Senior Living News Wire

Following its announcement of expanding into Canada with a 42-property portfolio, Health Care REIT, Inc. (NYSE:HCN) released its earnings results for the fourth quarter ended Dec. 31, 2011, reporting a net income of $42.3 million. This represents an 8% decrease from 2010′s $46 million and may stem from the REIT’s rigorous recent acquisition activity.

The REIT posted a net income attributable to common stakeholders of $27.3 million, or $0.15 per diluted share, compared to just under $40 million, or $0.29 per diluted share, during the same period last year.

For the twelve months ended Dec. 31, HCN’s net income was $212.7 million, a 65% increase over the previous year. The yearly net income attributable to common stockholders stood at $157.1 million, or $0.90 per diluted share, compared to last year’s $106.9 million and $0.83 per diluted share.

“The continued success of our relationship investment program was demonstrated by an additional $1.2 billion in gross investments for the quarter and $6.0 billion for the year,” said George L. Chapman, Chairman, CEO and President of Health Care REIT. “We believe that our immersion in health care will continue to generate future investment opportunities with leading operators and health systems, positioning the company for sustainable long-term growth as we shape the evolution of health care delivery.”

Total revenues in the quarter more than doubled to $407.4 million in the fourth quarter, compared to $196.4 million. The bulk of that came from rental income, at just under $261 million. For the year, HCN’s revenues were $1.4 billion, more than twice than the previous year’s $657.3 million.

At year’s end, total expenses had also more than doubled to nearly $1.3 billion, compared to $582.7 million in 2010. Property operating expenses tripled to $112.7 million in the fourth quarter compared to the same period the previous year, while for the total year they more than quadrupled.

The fourth quarter normalized funds from operation of $0.91 per share is an increase of 21% from the previous year, with a 2011 normalized FFO of $3.41 per share, up 11% from 2010.

In 2011, HCN completed gross new investments totaling $6 billion, including acquisitions totaling $5.6 billion. $1.2 billion worth of investments took place in the fourth quarter, including acquisitions worth $1.1 billion.

During Q4, the REIT completed $627 million in seniors housing operating acquisitions at a blended yield of 6.2% in high-barrier-to-entry markets along the west coast. These transactions include acquisitions done with partners Merrill Gardens (a $415 million, nine-property portfolio) and Silverado Senior Living ($27 million). HCN also completed a $185 million acquisition with Belmont Village Senior Living, a new operating partner with the company.

The REIT just announced that it’s entering into a RIDEA-structure relationship with Canadian REIT Chartwell Seniors Housing to acquire a 42-property portfolio for $952 million.

Going forward, HCN’s 2012 guidance expects the REIT to report net income attributable to common stockholders in a range of $1.26 to $1.36 per diluted share, and normalized FFO in a range of $3.68 to $3.78 per diluted share, representing an 8-11% increase.

View HCN’s fourth quarter and year-end earnings report here.

Written by Alyssa Gerace

This is the first in a multi-part series exploring senior housing & care options and alternatives following the article, Will the Nation Go Broke Paying for Senior Housing & Long-Term Care?

A recent article in The Fiscal Times pondered the “coming nursing home shortage,” and posed the question: Are the elderly the latest casualty of the Great Recession, thanks to cuts in government payments for patient care and less construction of new nursing homes?

The article cited the growing senior population and the fact that the number of nursing homes dropped nearly 9% between 2000 and 2009, but it’s not just nursing homes that are getting fewer in number: there are fewer nursing home residents, too.

Number of Nursing Homes Residents Declining Along with Facilities Themselves

In the wake of the Great Recession, managing care costs is becoming an increasingly important strategy for many states, according to an AARP report, “On the Verge: The Transformation of Long-Term Services and Supports,” and in many instances, this is being manifested through a flat or declining nursing home census as states shift away from institutionalized care.

More than half of state officials who responded to AARP’s state survey, at 56%, said the Medicaid nursing home resident census decreased in fiscal year 2011, with nine more saying the census remained static and only seven reporting growth.

