Posts Tagged ‘CCRC’

On Monday June 6, 2016, The “Ask Encore” column by Glenn Ruffenach in the Wall Street Journal responded to a question from a reader about “what features, at a minimum, should be added to our current home or incorporated in a new home so that we can stay in our home as we get older.”   The columnist’s response identified three resources to make a home accessible and adaptable for seniors.   These included:

These all appear to be useful resources and the Wall Street Journal column cites the Harvard Study as saying five features, in particular, that make for safe and acceptable homes are: no-step entries; single-floor living; switches and outlets reachable at any height; extra-wide hallways and doors and lever-style door and faucet handles.   The Harvard Study indicates that 90% of existing homes have one of these features but that only 57% have more than one.

Research (AARP United States of Aging Survey, 2012) indicates that 90% of seniors would prefer to stay in their own home vs. moving to a seniors housing community and I have no doubt that for some seniors making adaptations to an existing home or buying a new home with adaptable feature may allow them to defer a move to seniors housing for some period of time.  However, because of most seniors’ strong bias toward staying in an existing home, I see far too many seniors resisting a move to seniors housing even when this would be more beneficial for their health, their finances and their families.

I believe it is important for a senior and her or his family to also consider other issues when considering whether to modify an existing home vs. moving to a seniors housing community. Chief among these are (1) the location of one’s existing home, (2) the age and medical conditions of the residents, (3) access to companions and support services, and (4) the cost of maintaining a home.  The key points I want to make are:

  • seniors and their families need to think through how making accessibility improvements to a home will meet a senior’s physical and mental health needs over time, not just at a single point in time, and
  • staying vs. moving should be considered in light of the full occupancy and care costs for each alternative.

Location

Location is important for the resident, her or his family and other formal or informal caregivers. Too often, seniors of advancing age become increasingly isolated in their homes because they are not located where public transportation, taxi or Uber-like services are readily available. If this is the case, as a senior’s ability to drive diminishes, which it invariably does, a senior’s ability to visit friends, see medical professionals, attend social, educational and civic events will be restricted with negative implications for their physical and mental health. If they are living alone, studies have show poor diet and social isolation can take a heavy toll. Technology may be able to reduce these isolating effects in the future but is not yet able to overcome all the location issues noted here.

Location is also important for family members and other formal and informal caregivers. If you live hundreds of miles from your children or if your home is not readily accessible in good and bad weather to formal and informal caregivers, a home modified to be accessible for a senior may still prove unable to meet a senior’s needs over time as their physical or mental health deteriorates and caregivers are needed.

Age and Medical Condition

The age and medical condition of residents is also important to consider when thinking about whether to modify one’s home or move to a retirement community. Physical limitations, such as needing a walker, shower grab bars, lever door handles can help extend the ability of an existing home to accommodate a senior. But, if a senior is 85 or older or has medical conditions that will escalate over time, the benefit of these types of improvements may be short lived and fully modifying a home for a wheelchair equipped senior – completely flat floors, wider doorways, larger baths with turning radius for a wheelchair can get very expensive. In addition, if a senior has early signs of dementia, this condition too is likely to deteriorate over time and may require a more secure setting with full time care at some point, which an individual’s home cannot provide.

Access to Companions and Support Services

The cost to bring qualified caregivers and other support services into one home can quickly exceed the cost of a seniors housing community if care is required on a 24/7 basis. It can also be difficult for a senior or their family to manage care and home maintenance services and to monitor the quality of care delivered in a senior’s home, particularly if the family does not live nearby.   The availability of qualified caregivers varies with geography, with access to public transportation and with population density tending to improve the availability of care.

Cost of Maintaining A Home

When comparing the costs of staying in one’s home vs. moving to a senior housing community, seniors and their families too often view the cost of staying in one’s home as only including the cost of making accessibility modifications and do not fully consider the cost of part-time or full-item care, the cost of taxes and maintenance, or the income that can be generated from investing proceeds from the sale of a home. This sticker shock of a $2,500 to $6,000 per month fee for seniors housing may seem a lot less daunting when one makes a accurate assessment of the costs of staying at home.   It is also important to understand that the average length of stay for an 85 + senior in assisted living is about two years, so $150,000 in home sales proceeds is usually sufficient to fund an average stay.

