Ladies and gentlemen, thank you for standing by, and welcome to the Ventus 4th Quarter 2020 Earnings Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer I would now like to hand the conference over to your first speaker today, Sarah Whitford, Director of Investor Relations. Please go ahead.
Thanks, Amy. Good morning, and welcome to the Ventas 4th quarter financial results conference call. Earlier this morning, we issued our 4th quarter earnings release, supplemental and investor presentation. These materials are available on the Ventas website at ir.ventasreit.com. As a reminder, remarks made today may include forward looking statements, including certain expectations related to COVID-nineteen and other matters.
Forward looking statements are subject to risks and uncertainties, and a variety of factors may cause actual results to differ materially from those contemplated by such statements. For a more detailed discussion of those factors, please refer to our earnings release for this quarter and to our most recent SEC filings, all of which are available on the Ventas website. Certain non GAAP financial measures will also be discussed on this call. For a reconciliation of these measures to the most closely comparable GAAP measures, please refer to our supplemental posted on the Investor Relations section of our website. I will now turn over the call to Deborah A.
Cafaro, Chairman and CEO.
Thank you, Sarah, and good morning to all of our shareholders and other participants. On behalf of all my colleagues, we want to welcome you to the Ventas 4th quarter year end 2020 earnings call. Let me begin by expressing my deep gratitude and optimism, born of the strength, resilience and innovation so many have demonstrated over the past year and the positive developments we are seeing on the ground in our portfolio virtually every day. Our results in the 4th quarter demonstrated Ventas' resilience with normalized FFO reported at $0.83 a share and $0.74 ex much appreciated funding from HHS to our senior living communities that have been affected by COVID-nineteen. I've reflected on the grueling year we've all had.
I couldn't be prouder of our productive and skilled team, our enterprise and our capable, dedicated partners. After a fast and positive start to 2020, the last year has been dominated by the COVID-nineteen pandemic and punctuated by extreme weather disruptions, both of which have continued into the Q1 of 2021. Throughout, we've put the full force of our firm's resources and energy behind keeping people safe, demonstrating remarkable resilience and becoming part of the solution, whether in employee testing, advocacy or assistance to tenants and operators who needed it. Financially, through our foresight, our long standing diversification strategy and our decisive action, we've kept our enterprise strong and stable, generating almost the same EBITDA in 2020 as we did in 2019 and benefiting from our investments in people, systems and preparedness, our balance sheet flexibility and our embedded relationships with best in class partners. And we found ways to grow and advance our strategic including building value through acquisition and development in life sciences, investing in La Groutte Maurice's attractive senior housing development pipeline, creating new partnerships and establishing a third party investment management platform that will provide more options for future growth.
We remain committed to our core values and respect and integrity and accelerated our actions to promote sustainability, diversity and social justice in our company, our communities and our country. Finally, we were very fortunate to recently add 2 top notch directors to the company, 1 a leader in healthcare and the other in real estate and REITs. My gratitude and optimism also flow from the life saving COVID-nineteen vaccine discovery by doctors and scientists in record time and the recent acceleration of vaccine delivery by the Biden administration. Nationally, ending COVID-nineteen is foundational to spur sustained economic recovery and restore vitality to so many businesses, households and workers. At Ventas, we're proud that 100% of our U.
S. SHOP, AL and memory care communities have already received the vaccine and nearly 90% of them will complete their 2nd dose by the end of this month. Notably, senior housing vaccine delivery represents one of the shining successes in our fight against COVID-nineteen. In our SHOP community, it is wonderful to know that about 30,000 vulnerable residents have already been vaccinated and are one step closer to feeling safe, seeing loved ones and enjoying a richer life. From our real time data, we also know that confirmed COVID-nineteen cases in our communities have recently begun to improve significantly, creating an enhanced sense of well-being and enabling more operators to open communities to new move ins.
And leads that our communities built to their highest level since the pandemic began in January, once again demonstrating the strength of the value proposition of senior housing and the resilient demand for the services our care providers deliver. While we expect SHOP's 1st quarter NOI and occupancy, which are lagging indicators, to decline sequentially as a result of November to January extreme COVID-nineteen conditions. We are encouraged by the breadth and consistency of all positive leading indicators. Conditions remain dynamic and it is too early to declare a definitive trend, but we like the picture we are starting to see. Post pandemic senior housing growth represents an incredibly significant value creation opportunity for our shareholders.
