NIC’s Executive Survey of operators in seniors housing and skilled nursing is designed to deliver transparency into market fundamentals in the seniors housing and care space at a time where market conditions are rapidly changing—providing both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions.

This report is a subset of the findings from NIC’s Executive Survey. Highlights of the responses from owner/operators of CCRC organizations are compared to responses from non-CCRC owner/operator organizations collected near the beginning of the COVID-19 pandemic through the end of May. Detailed reports for each “wave” of the survey can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Key Findings

1. The COVID-19 pandemic has caused the pace of move-ins for all seniors housing and care communities to slow. However, CCRC properties have experienced less disruption on move-in rates and have seen greater stability in occupancy rates than non-CCRC properties.
2. The impact of the virus among non-CCRC seniors housing and care properties has been swifter and more significant than for CCRCs.
3. The pace of move-outs for CCRC properties has been less effected than for non-CCRC properties over the course of the pandemic to date. More non-CCRC organizations have reported growing shares of acceleration in move-outs by care segment than CCRCs.
4. The largest impact on move-ins and move-outs among care segments has been on nursing care. As the highest acuity care segment, nursing care has experienced the most negative impact of the COVID-19 pandemic on occupancy levels and this has grown over time.

Pace of Move-Ins and Move-Outs

• Approximately one-third to one half of CCRC organizations reporting on their independent living, assisted living, and memory care units in Waves 6 and 7, across their respective portfolios of properties, saw a deceleration in move-ins from the prior month (52%, 42% and 32%, respectively). This compares to 42%, 31% and 21% in Waves 1 and 2—amounting to roughly a ten-percentage point difference—highlighting the growing influence of the COVID-19 pandemic on move-ins as time has passed.
• In contrast, the virus’s effect on move-in patterns among non-CCRC seniors housing and care segments was more significant. Approximately two-thirds to three-quarters of non-CCRC organizations reporting on their independent living, assisted living, and memory care units in Waves 6 and 7 saw a deceleration in move-ins from the prior month (65%, 72% and 68%, respectively). This compares to 67%, 69% and 62% in Waves 1 and 2.
• The CCRC memory care and assisted living segments reported the least change in the pace of move-ins in both timeframes, and the CCRC memory care segment saw a greater share of acceleration in move-ins in across the board in Waves 6 and 7.

• The largest impact among care segments has been on nursing care. Nearly two-thirds of the sample’s CCRC organizations with nursing care beds (65%) saw decelerations in the pace of move-ins in Waves 6 and 7, compared to just over half in Waves 1 and 2 (53%). However, more non-CCRC organizations with nursing care beds noted declines in the pace of-move-ins. Nearly three-quarters of the survey sample’s non-CCRC organizations with nursing care beds (73%) noted decelerations in the pace of move-ins more recently than in the earlier days of the COVID-19 crisis (68%).
• There is greater stability in the pace of move-outs reported by CCRC organizations compared to non-CCRC organizations. A potential reason for this survey finding could be that CCRCs offer multiple care segments (at a minimum, independent living and nursing care) typically by a single provider on one campus, and this full range of services allows residents to remain within the community as their care needs change.
• The majority of both CCRC and non-CCRC respondents noted no change in the pace of move-outs across the duration of the pandemic to date, apart from the non-CCRC nursing care segment. However, for non-CCRC properties, each care segment showed larger shares of organizations reporting an acceleration in move-outs as the COVID-19 pandemic progressed.

• Some possible explanations for the relatively better performance of CCRCs during the pandemic may include the following considerations:
  • While many CCRCs accept nursing care residents from outside of the community, the majority guarantee access to current residents. Furthermore, non-CCRC organizations with nursing care beds may have seen a greater effect on move-ins as the virus caused hospitals to curtail elective surgeries, reducing the amount of short-term, rehabilitation residents.
  • Non-CCRC residents tend to move in older and have more care needs, especially in the higher acuity settings. CCRC residents, on the other hand, tend to enter the independent living care segment of the community at younger ages and in better health both physically and cognitively, having planned to live on a campus that can meet any care needs they may have in the future without having to make a move from the community.
  • Multiple levels of care often spread out across a large footprint may make it easier for CCRC operators to distance vulnerable residents from others augmenting protection from contagion that is harder to do in properties that are home to residents with more diversity of care needs under one roof.

