ORANGE COUNTY, CA—Since Obamacare is pushingefficient healthcare delivery, seniorhousing is beginning to offer in-home healthcare services,experts tell GlobeSt.com. Last month, we reported on a discussion we had with severalsenior-housing executives on the subject of the BabyBoomers and senior housing. Here, we spoke with expertsStephen Jones, chairman/CEO of SnyderLangston; Brendan Morrow, director ofsenior living for the Weitz Co.; AlanUrsillo, SVP of Jones Lang LaSalle;Al Rabil, CEO of Kanye Anderson RealEstate Advisors; Dan Prosky, foundingprincipal of American Healthcare Investors and thepresident and CEO of Griffin-American Healthcare REITII; and Chuck Harry, managing directorand director of research and analytics for NIC,about the impact of the Affordable Care Act onsenior housing now and in the future.

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GlobeSt.com: How is Obamacare impacting the seniorhousing sector?

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Morrow: A key pillar of Obamacare ispushing healthcare delivery to the least expensive responsiblevenue. For a hospital that's part of an ACO, a memory-carecommunity is loads cheaper than an acute-care hospital. Likewise,for a senior-living community, in-home care in anindependent-living apartment is cheaper than moving a resident toassisted living or skilled nursing. So you'll see an interest startat the top of the acuity ladder in owning or affiliating withproviders at lower-acuity venues where they can partner on caredeliver. Thanks to Obamacare, hospital systems are literallyincented to provide care to a person from cradle to grave, so theycan deliver that care at the lowest-cost location. In the past,senior-living communities were looking to hospitals for referralsto their skilled nursing or rehab units. Now, the law motivateshospitals to find those communities that don't producereadmissions, even if that means building or buying one.

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Jones: With the onset of the ACA,there is a movement toward value-based services. In the evolvingworld of population health, the goal of the provider entity (healthsystem, medical group, health plan, etc.) is to respond to thecomplex dynamics of caring for a given population across the entirecontinuum of care. Where members of the population live and thecare they receive from all caregivers matters. These populationhealth managers are creating performance metrics in order topartner with senior-living communities and keep the members of thepopulation healthy. As this plays out, the reimbursement patternswill likely change and the successful player teams/communities willlook quite different from the way they provide services today.

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Ursillo: we have seen over the lastsix to eight months the merger of two large operators of seniorhousing. In my opinion, this merger took place to help bothcompanies deal with the insurance mandate of Obamacare. They havecreated the largest operator of senior housing in the US. Now theywill have economies of scale and be able to offer the bestcaregivers in each city where one of their facilities islocated—benefits that the smaller independent operators will not beable to offer their employees because it would be too costly forthem. I also see some states considering moving theirlower-level-care patients/residents from skilled-nursing facilitiesto assisted-living facilities, thus cutting costly governmentreimbursements to a skilled-nursing facility to a lower-costassisted-living facility.

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Harry: There isn't an immediateimpact, but I think in a number of years the impact will berecognized. With the objectives behind Obamacare of making sure wehave quality outcomes, I think there will be great opportunity forthe sector to demonstrate the quality of life that it affords itsresidents—that is, the stimulation of seniors engaging with othersin the community and how that results in healthier physical andmental outcomes. In time, we will see evidence of quality outcomesand the measures associated with that. We may see more of animmediate impact of making sure that these services are beingprovided by the lowest-cost provider. So, as it pertains to seniorhousing, I think a lot of that is going to be impacting more of theassisted-living segment. Services that may have meant longerhospital stays are migrating more into the assisted-livingcommunities or skilled-nursing or nursing-care segments. It isdifficult for the general population to grasp, given the sheer costof operating these properties. It's proven to be very costeffective relative to other providers within the continuum ofhealthcare.

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Prosky: I think Obamacare is impactingsenior housing very little, if at all. Senior housing is primarilyprivate pay. Obamacare long-term will have very little impact onour healthcare delivery and virtually no impact on senior housing.Long-term changes will be more market driven than governmentdriven. It's really much ado about nothing. We keep close tabs onit, but all we did was raise taxes, expanded Medicaid and haveinformed healthcare insurance.

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Rabil: I've not seen any impact atthis point. Of course, we don't know how Obamacare is playing out,but Medicare and Medicaid reimbursements are still virtuallyunchanged at this point. The aging of the population has nothing todo with Obamacare. From our perspective, we see strong demographictailwinds supporting this sector for many years to come.

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Carrie Rossenfeld

Carrie Rossenfeld is a reporter for the San Diego and Orange County markets on GlobeSt.com and a contributor to Real Estate Forum. She was a trade-magazine and newsletter editor in New York City before moving to Southern California to become a freelance writer and editor for magazines, books and websites. Rossenfeld has written extensively on topics including commercial real estate, running a medical practice, intellectual-property licensing and giftware. She has edited books about profiting from real estate and has ghostwritten a book about starting a home-based business.