There’s been a trend away from nursing home care, according to National Nursing Home Survey findings, which indicate that the rate of individuals aged 65 and older who choose nursing home care has declined 35% between 1984 and 2004.

“Although the number of older adults in the United States continues to grow, the absolute number of certified nursing home residents has slowly but steadily declined since 2000,” AARP says, citing the report.

Rather than seeing this as a cause for alarm, though, some say it merely reflects the expanding options for senior housing and care.

Trends Point Away from Institutional Care Toward Home and Community Based Care

AARP’s report shows an growing trend of restructuring service delivery systems and increasing home- and community-based services (HCBS) for Medicaid patients, which includes receiving care at home, at an adult day care facility, or at some sort of residential care facility, rather than in an institutional setting.

More than 70% of states responding to AARP’s survey reported an increased HCBS census from 2010 to 2011, and 31 out of 37 respondents expect increases between 2011 and 2012.

Out of 33 states that reported both nursing home HCBS caseloads, 15 saw increased HCBS caseloads and decreased nursing home caseloads, whereas none reported decreased HCBS caseloads and increased nursing home caseloads. This trend is expected to continue into 2012.

“Many states are undergoing or are about to undergo a dizzying array of long-term services and supports (LTSS) transformations,” says AARP. “The lagging economy and the increased demand for publicly funded LTSS have put pressure on state policymakers to redefine the way LTSS are financed and delivered in order to maximize access and system capacity.”

This is pushing a move “toward capitated, risk-based managed care for Medicaid enrollees with LTSS needs and focusing on better care and cost containment for people who are dually eligible for both Medicare and Medicaid coverage.”

Is There Actually a Need for More Nursing Homes?

It’s true that there’s been reduced construction of nursing homes in the past few years, but a lot of the lack of development has to do with states not believing it’s necessary to build more, points out Bruce Lederman, who has more than 20 years of experience in the senior care field in both management and community leadership roles.

Thirty-six states participate in some form of “Certificate of Need” programs, which are “aimed at restraining health care facility costs and allowing coordinated planning of new services and construction,” according to the National Conference of State Legislatures, and the remaining 14 states “still retain some mechanisms intended to regulate costs and duplication of services.”

This means that before building a nursing home in states participating in these programs, developers must first obtain a certificate of need from a state review board, says Lederman.

And with occupancy rates for nursing care hovering around 88%, according to the National Investment Center for the Seniors Housing & Care Industry, there are still plenty empty beds to be filled—and therefore not too much current “need.”

As for the future of the nursing home occupancy: it may keep declining.

“We can expect nursing facility census to follow trends of flat to decreasing census,” Jenna Walls, a senior consultant with Health Management Associates, told SHN during a discussion of AARP’s LTSS report.

Ultimately, Medicaid expenditures are projected to keep rising and continue to be a primary concern for states, Walls said, with state Medicaid spending accounting for nearly 24% of annual budget growth in 2012. This puts continued pressure on states to invest in alternatives to institutional care in an effort to stretch available funding to provide for a greater number of people.

The full AARP report can be viewed here.

Written by Alyssa Gerace

Based on preliminary projections of fiscal year 2014 FMAPs (Federal Medical Assistance Percentage—the share of each state’s Medicaid costs that the federal government covers), a majority of states should expect a decline in how much they will receive from the government, according to a report conducted by the National Association of Medicaid Directors.

About 30 states are projected to experience a decline, and only between four and seven could experience an increase, says the report.

“This reflects personal income shifts among the states as well as an unusual population growth pattern reported by the Census Bureau for 2009-2011,” it says. “Overall, the shifts are estimated to decrease federal Medicaid grants in FY 2014 by $1.1 to $1.9 billion when compared to the FMAPs for the current FY 2012, with decreases of $2 to $3 billion offset by somewhat more than $1 billion of increases for gaining states.”

