Omega: Skilled Nursing Will Come Back, But ‘No Overnight Fix’ to COVID-19 Crisis

Executives at Omega Healthcare Investors (NYSE: OHI) on Tuesday struck an upbeat tone about the long-term prospects of the skilled nursing marketplace, but with COVID-19 raging through more than a quarter of the company’s buildings, the real estate investment trust (REIT) emphasized that any kind of normalcy remains somewhere in the future.

“The nursing home industry is resilient, but there is no overnight fix to this pandemic as it relates to long-term care,” Omega senior vice president of operations Megan Krull said on the company’s first quarter 2020 earnings call.

The Hunt Valley, Md.-based REIT reported that the number of confirmed coronavirus cases in its facilities jumped from zero on March 15 to more than 4,100 at 250 buildings by the end of last week, with a total of 350 deaths across the portfolio.

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“Suffice it to say, these numbers are only going to climb as this virus continues to spread, and more test kits become available within our facilities,” chief operating officer Dan Booth said on the call.

Due to a variety of factors — including the suspension of elective surgeries, increased discharges to hospitals, and deaths — skilled nursing occupancy has dropped across the portfolio by 3% to 6%. Facilities with particularly significant COVID-19 outbreaks had deeper declines, while some properties without any coronavirus infections remain steady, executives noted.

Like many other publicly traded companies, Omega withdrew its guidance for 2020 in the wake of the COVID-19 crisis, and executives repeatedly parried analyst questions by noting that making sweeping future predictions is impossible at this stage of the pandemic.

“Ultimately, it would be both premature and irresponsible to attempt to project the impact of this virus on any given facility’s residents or staff, their occupancy, financial performance, or otherwise,” Booth said.

Many states have begun to cautiously develop and implement plans to reopen their economies and public spaces, but Krull emphasized that COVID-19’s impact will linger on nursing homes for much longer than the general population.

“Prior to the development of a vaccine and widespread testing, our operators are faced with figuring out how to navigate what will be the new normal for the industry,” she said. “As stay-at-home orders start to lift, and the rest of us start to get back to some semblance of normalcy, our operators, their employees, and residents will be dealing with us for a long time to come.”

But despite the staggering toll, Omega officials did find some bright spots. The speed of the infection rate — while still growing — has begun to slow in the last two weeks, according to executives, and the REIT has not had to implement any rent relief for tenants thus far.

“The demographics that drive our bullish perspective of increasing demand for needs-based skilled nursing care have not changed,” CEO Taylor Pickett said.

Only three skilled nursing operators even asked for concessions in April, and all three were denied; Omega has collected 98% of its rent for that month, with the remaining 2%, not related to any formal deferrals, expected shortly.

That said, Pickett expressed concerns about operators’ rising expenses, including skyrocketing personal protective equipment (PPE) and staffing costs — particularly in anticipation of permanent regulatory changes as a result of COVID-19.

“We do not know if future reimbursement rates will be sufficient to cover the increased cost of enhanced infection control and monitoring,” Pickett said.

Omega’s operators on average received $150,000 to $175,000 in Medicare relief per facility under the CARES Act, Krull noted — which works out to around two months’ of a building’s pre-COVID expenses. That’s on top of a total projected influx of $25 million through the end of the year due to the temporary suspension of the blanket 2% sequestration cut on Medicare reimbursements.

But as many other industry advocates have observed, the Department of Health and Human Services (HHS) has not yet opened up CARES Act stimulus funds to Medicaid providers, and many states have not allocated money specifically to long-term care operators from an expanded Federal Medical Assistance Percentages (FMAP) outlay.

If the coronavirus spread continues deep into the fall, executives expressed concern that additional emergency funding could be needed to keep operators in the portfolio afloat.

“All of these challenges are coming at the same time that occupancy is impacted,” Krull said. “With the added expense and strain associated with providing care in these settings, key to our operators’ success is federal and state support.”

The REIT’s leaders also expressed gratitude for the frontline caregivers at its senior housing and care properties, acknowledging the difficulty of keeping the virus at bay even under the best circumstances.

“This is a high-touch industry, and therefore controlling the spread of the virus once it gets in a building is difficult to say the least,” Krull said.

Booth told the story of a facility in Omega’s portfolio that elected to continue accepting COVID-19 patients even in the wake of a staff member’s death, with the administrator telling officials, according to Booth: “The team still wants to admit. It’s what we do. We need to do this.”

The COO concluded his prepared remarks by criticizing the portrayal of skilled nursing facilities in the news media.

“The public media has repeatedly maligned the skilled nursing industry as opposed to portraying the frontline caregivers as compassionate, courageous, heroic human beings who are risking their lives trying to make a difference by saving the lives of our most vulnerable population,” Booth said.

Omega logged net income of $92.3 million in the first quarter of 2020, up from $72.2 million during the same period in 2019 — a gain that the REIT attributed primarily to incremental revenue from new investments.

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