Turning to our investment outlook. Our diversified asset base with 5 verticals has given us the ability to continue successfully allocating capital over time and through cycles. For example, we've created tremendous value since our early cycle investments in our Research and Innovation business in 2016. We continue to find meaningful opportunities to drive that business forward in both ground up development and asset acquisitions with universities and in cluster markets alike. Our decision to add Life Sciences to our enterprise has provided uplift to our results, our investment activity and our value.
Here are a couple of current examples. Our $280,000,000 Life Sciences project known as 1U City in thriving research submarket of Philadelphia, which is bookended by Penn and Drexel is attracting significant leasing interest. In addition to the nearly $1,000,000,000 ground up development projects already underway, our university based development pipeline continues to hold about another $1,000,000,000 in active potential projects with both new and existing university relationships. In particular, with Wexford, we are in the design development phase of a nearly $500,000,000 project with a major research university on the West Coast that is substantially pre leased. We look forward to sharing more information with you later this year.
Outside of research and innovation, we continue to allocate capital to develop large Class A independent living communities with our partner LGM in Quebec. We've had 5 projects underway with investment also totaling nearly $500,000,000 and 2 of the projects were delivered in the 4th quarter. We are pleased to report that the 2 open communities have leased up quickly and occupancy is already nearly 80%. In addition, our pipeline of potential acquisitions in all 5 of our verticals is active and growing. We continue to invest with an eye toward growing reliable cash flow and favorable risk adjusted return.
We will also continue to evaluate and execute opportunities to recycle capital as well. Both Justin and Pete have been working with our deal team to target about $1,000,000,000 of dispositions during the year to optimize our portfolio. Finally, our institutional investment capital management platform continues to grow and succeed with well over $3,000,000,000 in assets under management, Bringing together our pre existing and new third party capital vehicles under one umbrella, The Ventas Investment Management business includes our Life Sciences and Healthcare Funds. The Ventas Fund stands out as one of the most successful launches of a first time real estate fund in any asset class. Our investment management platform provides a significant competitive advantage to Venhub.
It broadens our capital sources, augments our investment capacity, expands our footprint, leverages our team and industry expertise, improves our financial flexibility and liquidity and adds an incremental source of earnings. There is tremendous market opportunity within life science, medical office and senior housing real estate, and we are well positioned to capitalize it on capitalize on it in multiple ways. In closing, let me reiterate that demographically driven demand is right in front of us. The leading indicators in senior housing are improving rapidly, that team delivery is accelerating and the long term thesis for all of our asset classes and for Ventas remains firmly positive. All of us at BenPaz have an abiding commitment to staying strong and steady and winning the recovery on behalf of all of our
I'd like to begin by highlighting the 4th quarter performance and 1st quarter performance expectations. First, I would like to mention that we are humbled and grateful that HHS continues to recognize the crucial role senior living plays in protecting vulnerable older Americans. Through the CARES Act, HHS has provided several rounds of funding to assisted living communities to partially mitigate losses directly suffered because of the COVID-nineteen pandemic. Through this program applicable to sequential same store SHOP assets, our communities have received $34,000,000 in the 4th quarter $13,000,000 to date in the Q1, which has been applied as a contract expense to offset COVID-nineteen related expenses incurred. After a challenging Q4 January in which the national spread of COVID-nineteen hit all time highs, our communities experienced an increase in resident cases and we had more communities close to move ins.
Leading indicators have followed a similar pattern. Leads and move ins drifted down throughout November December, while at the same time, move outs were elevated. Although the Q4 was a challenging quarter, we are pleased our occupancy hung in there with a 90 basis point decline. Looking ahead to the remainder of the Q1. For the forecast Q1 sequential same store SHOP portfolio, we expect cash NOI to decline from the Q4 to the Q1, excluding HHS grants of $34,000,000 $13,000,000 to date in each respective period.
This NOI deterioration is driven by a 250 to 3 25 basis point expected occupancy decline, partially offset by a modest rate increase. We expect to see continued elevated operating expenses into the Q1. And while we are seeing continued high levels of COVID related costs, these are partially mitigated by $13,000,000 of Phase 3 HHS grant money received to date in the Q1. I'll add that recent severe winter weather across the country cause additional expenses as well as delays in movements. We haven't included any impacts, if any, in our guidance.