Additionally, adjusting for Medicaid eligibility expansion under the Affordable Care Act could cause “financial and program disruptions, as the federal government attempts to derive blended FMAPs for the two parts of the program.”

This is bad news for nursing homes, many of which rely heavily on Medicaid reimbursements. A study released in 2011 revealed a $6 billion Medicaid funding shortfall to nursing homes that year.

Click here to view the report, which includes a table of possible changes in 2014 FMAPs and potential financial impacts for all 50 states.

Written by Alyssa Gerace

The 55+ housing market saw gradual but steady improvement throughout 2011, says the National Association of Home Builders (NAHB), and this trend is expected to continue in 2012 as more baby boomers turn 55 and seek new homes and communities.

“NAHB is projecting that the number of housing starts in 55+ communities will increase 18% to 53,200 units in 2012, and another 25%, to 66,600 in 2013,” said Paul Emrath, NAHB’s vice president of survey and housing policy research, at the NAHB International Builders’ Show.

Despite this improvement, however, the market hasn’t recovered as quickly as might have been expected, and the market is still “fragile” as people continue to experience difficulties in selling their homes, Emrath continued.

Home builders were slightly more confident in the 55+ housing market for single-family homes in the fourth quarter of 2011, with the index rising four points to 18 compared to the same period the previous year, according to the most recent NAHB 55+ Housing Market Index, released Feb. 7.

“We are seeing increased optimism from builders in the 55+ housing segment,” said NAHB Chairman Bob Nielsen in a statement. “However, the market still remains weak as many people in the mature-market sector are hesitant to buy. They are concerned about selling their existing home at a fair price, due to low appraisals, an abundance of foreclosures and tighter mortgage lending criteria.”

Builder sentiment is measured based on current sales, prospective buyer traffic, and anticipated six-month sales for each particular market; an index above 50 is an indication that more builders view conditions as “good” rather than “poor.”

While the index remains in unfavorable territory, all components increased from a year ago:

55+ Single-Family Housing Market Index: Up four points to 18

• Present sales: Up four points to 17
• Expected sales for the next six months: Up two points to 26
• Prospective buyer traffic: Up five points to 15

55+ Multifamily Condo Housing Market Index: Up six points to 14

• Present sales: Up five points to 12
• Expected sales for the next six months: Up three points to 17
• Prospective buyer traffic: Up five points to 15

55+ Multifamily Rental Housing Market Index

• Present production: Up 17 points to 34
• Expected future production: Up 12 points to 35
• Current demand for existing units: Up 14 points to 42
• Expected future demand: Up 12 points to 44

“As with the overall single-family housing market, we are seeing gradual, but steady, improvement in the 55+ market segment,” said NAHC Chief Economist David Crowe. “A level of 18 in the 55+ HMI is the highest fourth quarter reading since inception of the index in 2008, but still a long way from a healthy housing market. Also, as with the overall multifamily rental housing sector, the 55+ rental market is showing continued strength. All the index subcomponents are at or above their highs since index inception in 2009.”

Written by Alyssa Gerace

Gentiva Health Services, Inc. (NASDAQ:GTIV), the the largest provider of home health and hospice services in the U.S. based on revenue, reported its fourth quarter and 2011 results on Feb. 7, showing losses of more than $449.8 million in the full fiscal year for a net loss attributable to shareholders of $450.5 million, or ($14.85) per diluted share.

In comparison, last year Gentiva had a net income attributable to shareholders of $52.2 million, or $1.71 per diluted share.

However, the company’s net revenue rose 27% to $1.79 billion for the year, compared to $1.4 billion in 2010. For the fourth quarter ending on Dec. 31, 2011, Gentiva’s total net revenues were $449.2 million, down 2% from the same period in 2010.

These revenues include home health episodic revenues of $217.1 million, down 3% from Q4 2010, and hospice revenues of $200.3 million, up 3% from the previous year. Hospice represented 45% of the company’s total net revenue in the fourth quarter, compared to 43% in 2010.