Changes in Occupancy Rates

• The highest acuity segments have experienced the most negative impact of the coronavirus on occupancy levels and this has grown over time. Shares of CCRC and non-CCRC organizations reporting a decrease in occupancy in the past 30-days are higher in Waves 6 and 7 than in Waves 1 and 2.
• The nursing care segment for both CCRCs and non-CCRCs reported the highest shares of organizations with occupancy declines over time (from 61% to 67% for CCRCs and from 68% to 78% for non-CCRCs).
• The memory care and assisted living care segments have seen the most change in occupancy from earlier in the pandemic to recently. Roughly three-quarters of CCRC organizations with memory care segment units (73%) and more than half with assisted living (59%) reported no change in occupancy from the month prior in Waves 1 and 2 compared to 43% and 47%, respectively, in Waves 6 and 7.
• Conversely, among the same non-CCRC care segments, there were more organizations reporting a deceleration in occupancy which widened over time—from 49% to 75% in assisted living—and from 42% to 70% for memory care.
• The independent living care segment has seen less downward pressure on occupancy compared to the assisted living, memory care and nursing care segments. Only about one-third of CCRC organizations reported occupancy declines in independent living between when the survey began to recent times (29% and 33%, respectively). However, more non-CCRC organizations with independent living reported occupancy declines in both timeframes (42% and 63%, respectively).

In conclusion, while the pace of move-ins has decelerated with the progression of the COVID-19 pandemic across all types of seniors housing and care communities, CCRCs have experienced less disruption, translating into more occupancy stability than non-CCRCs. 

These survey results are consistent with what has been reported in the NIC MAP^® data analysis of the performance of CCRC care segments compared to non-CCRC care segments in the past. As detailed in a recent blog post breaking down the market fundamentals at the care segment-level, CCRCs have reported stronger occupancy rates than freestanding and combined non-CCRC care segments.

During the great recession, CCRCs struggled with declining occupancy due to a strong development pipeline that delivered inventory during a devastated housing market, which made it difficult for residents to sell their homes to move into CCRCs. Additionally, adverse and uncertain economic conditions raised barriers to moving into choice-based, lifestyle-focused CCRCs. However, CCRC occupancy rebounded during the recovery period following the great recession, and since then, CCRC inventory growth has been muted compared to other seniors housing property types. For the past several years, CCRC occupancy rates have outpaced their non-CCRC counterparts.

Going forward, CCRCs entered the COVID-19 pandemic from a position of relative occupancy strength and have performed better than non-CCRCs in terms of move-ins, move-outs and changes in occupancy rates. Time will tell how well CCRCs will weather the current COVID-19 crisis and potential economic consequences to come.

Survey Demographics

• Waves 1 and 2 responses combined, collected between March 24 and April 12, 2020, included 48 responses from owners and executives of CCRC operators. Single-site CCRC operators made up 60% of the sample, and 96% of the organizations responding were exclusively nonprofit owner/operators.
• Non-CCRC operators included 148 responses from owners and executives. The Waves 1 & 2 combined sample was comprised of 75% multi-site operators (5 or more properties). The majority (82%) were exclusively for-profit providers.
• Waves 6 and 7 responses combined, collected between April 27 and May 24, 2020, included 51 responses from owners and executives of CCRC operators. Single-site CCRC operators made up 75% of the sample, and 94% of the organizations responding were exclusively nonprofit owner/operators.
• Non-CCRC operators included 218 responses from owners and executives. The Waves 6 & 7 combined sample was comprised of 74% multi-site operators (5 or more properties). The majority (78%) were exclusively for-profit providers.

NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and transparency into market fundamentals in the seniors housing and care space at a time where trends are rapidly changing. Your support helps provide both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions. 

If you are an owner or C-suite executive of seniors housing and care properties and have not received an email invitation but would like to participate in the Executive Survey, please click here for the current online questionnaire.

Operators and staff of nursing homes are facing enormous challenges. To help nursing homes tackle these challenges with pragmatic and real-time solutions, the Institute for Healthcare Improvement, with support from the John A. Hartford Foundation, has launched a free COVID-19 Rapid Response Network for Nursing Homes. 