While we are experiencing choppy waters at this stage of pandemic, I would like to highlight green shoots that support a more optimistic outlook ahead. I'll start by highlighting our improving clinical trends. Consistent with the U. S. COVID case trends, our SHOP communities are experiencing a significant decline in new COVID cases.
In the most recent week, we are averaging 9 cases per day, which is the lowest since October and down from 92 cases per day at the peak in January. We couldn't be more relieved about this improvement knowing this means less illness and less people potentially dying from COVID. This positive clinical trend is also important to local health departments' support of our community's ability to accept new move ins and to offer a more robust living experience for our residents. I'd like to comment on the early success our operators have had deploying the vaccine to residents and employees within our SHOP portfolio. As Debbie mentioned, 100% of our assisted living and memory care communities have hosted their first vaccine clinic.
In other good news related to the vaccine, 2 studies from Spain and Israel have come out showing favorable data that people who are vaccinated and still contract COVID-nineteen are far less likely to spread the illness to others than if they were not vaccinated. The execution of the vaccine is a massively important step toward the stabilization and growth in our senior housing platform. I'll note that 95% of our communities are already open to move ins, which is near a pandemic high. I'll remind you of the importance of the segments mentioned in our business update. Currently, 80% of our communities are operating in Segment 3.
This is up from 64% a month ago. Segment 3 is the least restrictive operating environment. Communities in the segment offer a more robust living experience, includes a more open dining experience and small group activities. Most importantly, it allows for less restrictive visitation between residents and their loved ones. As more communities expand their service offering, demand for our services should improve.
Leads and move ins started to pick up again in January with the highest number of leads we have witnessed since the beginning of the pandemic. We have seen broad based strength in lead volume across regions and the initial indication is that this momentum has continued into February. The increase in leads have been bolstered by very strong growth in our Le Group Maris portfolio in Canada and consistent strong lead performance by Atria in the U. S. To summarize our optimism, new COVID cases down, vaccine distribution on track, leading to a more robust living experience and all combining to support higher leads.
We continue to monitor these positive trends on a real time basis and remain focused on supporting our operating partners as they get in position to win the recovery. Moving on to triple net senior housing. In the Q4 and through January, Ventas received all of its expected triple net senior housing cash rent. Our underlying triple net senior housing portfolio performance continues to be impacted by COVID-nineteen. However, due to a mix of lease resolutions executed in 2020, government subsidies including PPP loans and HHS funds and other tenant resources, our tenants have continued to pay as expected.
Our trailing 12 month cash flow coverage for senior housing is 1.3 times, respectively. I'll comment on the senior housing industry outlook. Our competitive outlook has continued to evolve amid the pandemic. In 2020, construction starts nationally were down 50% year over year and deliveries were at their lowest level since 2013. Our shop markets witnessed particularly favorable supply trends with starts down 66% versus the prior year and deliveries down over 40%.
We are optimistic about the long term impact from lower construction starts. Fewer starts today, combined with the compelling aging demographic trends where the 80 plus population is expected to grow nearly 15 percent between now and 2024, which is 5 times faster than the broader population, will provide a potent tailwind over the next few years. Moving on to final comments. I'd like to comment on the tremendous job well done our operator partners and frontline staff have done prioritizing the health and safety of our residents and employees throughout a very challenging period. We couldn't be more proud of their focus, determination, courage and perseverance throughout the pandemic.
I'd also like to note our excitement and support for Jack Callison, the new CEO of Sunrise Senior Living. We know Jack to be an accomplished and charismatic leader who is extremely qualified to lead Sunrise. I'll finish by reiterating our optimistic outlook as we consider the improving clinical trends, vaccine rollout, communities opening for move ins with a more robust living experience and post pandemic supply demand tailwinds that give us continued confidence and a very strong positive growth trajectory in senior housing. With that, I'll hand the call to Pete.
Thanks, Justin. I'll cover the office and healthcare triple net segments. Together these segments represent 47% of Ventas' NOI. They continue to produce strong results, showcasing their value proposition and financial strength amongst the pandemic. In fact, for the full year 2020, these segments combined to generate same store cash NOI growth of 3%.