The company’s fourth quarter was marked by downsizing after a “comprehensive review of its branch structure, support infrastructure and other significant spend areas” in Q3 following the implementation of reduced Medicare reimbursement rates and the possibility of further cuts.

As a result of this assessment, the Company closed 34 locations (25 home health and 9 hospice) and sold 9 home health locations in the fourth quarter of 2011.  The financial results of the impacted locations were included in the Company’s results from continuing operations.  Related to the cost savings and branch reduction initiatives, the Company recorded a pre-tax charge of $12.4 million in the fourth quarter of 2011 for severance, lease terminations and other items.  Subsequent to year-end, the Company entered into agreements to sell 8 additional home health branches and 2 hospice branches as part of its branch assessment.

Adjusted income from continuing operations attributable to Gentiva shareholders in the fourth quarter stood at $11.3 million, or $0.37 per diluted share, down significantly from the previous year’s $20.9 million and $0.69 per diluted share.

In 2012, Gentiva expects full-year net revenues to be in the range of $1.7 billion to $1.76 billion.

View Gentiva Health Services’ Fourth Quarter and Full-Year 2011 Results here.

Written by Alyssa Gerace

Each year, U.S. News and World Report releases its list of “Best Nursing Homes,” determined by quarterly ratings from the Centers for Medicare & Medicaid Services (CMS), and it also issues an Honor Roll which consists this year of 39 nursing homes that earned the highest possible ratings in all four quarters of 2011.

Notably, three East Coast states (Connecticut, Massachusetts, and New York) have three or more nursing homes on the Honor Roll, while eight more states, including California and Maine, have two or more homes on the list.

The 39 nursing homes on the Honor Roll are the only ones out of more than 15,500 that U.S. News reviewed to receive the four straight quarters of perfect five-star ratings from CMS in all three areas of consideration: health inspections, nurse staffing, and quality of care.

Click here to view the 2012 Honor Roll of Best Nursing Homes.

Written by Alyssa Gerace

Those working at not-for-profit assisted living facilities earned significantly more in base salary than their for-profit counterparts, according to the Assisted Living Salary & Benefits Report for 2011-2012, published by the Hospital & Healthcare Compensation Service (HCS).

Looking at comparisons on positions for which HCS was able to gather sufficient data, not-for-profit CEOs/Presidents, Administrators, and Directors of Marketing, Human Resources, Nurses, Dining and Food Services, and Memory Care Programs got higher base salaries than those working in the same roles at for-profit facilities.

Out of 18 positions which appear in both for-profit and not-for-profit facilities, nearly all positions at not-for-profit facilities (on average) earned more when comparing the median salaries, with few exceptions that include Social Service Directors, Marketing Representatives, and Housekeeping Supervisors.

For example, for-profit administrators received an average $74,491 compared to a not-for-profit administrator’s average of $74,264. And for-profit directors of marketing got an average base salary of $48,361 compared to a $64,980 compensation for not-for-profit marketing directors.

Bonuses make up a significant portion of marketing directors’ and representatives’ overall compensation, at 19.96% and 21.38%, respectively. Only CEOs/Presidents of assisted living facilities receive bigger bonuses relative to their salaries, at 28.38%.

In terms of size, 13 out of 19 positions earn more when they’re working at facilities that have 75 or more beds, compared to those working at facilities with fewer than 75 beds, including CEOs, administrators, and directors of nurses.

For regional and individual state data on salaries, order the HCS compensation report for 2011-2012.

Written by Alyssa Gerace

Between 2010 and 2012, skilled nursing facilities in 40 states across the nation dealt with Medicaid payment rates that were either cut or frozen, highlighting the importance of stabilizing federal nursing home rates, according to a recent Avalere survey.