There is some additional discussion of housing options and issues to consider when moving to seniors housing on this blog www.robustretirement.com.  The American Seniors Housing Association also has a new website Where You Live Matters with a lot of information for seniors considering whether to stay in their existing homes or move to a retirement community, including cost calculators.    Specific posts on this website that may be of interest include:

 

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Posted in Finance, Lifestyle Choices, Senior Housing & Care | 1 Comment »

UnSenior “Seniors Housing”

Earlier this month I toured The Stories at Congressional Plaza, a new type of “seniors housing” project designed to appeal to seniors as well as those of other ages looking for a high-tech, high-service environment in an urban mixed use setting.  The Stories opened in February 2016 and is a joint effort of Federal Realty Investment Trust and Ryan Frederick’s Smart Living 360.

Federal Realty is a publicly traded REIT (NYSE: FRT) that specializes in the ownership, operation, and redevelopment of high quality retail real estate in the country’s best markets and is increasingly developing mixed-use projects in connection with its retail holdings.   Ryan Frederick has long been known as one of the leading thinkers on the future of seniors housing through his Point Forward Solutions consulting company.   Ryan has now created a new company, Smart Living 360, to work with a retail/mixed use developer, rather than a seniors housing company or health care REIT, to bring us his vision of the future of “seniors housing” in a property designed to appeal to seniors but open to those of all ages.

The Stories is a new 48 units apartment building located at 1628 E. Jefferson Street in Rockville, Maryland.   It is part of Federal Realty’s Congressional Plaza redevelopment that includes a high-end shopping center, Federal’s corporate headquarters and an existing 150+/- unit apartment building with structured parking (The Crest), now about 10 years old.   The Stories was developed on a site long designated for residential use as phase 2 of the Crest. According to Ryan, Federal became interested in consciously designing The Stories to appeal to the seniors market because they wanted a way to differentiate the projection from other high-end rental projects in the same area of the Rockville Pike, northwest of Washington and Bethesda.

The Stories is designed to appeal to the baby boomer market, now passing age 67, and other seniors with a “younger” outlook, unlikely to consider independent or assisted living or even a continuing care retirement community (CCRC).   This market is large and rapidly growing and not well served by well served by conventional seniors housing. While those 75 and up are considered part of the senior housing markets in many market studies, the average entrance age for most dedicated senior housing communities is now closer to 85 than 75 (See Slow 80+ Pop Growth, Elevated Construction Spark Concern For Seniors Housing on this blog – http://03c242c.netsolhost.com/WordPress/?p=209.

Ryan and Smart Living 360’s vision for The Stories is derived from a view of what “younger” seniors want in a living environment to enhance their wellbeing and tries to anticipate the growing role of technology for enhancing seniors’ lifestyle and delivering the services they want and need.   It is also purposefully designed to be flexible so it can adapt to the needs of its target market as they are discovered over time.

To understand what Federal and Smart Living 360 have created at The Stories, you need to think outside the traditional seniors housing box regarding design, services and technology.

Physically, The Stories is a attractive 5-story modern apartment community located in high-income, high-wealth, high-education zip code with a unit mix favoring larger 2 and 3 bedroom units (75% 2 bdrms) over one level of structured parking.   With rents from $2,500 to $4,000, The Stories is priced at about half the cost per square foot of traditional IL properties in its market.  But unlike conventional IL properties, The Stories does not bundle food service and activity programs into its rent.   It is part of a mixed-use project including retail, office and other residential uses in a nice residential area a block off a heavily travel arterial street, the Rockville Pike, MD 355.   The property faces other residential uses and fronts on a relatively quiet suburban street.

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Units within The Stories look like high-end non-age-targeted residential rental units with small balconies that are designed with largely invisible accommodations for an aging senior market – wider doorways and master baths able to accommodate a wheel chair with higher toilets, easy entry showers, modest grab bars in the bath with studs behind the wall to allow more to be installed, roll out lower shelves in cabinets, electrical outlets further up on the wall, etc.   These are accessible units that intentionally look like conventional units.

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Common areas include a large fitness room with some specialized equipment for seniors that could also be used by personal trainers or rehab therapists, a central lounge with a refrigerator and cooking equipment and a self-serve coffee bar.  
There is a small conference room that is designed so that it can also be used for a visit by a health professional or for telemedicine care.   The entire building is pre-wired for high speed Verizon Fios internet with pre-installed routers; and service providers are available to install Sonos wireless speaker systems and other electronic amenities in the units.   The electronics designed into the building are intended to accommodate increased use of patient self-monitoring and wellness devices that Ryan believes will become increasingly prevalent, sophisticated and integrated over time.

