~40%. Operators may now be combatting what is being referred to as the ‘tripledemic’ – a collision of RSV, influenza, and COVID-19 that is sickening millions – which may be tempering move-ins.
Lead volumes being reported are higher now than in most previous waves, but as noted above with the pace of move-ins holding steady, the reported increase in lead volumes is not yet materializing with move-ins."
--Ryan Brooks, Senior Principal, NIC
This Wave 48 survey includes responses from November 14 to December 11, 2022, from owners and executives of 40 small, medium, and large senior housing and skilled nursing operators across the nation, representing hundreds of buildings and thousands of units across respondents’ portfolios of properties. More detailed reports for each “wave” of the survey and a PDF of the report charts can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.
New questions in the Wave 48 survey asked about the impact of the current operational environment (occupancy rates, operating expenses, inflation, etc.) on the ability to service debt as well as the impact of increased interest rates on the ability to service debt.
With regard to the impact of the current operational environment on the ability to service debt, almost half (44%) of nursing care operators reported there was no impact, followed by one-third of assisted living, independent living, and memory care operators. Comparatively, one quarter of assisted living and nursing care operators reported the current environment had a significant impact on their ability to service debt, while one-fifth of independent living and memory care operators reported a significant impact.
When specifically asked what impact the increase in interest rates has had on their ability to service debt, nine in ten (89%) nursing care operators report no impact on their ability to service their debt as a result of increased interest rates. This is followed by two-thirds of assisted living (64%) and memory care (63%) operators, and finally independent living, of which 58% reported no impact to their ability to service debt. As for operators reporting a significant impact on their ability to service their debt, 15% of assisted living and memory care operators report significant impact, as did 13% of independent living operators. No nursing care operators reported the increase in interest rates has had a significant impact on their ability to service their debt.
Organizations reporting an increase in the pace of move-ins has held steady now for several consecutive waves. When the BA.4 and BA.5 variant surge occurred in summer of 2022, the rate dropped from more than 50% of operators reporting an increase in the pace of move-ins to the current ~40%. Operators may now be combatting what is being referred to as the ‘tripledemic’ – a collision of RSV, influenza, and COVID-19 that is sickening millions – which may be tempering move-ins.
Lead volumes being reported are higher now than in most previous waves, but as noted above with the pace of move-ins holding steady, the reported increase in lead volumes is not yet materializing with move-ins.
Regarding the current share of all full-time open positions across respondent organizations, in the Wave 48 survey, approximately two out of five respondents have between 10% and 20% of full-time positions unfilled, whereas roughly one in five respondents have 20% or more positions currently unfilled. This is an improvement from the Wave 42 findings from June 2022, where one-half of respondents had between 10% and 20% of full-time positions unfilled and another one in five had 20% or more full-time positions unfilled.
When asked about backfilling staff shortages, nearly all respondents (93%) reported paying overtime in Wave 48, and two out of three respondents are currently tapping agency or temp staff (68%). Other identified strategies for finding needed staff include the creation of a dedicated corporate recruiter, shift incentives, and partnering with organizations outside of the senior housing and care industry. Of those organizations currently utilizing agency or temp staff, one-half expect their reliance on agency staff to decrease in the next six months. Slightly under one-half (44%) expect their utilization to stay the same, and only 5% expect their agency utilization to increase.
There is evidence provided in the Executive Survey Wave 48 that there may be a sign of relief coming with regards to the industry’s staffing challenges. One-third of respondents (31%) anticipate staffing challenges will improve in the first six months of 2023 while another one-third (36%) anticipate improvements in the second half of 2023. About one in six respondents (17%) anticipate it will take until 2024 before staffing challenges improve and finally, one in six (17%) predict the staffing challenges will remain until at least 2025.
While there may be indications of improvement on the staffing front, staffing and labor challenges certainly persist. When asked whether they were currently experiencing a staffing shortage, 90% of respondents indicated that they were. Of these organizations reporting a staffing shortage, one-third are experiencing the shortage in the entirety of their property portfolio, while another one-third are experiencing the shortage at more than 50% of their properties.
When asked about providing rent concessions, approximately one-third of respondents indicate they are offering rent concessions to attract new residents. Over the last four waves in which this question was asked, there has been a consistent decline in the rate of organizations offering rent concessions. At the beginning of 2022, Wave 37 findings show almost half (47%) of respondents were offering rent concessions. In November and December of 2022, Wave 48 findings show just over one-third (38%) of respondents are offering rent concessions.
In the Wave 48 survey, there were no organizations offering rent concessions in all their properties, down from 7% in Wave 46 and 20% in Wave 41. Conversely, almost one-half (45%) of organizations are currently offering rent concessions in just 0-25% of their properties, while one-third (36%) are currently offering rent concessions in 26-50% of their properties. Of organizations who are currently offering rent concessions, the most common forms being offered are rent discounts (39%), followed by free rent for a specific period of time (26%), upgrades to units (13%), and rent freezes (13%).
Wave 48 Survey Demographics
- Responses were collected between November 14 and December 11, 2022, from owners and executives of 40 senior housing and skilled nursing operators across the nation.
- Owners/operators with 1 to 10 properties comprise roughly two-thirds (63%) of the sample. Operators with 11 to 25 properties account for 25%, and operators with 26 properties or more make up the rest of the sample with 13%.
- Half of respondents are exclusively not-for-profit providers (50%), just under one-half operate for-profit seniors housing and care properties (48%), and 3% operate both.
- Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 63% of the organizations operate seniors housing properties (IL, AL, MC), two-thirds (38%) operate CCRCs – also known as life plan communities, and 13% operate nursing care properties,
This is your survey! Owners and C-suite executives of seniors housing and care properties, please help us tell an accurate story about our industry’s performance. While some standard questions will remain for tracking purposes, in each new survey wave, new questions can be added based on respondents' suggestions. Please let us know what you think.
Wave 49 of the ESI is now live. The current survey is available and takes ten minutes to complete. If you are an owner or C-suite executive of seniors housing and care and have not received an email invitation to take the survey, please contact Ryan Brooks at email@example.com to be added to the list of recipients.
NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to provide the broader market with a sense of the evolving landscape as we recover from the pandemic.
About Ryan Brooks
Senior Principal Ryan Brooks works with the research team in providing research, analysis, and contributions in the areas of healthcare collaboration and partnerships, telemedicine implementation, EHR optimization, and value-based care transition. Prior to joining NIC, he served as Clinical Administrator for multiple service lines within the Johns Hopkins Health System, where he focused on patient throughput strategies, regulatory compliance, and lean deployment throughout the organization. Brooks received his Bachelor’s in Health Services Administration from James Madison University and his Master’s in Business Administration from the University of Maryland.
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