“These findings speak to the financial pressures nursing facilities face on the Medicaid front,” said Emil Parker, lead author of the Avalere study, in a statement.  ”In fact, while the general perception is that the state fiscal picture is improving, the number of states reducing nursing facility Medicaid rates rose from seven in fiscal year 2010 to 16 in fiscal year 2012.”

Nearly half of all states, at 23, reduced nursing facility payment rates during at least one year between 2010 and 2012, and another 17 froze rates during at least one (and more often more than one) of those years.

“The Avalere data adds important context in helping to objectively assess the true level of instability facing the SNF sector as crucial budgetary and regulatory decisions are pending action,” said Alan Rosenbloom, President of the Alliance for Quality Nursing Home Care.

Further, due to legislative and regulatory changes in the last five years, SNFs will absorb $127 billion in Medicare reductions throughout the fiscal years 2012-21 budget window, Rosenbloom added.

A previous national Avalere survey of skilled nursing facilities finds regulatory changes made by the Centers for Medicare and Medicaid Services (CMS) to reduce Medicare reimbursements (where were effective Oct. 1, 2011) are projected to result in the loss of up to 25,000 SNF jobs, Rosenbloom said, and it could mean that another 25,000 jobs are not created as facilities cancel expansions and renovations due to budget crunches.

“Federal policy makers cannot ignore the deteriorating Medicaid situation when determining Medicare rates,” he continued. “Medicare and Medicaid populations overlap in the SNF setting, and skilled nursing facilities budget based on their revenues from all payers. Profit margins for skilled nursing remain the lowest of any healthcare sector, and we urge Congress to sustain Medicare rates for the benefit of patients and workforce stability.”

The Avalere survey found just 11 states that were not adversely affected by nursing facility Medicaid rates.

View the Summary of Reductions and Freezes in State Medicaid Nursing Facility Payment Rates here.

Written by Alyssa Gerace

Last year saw $227.4 billion worth of healthcare merger, acquisition, and takeover activity, representing an 11% increase from the $205.6 billion spend in 2010, according to Irving Levin Associates, Inc.

In terms of financing dollars, 2011 was the fourth-largest year of the past decade, although the actual number of deals announced in the year decreased 3% from 2010, going from 1,007 transactions across 13 sectors of the healthcare industry to 980.

However, this number is expected to rise as more information is released and other deals are brought to light through annual 10-K filings, says Irving Levin.

Of the 13 healthcare sectors, rehabilitation, laboratories/MRI/dialysis, managed care, medical devices, and long-term care saw the most notable dollar volume growth from 2010 to 2011.

Managed care and long-term care also saw positive growth trends in deal volume, led only by physician medical groups, behavioral health.

Source: Irving Levin Associates, Inc.

“We predict that the dynamics of the 2011 market will forge ahead into 2012,” said Sanford B. Steever, Ph.D., editor of The Health Care M&A Report, in a statement. “In particular, we expect to see strong deal making in the four technology sectors as well as in facility-based service sectors, such as Hospitals and Long-Term Care. Despite the rhetoric of repeal, hospitals and other providers will keep pursuing mergers and acquisitions to assemble the component parts for building accountable care organizations.”

However, external factors such as 2012 being an election year may influence the pace of the M&A market, according to Irving Levin Associates’ managing editor Stephen Monroe.

“Deals in provider sectors dependent on government payments will be particularly vulnerable as changes to reimbursement protocols, real or threatened, are bandied about,” he said in a statement. He added that Europe’s debt and economic uncertainty means American companies will lead the healthcare M&A market.

Ultimately, merger and acquisition activity in the healthcare industry is “expected to remain robust for 2012.”

View a list of fourth-quarter acquisitions covered by Senior Housing News, or go here to check out both recently covered acquisitions as well as those dating back to the beginning of 2011.

Written by Alyssa Gerace

Group therapy was virtually extinct in the first quarter of 2012 as skilled nursing providers “significantly” changed the mode of patient therapy from group to individual after the Centers for Medicare & Medicaid Services (CMS) revised the RUG reimbursement system, according to a CMS report.