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The building offers a secure electronic entry system, with an enhanced concierge called a Lifestyle Ambassador (services described below) manning the front desk during the day. The building is monitored in the evening by management personnel from the larger Crest Apartment building that is located at the other end of the block, across a parking lot from The Stories.   The number and length of coverage by on-site personnel is partly limited by the buildings relatively small size, only 48 units.

What really sets The Stories apart as a community that will appeal to seniors is its use of a Lifestyle Ambassador, in this case a hotel industry trained and certified concierge cross-trained in seniors housing design and services.   The role of the Lifestyle Ambassador is threefold – 1. Help residents connect with one another and with the outside community, 2. Provide access to any needed services, and 3. Simplify resident’s lives by taking care of pets and plants while residents are traveling and providing other services.   Smart Living 360 makes use of many off-the-shelf on-demand services, has prearranged for a wide range of additional services to be available to residents of The Stories and will provide referrals to providers, including:

  • Transportation
  • Pharmacy
  • Physicians
  • Food Delivery
  • Financial Advisors
  • Case Managers
  • Home Healthcare
  • Personal Trainers
  • Tech Services

The goal at The Stories is to offer attractive housing, location and services to enhance the well being of baby boomers and other “younger”, generally healthy seniors without the stigma of a traditional seniors housing community with a large percentage of very old, frail people; and to do it in a flexible way that allows it residents to order in any services they may need and to adapt to rapidly evolving technology for medical monitoring and wellness.

Smart Living 360 hopes to monitor residents of The Stories over time to see if the building’s design and the flexible services it offers will enhance residents’ well being compared to those living in other residential settings. This will be done using the Gallup-Healthways Well-Being Index that measures five factors:

  1. Purpose – Liking what you do each day and being motivated to achieve goals
  2. Social – Having supportive relationships in your life
  3. Financial – Managing your economic life to reduce stress and increase security
  4. Community – Liking where you live and having pride in your community
  5. Physical – Having good health and enough energy to get things done.

What is interesting to me about Smart Living 360’s approach compared to a traditional senior housing facility is that Smart Living 360’s Life Style Ambassador begins with the residents’ wishes and customizes activities and services the resident desires while a traditional senior housing facility has a menu of services into which it tries to fit a resident. I see the Smart Living 360 approach as more resident centric, more personalized and more adaptable over time.

The Stories occupies an interesting place somewhere between non-age-restricted market rate apartments and conventional seniors housing.   Interestingly, the project was voluntarily described as 55+ housing in pre-opening marketing material but the developers have now decided to market its advantages for seniors but without the age restriction, which they believe may be a turn-off for their primary but not only target market.   Of the first several residents moving in, two are seniors and one is age 29 but liked the amenities.

It remains to be seen whether The Stories will be successful in attracting baby boomers and other seniors with a “younger” outlook and how Ryan Frederick’s vision of meeting residents’ needs and increased use of electronic devices to monitor and enhance health and wellness will come to pass.   But I believe, even at this stage, The Stories has some interesting lessons for seniors housing and multi-family developer/operators and institutional real estate investors.   These include:

  1. Non-age restricted housing and un-senior “seniors housing”, as I categorize the Stories, may be more appealing to under 80s seniors, and even those over 80 in good health with younger outlook, than more conventional seniors housing projects.   For a significant portion of the senior population today and I believe for even a larger portion of the baby boomers, living in mixed aged neighborhoods or even in mixed age buildings like The Stories may be preferable to living in a senior ghetto or in an isolated age-restricted community.
  2. We have already seen obsolescence in seniors housing communities, such as IL projects without sufficient provisions for handicapped residents, IL and CCRC projects without AL and memory care units, AL communities with insufficient common space for gyms or rehab care and IL and AL buildings with too many small units.   This history suggests that building flexible design into seniors housing communities, which The Stories has very deliberately tried to do, may be an advantage for the community over time.
  3. Seniors housing located in mixed use projects or higher density urban areas, where services and amenities are close-by, while often more difficult and more expensive to develop than stand-alone conventional IL or AL communities, would seem to offer a lot of appeal for the baby boomer age cohort and other active seniors.
  4. In an age of on-demand services, such as Uber and Foodler, planning seniors housing around services delivered by outside vendors may prove both cost effective and better able to meet seniors desires and needs than the service packages typically available in seniors housing communities.
  5. Seniors, particularly the baby boomer age cohort, are increasingly tech-savvy and should be able to adapt to electronic delivery of health and wellness services, as well as other on-demand services, and may see projects designed to accommodate more high-tech amenities as more appealing than conventional care models.
  6. The resident centric and holistic approach to meeting resident’s needs built into the Lifestyle Ambassador approach that incorporates both social and care needs, seems to offer some advantages over the way conventional seniors housing services are organized with responsibility fragmented between healthcare, activities, dining and caregiving personnel, each of whom may only see themselves responsible for a slice of a senior’s needs.   While the staff in any well managed seniors housing project should get to know the “whole resident”, making resident on-demand centric services the organizing principal of your care delivery system appears to offer some advantages and a have a better chance of assuring a residents need are met.

 

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Confessions of a Recent CCRC Mover

The question I most encounter when speaking with friends, family members and acquaintances about seniors housing is: How do you get a reluctant family member of advanced age living alone to agree to move to seniors housing? It doesn’t seem to matter if the family member is 79 or 99, there is still a strong reluctance on the part of many of today’s seniors to move to any type of seniors housing despite objective information that such a move improves socialization, nutrition and overall health and wellness, and may increase longevity.

While “How to get a reluctant family member to move?” may be the quintessential question to which families would like an answer, I find very little useful information on the web and from seniors housing organizations on how to address this question.   In order to seek an answer for myself and for those who ask me about it, I interviewed a 97 year-old friend and former neighbor who made the decision to move to a CCRC about 18 months ago.   I wanted to understand her decision to move, what finally convinced her to move and how her experience has been since moving to her CCRC.   For the purpose of this blog, we will call her Ms. F.

Ms. F is a remarkable person in many ways but I believe her decision to move to seniors housing and her experience after she arrived are still illustrative for others.   As I indicated, Ms. F is 97 years old. She moved from the large, single family home where she raised her family to a condominium in 1979, when she was only 60, partly due the health of her husband who died seven years later.     She continued to live in a full-service elevator-served condominium with a wide-range of resident ages until 2014, when she made the move to a CCRC. In her condo, Ms. F had occasional cleaning help but lived independently and drove. When living at her condo, Ms. F attended a Pilates class once a week, played 9-holes of golf regularly through 2013 and had an active social and cultural life. Ms. F is college educated, cultured, very well dressed and had enough wealth so that all housing and care options were available to her.

The discussion of a move to seniors housing started with Ms. F’s children, the oldest of whom is 74, about three years before Ms. F’s decision to move.   Her children, who live in another city at least six month of the year, were concerned about her living on her own and continuing to drive.   Ms. F indicated she finally agreed to move to a CCRC to make her children happy and because after a bout of pneumonia in the winter of 2013 she did not bounce back completely to her previous stamina.   The discussions for her to move also began after her significant-other, with whom she had a very long-term relationship, died.

Ms. F’s reluctance to move to a CCRC or another type of seniors housing primarily arose from the fact that moving to such a facility would require her to “admit she was old”, something she had never really done despite being 95 at the time of her move.   Ms. F, like many in the current generation of Roaring Twenties Babies in their 80s and 90s, also saw moving to seniors housing in a negative light because it indicated to her that she could no longer live on her own and she saw it as giving up some of her independence.

One of the key lessons I took from Ms. F’s experience is that us Baby Boomers, the children of today’s 80 and 90 year-olds, tend to see their parents as very old, frail people in need of care while many seniors do not view themselves as old and cherish their independence. This suggests that any conversation about a move to seniors housing should not begin with the senior’s frailties but how such a move could enhance and prolong independence.   It would be better for us Boomers to approach these discussions thinking about the attributes of senior housing that we would find attractive because a seniors’ view of him or her self, if still healthy and not cognitively impaired, sees 80 or even 90 as the new 60.