The Rapid Response Network offers a daily 20-minute National Nursing Home Huddle that includes solutions that can be implemented immediately to address key challenges posed by COVID-19. Its goal is to support nursing home leadership, staff, residents, families, and communities impacted by the pandemic.

So far, these huddles have included creative ideas to help with the most pressing challenges faced by nursing home and long-term care staff and residents. Representatives from organizations such as the CDC have also participated to provide data and policy updates. Topics have included PPE, testing and screening, hospital to nursing home transfers, staff illness and absences as well as the emotional well-being of staff and residents.

Institute for Healthcare Improvement states the following as benefits of participation:

• Immediate access to specific, pragmatic guidance on clinical and operational issues confronting the nursing home community today. Guidance will be focused and ready to implement.
• Ability to speak with a collective voice to federal and state policy makers, regulators, health care systems, and others to help remove policy and regulatory barriers to mission-critical operational challenges.
• Access to tools and materials to help explain the work of nursing homes and promote participation in the COVID-19 Rapid Response Network for Nursing Homes. These tools will help nursing homes communicate with local media outlets about efforts to serve and protect residents and staff.

To learn more and to sign up to participate in the free daily huddles, visit the Institute for Healthcare Improvement registration page.

First Monthly Data Release from NIC’s Skilled Nursing Data Initiative

Data Ending March 2020 Shows 132-Basis Point Decline in Occupancy from February.

In response to rapid market changes caused by the COVID-19 pandemic and its impact on the skilled nursing industry, NIC has increased the data release frequency for key performance metrics. Starting now and going forward, NIC will release data from its Skilled Nursing Data Initiative on a monthly basis. NIC will post data through April 2020 by July 7, 2020. Key points from the first monthly release with data from January 2012 through March 2020 are summarized below. 

1. The initial effects of the COVID-19 pandemic were evident on skilled nursing occupancy in March, with a 132-basis point decline from the prior month and a 53-basis point decline from year-end 2019 to 83.4% in March 2020. This pushed the occupancy rate to its lowest level since NIC began collecting the data in 2012. Larger impacts are anticipated in April when the pandemic was significantly more pervasive. Occupancy usually increases from the fourth quarter to the first quarter given the flu season and higher admissions in the winter months, but the coronavirus changed that pattern as a result of hospital transfers associated with the illness and fewer admissions related to post-acute elective surgery care needs. Furthermore, occupancy decreased year-over-year as it slipped 134 basis points from March 2019.
2. Skilled mix increased 17 basis points from the fourth quarter 2019 to end March 2020 at 25.3% as Medicare and managed Medicare patient day mix increased from December 2019. However, there was a drop in both Medicare and managed Medicare from February to March 2020, falling 18 basis points and 46 basis points, respectively. These declines suggest the pressure on new post-acute admissions began in the month of March as COVID-19 started to impact skilled nursing properties. The pressure on Medicare and managed Medicare in March resulted in skilled mix decreasing 59 basis points from February to March 2020. Skilled mix also showed a decline year-over-year as it decreased 60 basis points from March 2019.
3. Overall managed Medicare revenue mix continued to hover around 10%. Managed Medicare revenue mix initially increased as expected in the first quarter of 2020, rising from 9.9% in December to 10.4% in January to 10.8% in February 2020 before slipping 76 basis points in March as COVID-19 likely started to impact managed Medicare admission due to various factors such as suspension of elective surgeries. Managed Medicare revenue mix was down almost two percentage points from a high-water mark of 11.9% in February 2019 due to continued revenue per patient day pressure and more recently the effects of the coronavirus.   However, over the longer-term since 2012, managed Medicare revenue mix has been in an upward trend increasing from 6.8% in January 2012.
4. Medicaid patient day mix held relatively steady in the first quarter of 2020, increasing slightly by 9 basis points from December 2019 to 67.1% at the end of March 2020. Compared with February, Medicaid patient mix increased 66 basis points as less of the patient population was likely associated with post-acute care, i.e., Medicare and managed Medicare stays were likely down due to the numerous measures implemented to contain COVID-19. This is notable and suggests that the occupancy decrease from February to March was mainly, if not all, due to the decreases in post-acute admissions.