Most Medicare patients are in skilled nursing for short-term stays, and between 2010 and 2011, approximately 92% of these patients were classified into a rehab category, according to a Department of Health and Human Services CMS final rule on the Medicare prospective payment system (PPS).

SNFs received about 17% of their total income from Medicare reimbursements in 2005, according to a Georgetown University survey on national long-term care financing, and they get the highest reimbursement rates for residents who receive rehabilitation services.

Providers can bill Medicare for therapy that was given in a group setting (one therapist working with residents who are all doing the same “task”), concurrent (one therapist working with multiple residents who are doing different “tasks”), and individual (one therapist working with one individual).

In previous years, providers could bill Medicare for each individual in a group therapy setting, but that was changed after government reports showed this “triggered a significant increase in overall payment levels” under that RUG system that resulted in “substantial overpayments to SNFs,” according to the August 2011 final PPS rule.

When CMS announced RUG-IV, providers were in for an 11.1% reduction in reimbursements, and according to a new government report, 2012 data for the first quarter indicates that group therapy is virtually nonexistent, with facilities almost exclusively providing individual therapy (99%), with the remaining 1% in concurrent therapy. This is a dramatic shift from 2006-2007, when about one quarter of patients were in concurrent therapy, according to CMS.

Source: Centers for Medicare & Medicaid Services

Other changes for 2012 (so far) is that the overall patient mix (of those in categories such as rehabilitation, extensive services, special care, etc.) isn’t significantly different from what was observed in 2011, with “rehabilitation plus extensive services” seeing the biggest change, from 2.38% to 1.78% in 2012, while rehabilitation alone increased 40 basis points to 88.9%.

Click here to see the fiscal year 2012 SNF PPS Monitoring Activities from CMS.

Written by Alyssa Gerace

Senior housing assets that are packaged as a portfolio sell for more than if they were sold on a stand-alone basis, according to a recent survey conducted by Integra Realty Resources.

The commercial real estate consulting and valuation firm gathered results from 12 brokers and buyers who responded to a question regarding the presence and extent of a portfolio premium for a portfolio consisting of six “Class A” independent/assisted living assets each worth about $15 million.

Source: Integra Realty Resources

A majority 83% responded that a premium did indeed exist, of about 5%, while 17% said the premium was more than 5%.

It’s important to note that the larger and more homogenous the portfolio (meaning properties in a similar asset class), the larger the premium could be, Integra told SHN. However, “for a smaller portfolio, or one with assets exhibiting a mix of care types and quality, no premium may exist.”

These signs point to sellers being able to command a higher price for aggregated properties, the firm continued.

Written by Alyssa Gerace

The seniors housing sector continues to see recovery, with positive rent growth trends and a slightly higher occupancy in fourth quarter of 2011, although construction activity continued to decline, according to NIC MAP, a data analysis service of the National Investment Center for the Seniors Housing & Care Industry (NIC).

The average occupancy rate for seniors housing properties in the last quarter rose to 88.2%, up 0.1% from the previous quarter, and a 0.7 percentage point increase from a year ago, the data analysis service reports.

For independent living properties, occupancy averaged 88%, 60 basis points beneath the average of 88.6% for assisted living properties. However, the independent living segment was the only one to show improvement from the prior quarter, posting a 0.2 percentage point increase from the third quarter.

Average occupancy for both independent and assisted living are both 1.2% above their respective cyclical lows, says NIC.

“With occupancy continuing to rise, it is clear the recovery is underway, however, independent living has been driving much of the occupancy gains in recent quarters,” Michael Hargrave, vice president of NIC MAP, said in a statement.

Source: NIC MAP

Year-over-year rent growth for seniors housing was boosted 0.1 percentage points to 1.7%, compared to 0.8% in the fourth quarter of 2010.

“While rent growth continues to slowly improve, it is important to note that current rent growth remains below the current level of inflation,” Chuck Harry, NIC’s director of research and analysis, said in a statement.