The other clear lesson from Ms. F’s experience, and that of other seniors and their families that I have observed, is that the decision to move to seniors housing, if made voluntarily, is often a prolonged process that can stretch to a year or more. It is also important to realize that senior housing facilities offer a broad range of housing and lifestyle choices and may involve trade-offs between housing and lifestyle amenities, something that seniors and, in many cases, their children may not understand.   Visits and short-term stays, which many facilities offer, can help a senior and their families get to know a facility well before committing to move.

It is also worth noting that a mixed-age full-service condominium served Ms. F very well as a housing choice for 35 years, from the time she was 60 until she was 95.    With the growing availability of smart-phone accessed transportation, grocery and food delivery and home care services, it is important for the seniors housing industry to realize that well-designed, mixed-age apartments and condominiums can be a very viable option for many seniors and that seniors may prefer such options that don’t require them to “admit they are old”.

Ms. F and her family did not undertake an exhaustive search of senior housing facilities because they were looking for something high-end and were familiar with many of the choices because Ms. F, at 95, knew people living at a number of the likely choices.   The facility Ms. F chose was relatively close to her condominium, offered extensive educational and cultural programming, which appealed to her, and had friendly and welcoming staff.   The downside of the community Ms. F chose was that it dates from 1984 and did not offer some of the amenities within its units and common areas of other facilities that were newer or which had undergone extensive renovations.   Ms. F looked at a number of different units before she found one on an upper floor that had enough natural light to make it appealing. Ms. F moved from a modern three-bedroom, two-bath condo with larger windows and lots of light to an oversized one-bedroom, one-bath senior housing unit.   She believes the size of the unit is fine but would prefer a larger bath and a separate powder room for when she has quests.     Ms. F’s focus on a welcoming staff, light in units and other factors dovetail well with industry studies of independent living customer satisfaction.   (See my blog on Finding Happiness In Seniors Housing http://03c242c.netsolhost.com/WordPress/2015/08/20/finding-happiness-in-senior-housing/).

It is worth noting that the CCRC to which Ms. F moved is about to undertake a major expansion and renovation that will add larger independent living apartments in response to demand, add a memory care section and renovate public areas to update the look and add casual café-style dining in addition to the formal dining room.

Ms. F’s transition to a CCRC has been relatively easy for her. She only knew one person well at the CCRC when she moved but Ms. F was able to make friends quickly.  Today Ms. F gets around without a walker but does worry about falling and is careful when she walks. Ms. F was still driving at the time she moved to a CCRC but not long after she arrived she had a minor traffic accident and decided to give up driving.   However, using the CCRCs and private transportation services, Ms. F still gets to her Pilates class once a week and to cultural events (She will be traveling to New York soon to see Hamilton) and she has added personal fitness training at the CCRC and is attending many of the programs that the facility offers, including a current lecture series on the Supreme Court planned before Justice Scalia’s death.

I believe Ms. F’s attitude toward her move to a CCRC also eased her transition.   Rather than focus on the space she was giving up and the things she was leaving behind, Ms. F chose to view her move as an opportunity.   She got help from a decorator to design and furnish her new home, bought some new things and recovered some of the furniture she chose to move from her condominium.   So she made it a new beginning rather than a move down.

Ms. F is very positive on her CCRC now that she has moved and agrees that she may have benefitted from moving sooner. But Ms. F doubts she could have made the decision to move until she started to notice herself slowing down following her pneumonia, had lost her significant other and was ready to admit she was old.  One of the benefits she sees at the CCRC is knowing other couples that are older than her but still mentally active and able to get around.   Her close friends at the facility include a couple that are 102 and, while he uses a walker, are still in very good health and very alert.

Top on Ms. F’s list of what makes her CCRC a good place to live are:

  • Activities/Programming – special events (St. Patrick’s Day and Easter Dinners for example), movies including first run movies such as Spotlight and Brooklyn, Lectures that cost residents $25 and outsiders $125, religious services, entertainment every Wednesday and other events like a forum for local mayoral candidates.
  • Volunteer Opportunities
  • In-House Exercise Programs and therapy
  • Housekeeping Services that include weekly linen service, biweekly cleaning and an annual complete unit cleaning as part of the base rate and PAL service that for $21 per hour provide additional light cleaning, laundry and making the bed.
  • Friendly Staff who know you by name and friendly residents. Many of the staff are African American high school students interested in careers in healthcare or food service/hospitality industry that the facility trains.
  • Someone Looking Out For You – It is comforting knowing there is always someone there for you. The facility has an electronic monitoring system that can tell if you are not up moving around your unit by a certain time and uses other checks such as attending meals and taking in your paper to check to be sure you are all right, as well as emergency alert system.
  • A Healthy Future – Ms. F can see that she is not the oldest and certainly healthier than some others.
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Reusing Suburban Corporate Headquarters As CCRCs