   To get more trends from the latest data, please download the NIC Skilled Nursing Data Report. There is no charge for this report. The latest quarterly report will be released on June 10, 2020.

   This report provides aggregate data at the national level from a sample of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators in order to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form here. NIC maintains strict confidentiality of all data it receives.

A NIC report developed to provide timely insights from owners and C-suite operators and executives on the pulse of seniors housing and skilled nursing sectors.

NIC’s weekly Executive Survey of operators in seniors housing and skilled nursing is designed to deliver transparency into market fundamentals in the seniors housing and care space at a time where market conditions are rapidly changing—providing both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions. 

This week’s sample (Wave 7) includes responses collected May 11-May 24, 2020 from owners and executives of 155 seniors housing and skilled nursing operators from across the nation. Detailed reports for each “wave” of the survey can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Join other operators in the sector and participate in the next wave.

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Summary of Insights and Findings

While most organizations continue to report a deceleration in move-ins in the past 30-days, in Wave 7 of the survey, the shares of organizations reporting deceleration is the lowest—across each of the care segments—since the first two waves of the survey (data collected March 24-31 and April 1-12).

Reasons cited for a deceleration in move-ins continue to primarily be slow leads conversions/sales resulting in difficulty replacing residents who have passed away or moved out; however, about 20% fewer organizations cite an organization-imposed ban on move-ins in Wave 7 compared to Wave 4, as all of the states in the country have begun to loosen social and economic restrictions. About one-half of respondents continue to cite resident or family member concerns about moving in. Others note fewer hospital referrals and elective surgeries, and general concerns about the economy.

Most organizations continue to report no change in the pace of move-outs in the past 30-days. Of those that did experience an acceleration in the pace of move-outs, reasons cited include a growing percentage of residents transferring to higher levels of care. Other respondents cited nonspecific resident deaths and hospitalizations, resident or family member concerns and normal discharges.

Fewer organizations saw a decrease in occupancy compared to earlier survey waves. Respondents with assisted living and memory care segment units report slightly higher shares of stable or improving occupancy rates from a week ago. And, just over one-third of the organizations reporting on their nursing care segments, in two consecutive waves of the survey, note occupancy rate declines from one week prior (38% and 36%)—significantly lower than in Waves 5 and 4 (67% and 62%).

The percentage of residents that were tested for COVID-19 by care segment rose with acuity level. The operator average share of residents tested by segment ranged from 2.1% for independent living, 13.5% for assisted living, 18.2% for memory care and 24.0% for nursing care. These rates of testing are higher than the previous time frame, with the exception of the independent living segment.

Wave 7 Survey Demographics

• • Responses were collected May 11-May 24, 2020 from owners and executives of 155 seniors housing and skilled nursing operators from across the nation.
  • More than one half of respondents were exclusively for-profit providers (57%), about one-third (32%) were exclusively nonprofit providers, and 11% operate both for-profit and nonprofit seniors housing and care organizations.
  • Owner/operators with 1 to 10 properties comprise 58% of the sample. Operators with 11 to 25 properties make up 23% while operators with 26 properties or more make up 19% of the sample.
  • Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 77% of the organizations operate seniors housing properties (IL, AL, MC), 36% operate nursing care properties, and 33% operate CCRCs (aka Life Plan Communities).

Key Survey Results

Pace of Move-Ins and Move-Outs

Respondents were asked: “Considering my organization’s entire portfolio of properties, overall, the pace of move-ins and move-outs by care segment in the past 30-days has…”

• • In Wave 7 of the survey, between 65% and 59% of organizations reporting on their independent living, assisted living and memory care segments, and 75% of organizations with nursing care beds indicated that the pace of move-ins decelerated in the past 30-days.
  • The shares of organizations reporting a deceleration in move-ins in the past 30-days is the lowest, across each of the care segments, since the first two waves of the survey (data collected March 24-31 and April 1-12).
  • Approximately 40% of organizations with memory care and/or independent living segments and about one-third and one-quarter of organizations with assisted living units and/or nursing care beds saw no change or an acceleration in move-ins in the past 30-days.