Annual absorption was at 2.0% in the fourth quarter, compared to 1.9% in the third quarter and 1.7% during the same period of the previous year. This marks the fifth consecutive quarter where annual absorption outpaces the annual inventory growth, which serves to pressure occupancy, Harry noted.

Seniors housing annual inventory growth rate was 1.2%, better than the previous quarter’s 1.0% but down from 1.5% in the 2010′s fourth quarter, NIC reports. Construction as a share of existing inventory for seniors housing was also down, at 1.5% compared to 1.6% in the third quarter.

Nursing care occupancy rate declined slightly to 88.2%, and NIC says that this segment’s occupancy has been “marginally declining” for several years now. Annual inventory posted negative growth of -0.4% in the quarter, “continuing the established trend of slightly declining inventory growth.”

However, private pay rents for the sector grew 3.4% year-over-year in the quarter, NIC says, keeping pace with third quarter results.

Click here to access the regional quarterly NIC MAP data.

Written by Alyssa Gerace

Equity LifeStyle Properties, Inc. reported a net loss of $0.2 million, translating to $0.00 per share, available to common stockholders on a fully-diluted basis for the fourth quarter ended Dec. 31, 2011, as the company continues to encounter costs associated with an acquisition made in May 2011.

Overall net income for the year was $22.8 million, or $0.19 per share, down from the previous year’s $38.4 million and $1.26 per share.

The company’s funds from operations (FFO) increased nearly 68% to $43.5 million or $0.96 per share, up from the third quarter’s $25.9 million, or $0.73 per share.

The FFO would have been still higher, at $44.7 million and $0.99 per share on a fully-diluted basis, excluding the costs associated with ELS’ $1.43 billion acquisition of a portfolio of 75 manufactured home communities and one RV resort made on May 31, 2011. In the fourth quarter, ELS recorded transaction costs connected with the acquisition of approximately $1.2 million.

Without this $1.2 million transaction cost, the company would have posted a net gain of $0.9 million, or $0.02 per share, available to common stockholders. Throughout the year ended Dec. 31, 2011, ELS closed on 75 properties, with associated transaction costs of approximately $18.5 million. The purchase agreement for one of the Michigan properties was terminated, although the company continues to do due diligence on said property.

ELS reported property operating revenues, excluding deferrals, of $158.4 million in the fourth quarter, up 31% from the same quarter in 2010. Out of this revenue, approximately $34.5 million can be attributed to the 75-property acquisition. Total revenues for the quarter were $159.3 million.

For the year ended Dec. 31, 2011, property operating revenues were $570.2 million, compared to $506.5 million the previous year, including a total of $56.6 million of revenue from the portfolio acquired in May. Community base rental income continues to account for the majority of the quarterly revenue, rising nearly 52% from last year to more than $99 million. Property operating and maintenance expenses rose less than 20% to $52.2 million in the fourth quarter.

During the fourth quarter earnings call, ELS CEO Thomas Heneghan spoke to the success of the company’s RV sector.

“Our RV customer is resilient,” he said. “Over the last few years, we’ve seen significant fluctuations in gas prices and extremely difficult economy, yet this revenue stream continues to grow. It is clear the installed base of approximately 8 million RV owners find this lifestyle attractive.”

In response to a later question about the company’s 2012 guidance for growth assumptions around RV membership success, Heneghan said the RV sector would “trail off a little bit next year… but we still like the RV business and we’re still trying to figure out how to grow that business.”

As of Dec. 31, 2011, ELS had a cash balance of approximately $70.5 million. Looking ahead, the next quarter’s average estimate for revenue is $153 million.

View Equity LifeStyle Properties’ fourth quarter earnings report here.

Written by Alyssa Gerace

Delayed discharge summaries may play a large role in why so many Medicare patients are rehospitalized after being discharged to nursing homes, according to research published in the Journal of General Internal Medicine.