The Wall Street Journal on Tuesday, February 9, 2016 featured an article entitled “Office Glut Strains Suburbs – Landlords, officials at odds over revamping vacant campuses as firms leave for cities”.    The article highlights a growing trend of major corporations abandoning leafy suburban headquarter’s campuses for urban locations where transportation options are better and it is easier to attract tech-savvy Millennials.    The article focuses on the relocation of Pearson Education from its Upper Saddle River, N.J. site to locations in Manhattan and Hoboken, N.J.

The site Pearson is leaving is a 47 acre site in a wealthy town of about 8,000 people located about 30 miles northwest of Manhattan.   It features a “bunkerlike” structure of grey concrete built in 1973 for Western Union with 470,000 sq. ft. of space and few prospects.   The suburban couplex is owned by publicly traded Mack-Cali Realty Corp. (CLI).   The building previously generated annual revenue of $8.6M but after testing the market, Mack-Cali found no office takers.    The company is proposing to replace the former Pearson Education headquarters with 240 apartments, which some in the town oppose because it would change the character of the community and generate expenses for public services while bringing in less taxes than a corporate office property.   Other locations noted in the WSJ article with similar former headquarters locations include:   the former Bell Labs headquarters in Holmdel, NJ; BASF’s former North American headquarters in Mount Olive, NJ and the former home of Merck & Co. in Readington, NJ.

None of the real estate owners or developers cited by the WSJ were mentioned to be considering a continuing care retirement community (CCRC) as a primary reuse for these corporate office sites or as a principal use in a larger mixed-use complex that might combine office and retail and non-age restricted housing together with a CCRC.   Yet, a CCRC would appear to offer a number of benefits.    Principally, a CCRC would:

  • Target the existing older, affluent residents of the wealthy suburbs where these former headquarters are located.
  • Likely generate more in tax revenue than would be required to service the CCRC because CCRC residents would not have children in public schools.
  • Generate less in the way of traffic congestion than conventional apartment or condominium development and less than a former corporate headquarters.
  • Generate spending in the community for existing or to-be-built retail space.
  • Generate demand for additional healthcare and other services that might be found in the community or incorporated on the site.
  • Generate greater demand for employment on the site and potentially taxes than would a conventional housing development.

CCRCs typical range in size from about 250 units including a mix of independent living, assisted living, memory care and skilled nursing or healthcare units/beds to as many as 2,000 units/beds in large complexes that have principally been developed by Erickson Living.    While there is an emerging trend among seniors housing developers, like office developers, to consider higher density, mixed use urban locations, I believe there is still significant demand for suburban CCRCs, particularly in wealthy, aging, hard to develop locations, like northern New Jersey, where the corporate headquarters sites noted above are located.

CCRC’s are typically developed in either an entrance-fee or rental format.   In an entrance-fee format, residents pay an upfront fee that may be partially or fully refundable.   This fee is used to repay construction debt and the non-refundable portion is amortized over time to reduce the monthly cost of housing and care.   In a rental format, there is no entrance fee, more long-term financing is used and monthly rent must cover the full cost of housing and services.    The largest CCRC campuses typically incorporate multiple casual and formal dining venues, pools, gyms, lecture halls, entertainment and recreational amenities and may include full physician practices and their own health plans as well as health centers that provide therapy space.

In 2014, while I was still working in investment banking, I pitched seniors housing as a reuse for some undeveloped or partially developed suburban office locations to a publicly traded suburban office REIT.   However, the sites this company had available at the time were not as large or as well located as the corporate headquarters’ sites noted above and were not well suited to CCRC developments of scale.    While CCRCs are well outside the comfort zone of most office owners/developers, outright sale of large suburban headquarters sites for this purpose or joint venture development with existing owners of suburban headquarters sites and CCRC developers or healthcare REITs would appear to be a very viable option for such locations, particularly in cases where a CCRC would be an element in a larger mixed use campus that might include some conventional apartments (potentially for staff), retail and office/healthcare uses.

 

 

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