ORANGE COUNTY, CA—Since Obamacare is pushing efficient healthcare delivery, senior housing is beginning to offer in-home healthcare services, experts tell GlobeSt.com. Last month, we reported on a discussion we had with several senior-housing executives on the subject of the Baby Boomers and senior housing. Here, we spoke with experts Stephen Jones, chairman/CEO of Snyder Langston; Brendan Morrow, director of senior living for the Weitz Co.; Alan Ursillo, SVP of Jones Lang LaSalle; Al Rabil, CEO of Kanye Anderson Real Estate Advisors; Dan Prosky, founding principal of American Healthcare Investors and the president and CEO of Griffin-American Healthcare REIT II; and Chuck Harry, managing director and director of research and analytics for NIC, about the impact of the Affordable Care Act on senior housing now and in the future.

GlobeSt.com: How is Obamacare impacting the senior housing sector?

Morrow: A key pillar of Obamacare is pushing healthcare delivery to the least expensive responsible venue. For a hospital that's part of an ACO, a memory-care community is loads cheaper than an acute-care hospital. Likewise, for a senior-living community, in-home care in an independent-living apartment is cheaper than moving a resident to assisted living or skilled nursing. So you'll see an interest start at the top of the acuity ladder in owning or affiliating with providers at lower-acuity venues where they can partner on care deliver. Thanks to Obamacare, hospital systems are literally incented to provide care to a person from cradle to grave, so they can deliver that care at the lowest-cost location. In the past, senior-living communities were looking to hospitals for referrals to their skilled nursing or rehab units. Now, the law motivates hospitals to find those communities that don't produce readmissions, even if that means building or buying one.

Jones: With the onset of the ACA, there is a movement toward value-based services. In the evolving world of population health, the goal of the provider entity (health system, medical group, health plan, etc.) is to respond to the complex dynamics of caring for a given population across the entire continuum of care. Where members of the population live and the care they receive from all caregivers matters. These population health managers are creating performance metrics in order to partner with senior-living communities and keep the members of the population healthy. As this plays out, the reimbursement patterns will likely change and the successful player teams/communities will look quite different from the way they provide services today.

Ursillo: we have seen over the last six to eight months the merger of two large operators of senior housing. In my opinion, this merger took place to help both companies deal with the insurance mandate of Obamacare. They have created the largest operator of senior housing in the US. Now they will have economies of scale and be able to offer the best caregivers in each city where one of their facilities is located—benefits that the smaller independent operators will not be able to offer their employees because it would be too costly for them. I also see some states considering moving their lower-level-care patients/residents from skilled-nursing facilities to assisted-living facilities, thus cutting costly government reimbursements to a skilled-nursing facility to a lower-cost assisted-living facility.

Harry: There isn't an immediate impact, but I think in a number of years the impact will be recognized. With the objectives behind Obamacare of making sure we have quality outcomes, I think there will be great opportunity for the sector to demonstrate the quality of life that it affords its residents—that is, the stimulation of seniors engaging with others in the community and how that results in healthier physical and mental outcomes. In time, we will see evidence of quality outcomes and the measures associated with that. We may see more of an immediate impact of making sure that these services are being provided by the lowest-cost provider. So, as it pertains to senior housing, I think a lot of that is going to be impacting more of the assisted-living segment. Services that may have meant longer hospital stays are migrating more into the assisted-living communities or skilled-nursing or nursing-care segments. It is difficult for the general population to grasp, given the sheer cost of operating these properties. It's proven to be very cost effective relative to other providers within the continuum of healthcare.

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

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