The study, funded by the University of Wisconsin Health Innovation Program and the National Institutes of Health, followed 489 Medicare patients who were sent to nursing homes after being discharged from the hospital.

About 20% of Medicare patients are rehospitalized within 30 days of discharge, reportedly at an annual cost of about $17 billion, and this could result from discharge summaries that either lack details or are inaccurate by the time they’re sent to nursing homes, according to the researchers.

Currently, each patient is supposed to have a discharge summary created within 30 days of their discharge, per Joint Commission rules, the study says. However, researchers found that this 30-day window may be “too broad and may contribute to poor discharge documentation quality.”

“Poor discharge summary documentation of actionable components, such as diet and therapy orders, has the potential to directly impact the patient’s plan of care/admission orders within the sub-acute care facility and may increase the risk for rehospitalization, excess sub-acute care nursing and therapy staff work load, and other negative post-hospital outcomes,” the study reads.

Discharge summaries are a key communication tool during care transitions, the study’s authors say, but those examined within the study “frequently omitted critical expert-recommended components, especially those within the actionable categories of ‘future plan of care’ and ‘name and contact information.’”

This poses challenges and problems for recently-discharged patients, as nursing home workers may not be able to provide necessary care without all pertinent information.

“Experts suggest that care during the hospital discharge and early post-hospital period may be critical in preventing at least a portion of these rehospitalizations,” said lead author Amy Kind.

The impending impact of healthcare reform may affect hospital readmissions through the Rehospitalization Reduction Act. The act may prompt hospitals to provide patient health care information to nursing homes more quickly and reliably, as it will penalize hospitals if their rehospitalization rates for patients with congestive heart failure, heart attacks and pneumonia are above a certain level, starting in 2013.

View the research, “Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients,” here.

Written by Alyssa Gerace

Where are seniors living and heading to these days? U.S. News lists “The 10 Best Places to Retire in 2012” and also looks into geographic concentrations of the 65 and older crowd.

By April 1, 2010, there were 40.3 million people aged 65 and older in the country, and now 10,000 Boomers are turning 65—and reaching retirement age—each day.

While all U.S. regions have seen growth in their 65+ populations since the census was taken in 2000, the West has the most rapidly growing older population, which has increased 23.5% from 6.9 million in 2000 to 8.5 million ten years later, according to U.S. News.

The Northeast has the largest percentage of those aged 65+, on the other hand, at 14.1% of the total population. Comparatively, 13.5% of those in the Midwest belong to this demographic, followed by 13% in the South and 11.9% in the West.

The five “oldest” states are Florida (17.3% are 65 or older), West Virginia (16%), Maine (15.9%), Pennsylvania (15.4%) and Iowa (14.9%). The state with the lowest senior population is Alaska, accounting for just 7.7% of the total.

Cities with the lowest numbers of seniors as a percentage of the overall population include West Jordan, Utah (4.6%), Killeen, Texas (5.2%), and Frisco, Texas (5.4%).

It’s probably no surprise that Scottsdale, Arizona is the city with the highest percentage of 65+ folks, at 20%—well above the national average of 13%. Other cities with high retirement-age populations include Clearwater, Hialeah, Cape Coral, and Miami, all in Florida; Surprise, Arizona; Honolulu, Hawaii; Metairie, Louisiana; Warren, Michigan; and Independence, Missouri.

With current geographic distributions in mind, which cities are being recommended as retirement locations in 2012 by U.S. News?

Although the 10 best places are unranked, Flagstaff, Arizona is the first city on U.S. News’ list. The city’s favorable climate and warm weather heavily influenced its inclusion.

Other cities include “affordable mountain town” Boone, North Carolina and “green” Walnut Creek, California. Pittsburgh, Pennsylvania is considered the “best mix of affordability and amenities” while Santa Fe, New Mexico is the “best place for recreation and culture.”

Go here to view U.S. News’s complete list of best places to retire, or check out data on where the 65+ crowd is (or isn’t) located.

Written by Alyssa Gerace