Reasons for Deceleration in Move-Ins

Respondents were asked: “The deceleration in move-ins is due to…”

• • Significantly fewer respondents in Waves 7 and 6 cited an organization-imposed ban on settling new residents into their communities than in Waves 5 and 4 (41% and 46% vs. 59% and 61%, respectively).
  • In Wave 7 of the survey, in similar proportions to the prior three waves, roughly two-thirds of respondents attribute a deceleration in move-ins to a slowdown in leads conversions/sales. Around one-half of organizations cite resident or family member concerns, and about one-quarter cite a mandatory government-imposed ban. Others cite fewer hospital referrals, elective surgeries and general concerns about the economy.

Move-Outs

• Between 60% and 69% of organizations reporting on their independent living, assisted living and memory care units in Wave 7 saw no change in move-outs in the past 30-days.

Change in Occupancy by Care Segment

Respondents were asked: “Considering the entire portfolio of properties, overall, my organization’s occupancy rates by care segment are… (Most Recent Occupancy, Occupancy One Month Ago, Occupancy One Week Ago, Percent 0-100)”

• • Approximately one-half to about two-thirds (54% to 65%) of organizations reporting on their independent living, assisted living and memory care units in Wave 7 of the survey—across their respective portfolios of properties—experienced a decrease in occupancy from the prior month, however roughly one-quarter to one-third report no change (25% to 36%).
  • Notably fewer organizations with assisted living units and/or nursing care beds report a decrease in occupancy in the past month compared to Wave 4 (65% vs. 81% and 73% vs. 82%, respectively).
  • The independent living and memory care segments also saw fewer organizations reporting a decrease in occupancy rates compared to earlier waves of the survey. The share of independent living organizations reporting a decrease in occupancy in the past month fell from 68% in Wave 4 to 54% in Waves 5, 6 and 7. Additionally, fewer organizations with memory care units in Wave 7 than in Wave 5 note declining occupancy rates (59% vs. 70%).

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  • The chart below breaks out the rates of change in occupancy by care segment with greater granularity, comparing the current timeframe (Wave 7 data collected between May 11 and May 24), the middle of the pandemic (Wave 3 data collected between April 13 and April 19), and earlier in the pandemic at the start of this survey when the majority of independent living, assisted living and memory care segments had yet to report major changes in current occupancy compared to one month prior (Wave 1 data collected between March 24 and March 31).
  • As shown in the chart, near the beginning of the pandemic (Wave 1), the share of operators that reported month over month occupancy rates declines increased as the pandemic progressed into Waves 3, and most recently, Wave 7.
  • Shares of organizations reporting a decrease in occupancy in the past 30-days in Wave 7 and Wave 3 are similar for independent living, assisted living and memory care, but slightly more organizations in Wave 7 report both wider declines and improvements in occupancy for the memory care segment than in prior waves of the survey. Fewer organizations with nursing care beds in Wave 7 report significant downward changes in occupancy compared to one-month prior than in Wave 3.

• • Regarding the change in occupancy from one week ago, respondents with independent living units consistently report the fewest declines in occupancy from one week earlier while nursing care, assisted living and memory care have been generally consistent with around 36% of respondents reporting decelerations in occupancy from the prior week for the last two waves; these are all below Wave 4 percentages, however.
  • Most organizations with independent living, assisted living and memory care segment units note no change (51% to 70%); however, slightly higher shares of organizations with assisted living and memory care segment units report no change or an increase in occupancy from one week ago.
  • Just over one-third of the organizations reporting on their nursing care segments in Waves 7 and 6 of the survey note occupancy rate declines from one week prior (38% and 36%)—significantly lower than in Waves 5 and 4 (67% and 62%). Greater shares report no change or an increase from the week prior in Waves 7 and 6.

Incidence of COVID-19 Among Survey Respondents

Data was collected between May 11 and May 24 (Wave 7) and April 27 and May 10, 2020 (Waves 5 and 6 combined).

Answering on behalf of their organizations, seniors housing and care owners and executives provided the COVID-19 incidence data shown below. The data represents a subsample of the total respondents that answered the COVID-19 questions fully, is self-reported and non-validated, and should not be considered a statistical representation of COVID-19 incidence in seniors housing and care, in general.

• • Considering the Wave 7 subsample of survey respondents, the percentage of residents that were tested for COVID-19 by care segment rose with acuity level. The operator average percent of residents tested by segment ranged from about 2.1% for independent living, 13.5% for assisted living, 18.2% for memory care and 24.0% for nursing care. These rates of testing are higher than the previous time frame, with the exception of the independent living segment.

NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and transparency into market fundamentals in the seniors housing and care space at a time where trends are rapidly changing. Your support helps provide both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions. 

If you are an owner or C-suite executive of seniors housing and care properties and have not received an email invitation but would like to participate in the current Executive Survey, please click here for the current online questionnaire.

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The COVID-19 pandemic has created an urgency for insights on data and trends in the seniors housing and care sector. NIC has long held that transparency, accuracy, and timeliness are key factors for well-informed decision-making.In response to the quickly developing situation presented by COVID-19, therefore, NIC has launched a number of initiatives to provide relevant data on an accelerated timetable, including last week’s release of NIC MAP^® Intra-Quarterly Data.

The NIC MAP Data Service team, working with diligence and passion, has produced a new monthly time series. The April data, released May 19, marks the inauguration of the new NIC MAP Intra-Quarterly Data series. 

Monthly Reporting of NIC MAP Data

With the launch of Intra-Quarterly Data, the NIC MAP Data Service will now report three-month rolling time series data on a monthly basis. The data represents performance for the three most recent months, labeled as the final month for the reported period. The rolling period for April 2020 covers February, March, and April 2020. This first data release includes 13 months of three-month rolling data on stabilized occupancy for both seniors housing and nursing care properties. The data series begins in April 2019 and is reported for the Primary Markets, Secondary Markets, and other aggregated geographic levels. 

The NIC MAP Intra-Quarterly Data will be delivered as an Excel file for NIC MAP clients and will also be featured in NIC’s Intra-Quarterly Snapshot, a new monthly publication offering highlights from the data. The Intra-Quarterly Snapshot, available for download on NIC.org, includes key takeaways on the reported time series data, visual representations, and statistics for the past 13 rolling three-month periods, plus three economic indicators to provide some perspective on the current economic conditions. 

Note that the publishing of the Intra-Quarterly Data and Intra-Quarterly Snapshot report will occur on the third Tuesday of each month. 

April 2020 Intra-Quarterly Data Key Takeaways 

In April 2020, following the onset of the COVID-19 pandemic, stabilized occupancy for both seniors housing and nursing care properties dropped significantly. Nursing care properties experienced the largest decline, falling 220 basis points from the prior month to 84.7% for the rolling period of February-March-April 2020 in the NIC MAP Primary Markets. The seniors housing stabilized occupancy rate fell a lesser 110 basis points over the prior month to 88.7% for the NIC MAP Primary Markets. Prior to April, both the seniors housing and skilled nursing stabilized occupancy rates had been relatively stable. 

The impact of COVID-19 was clearly reflected in the rolling period of April 2020, with a greater toll seen in skilled nursing than in seniors housing. Specifically, the drop in stabilized occupancy for both skilled nursing and seniors housing is indicative of the effects of the pandemic on existing properties without the effects of competition of new properties on market conditions.  In addition, some of the sharp decline in skilled nursing occupancy was likely driven by fewer hospitals discharging patients to post-acute care settings for rehabilitative therapy as hospitals defer elective surgeries due to the pandemic.

More to Come

Going forward, NIC will continue to expand the NIC MAP Intra-Quarterly Data set and report on additional metrics, geographies, and data subsets in the third quarter of 2020.

In the meantime, NIC will continue to respond to the pandemic by doing what we do best − delivering data, analytics, and connections – to continue to provide transparency to the sector. Details can be found on our COVID-19 Resource Center which puts new data initiatives, as well as COVID-19-relevant commentaries, regulatory updates, and popular webinar details all in one place.

NIC would like to recognize those directly impacted by the COVID-19 pandemic and those on the frontline keeping residents of seniors housing and skilled nursing communities safe. We understand that seniors housing and skilled nursing operators are bearing tremendous burdens, and applaud their efforts to protect and serve their residents.