First, I'll cover office, MOBs in Research and Innovation Centers. The two lines of business within our office portfolio, they play a key role in the delivery of crucial healthcare services and research for life saving vaccines and therapeutics. The office portfolio continued to provide steady growth, delivering $128,000,000 of same store cash NOI in the 4th quarter. This represents a 1.5% sequential growth led by our R and I portfolio which generated 3.6% same store cash NOI growth. Moreover, full year office same store cash NOI grew 3.3% versus 2019, near the midpoint of original 2020 office guidance of 3% to 4% despite the impacts of COVID-nineteen.
Normalizing for a paid parking shortfall and increased cleaning costs due to COVID, same store cash NOI grew 4.5% suppressed surpassing our pre COVID guidance range. In terms of rent receipts, office tenants paid an industry leading 99 0.2% of contractual rents in the Q4. For the entire period from April through December, tenants paid 99.4 percent of contractual rent. This is without deducts or deferrals, which were de minimis. So essentially all granted deferrals have been repaid and new deferrals were negligible during the Q4.
Continuing the trend, we have collected 98% of January contractual rents on track to meet or exceed the 4th quarter collection rate. February today collection results are also strong and are at a consistent pace when compared to the 4th quarter. This strong performance is enabled by the mission critical nature of our portfolio and by our high quality creditworthy tenancy. In our medical office portfolio, nearly 85% of our NOI comes from investment grade rated tenants in HCA. In our R and I portfolio, 76% of our revenues come directly from investment grade rated organizations and publicly traded companies.
Medical office had a record level retention of 88% for the Q4 and 87% for the trailing 12 months. Driven by this retention, total office leasing was 700,000 square feet for the quarter and 3,400,000 square feet for the full year 2020. This includes 540,000 square feet of new leasing. Total leasing far exceeded our pre COVID 2020 plan. All of our MOB properties are in elective surgery restriction free locations.
As a result, we are seeing utilization trends that mirror increased admissions and surgery volumes being reported by the health systems. As an example, paid parking receipts during the Q2 of 2020 were only 46% of normal. During the Q4, however, paid parking recovered to 71% of normal. As Debbie mentioned, we continue to be excited about the office business and particularly investment opportunities in the R and I space. In the 4th quarter, we closed our acquisition of the 3 asset 800,000 Square Foot Trophy Life Sciences portfolio in San Francisco.
Since last quarter's announcement, we have renewed a large tenant and signed 2 new leases bringing the building to 100% leased. A clear demonstration of the attractiveness of these buildings in the marketplace. We also opened our $80,000,000 R and I development on the campus of Arizona State located within the Phoenix Biomedical Campus, a 30 Acre Innovation District established by the City of Phoenix in the heart of downtown. The building is over 50% pre leased and is ahead of pro form a. Now let's turn to Healthcare Triple Net.
During the Q4, our Healthcare Triple Net assets showed continued strength. We have received 100% of 4th quarter rents as well as 100% of January and 100% of February rents. Trailing 12 month EBITDARM cash flow coverage improved sequentially for all our healthcare triple net asset classes except skilled nursing despite COVID-nineteen. Acute and post acute providers had early access to significant government funding to create liquidity and mitigate pandemic related losses. Acute Care Hospitals trailing 12 month coverage was a strong 3.3 in the 3rd quarter, a 20 basis point sequential improvement driven by a rebound in elective surgical procedures, prudent expense management, as well as government funding.
Arden continues to perform extremely well in this dynamic market condition and all of Arden's hospitals reside in jurisdictions that are open for elective procedures. We are excited to continue growing with Ardent. During the Q4, Ardent opened a new outpatient cancer center on the campus of their hospital in Amarillo, Texas. The cancer center features best in class equipment and facilities for radiation therapy, chemotherapy and cancer care. We invested approximately $30,000,000 at a near 8% stabilized yield.
IRF and LTAC coverage improved 10 basis points to 1.6 times in the 3rd quarter, buoyed by strong business results and government funding. In particular, Kindred has demonstrated its core competency in treating complex patient cases. Census levels continue to be very high. And finally, within our loan portfolio, our Colony, Holiday and Brookdale loans are all fully current. I'd like to close with a thank you, a sincere thank you to our frontline staff who have kept these critical facilities open during this difficult time.
You are all heroes. With that, I'll turn
the call over to Bob.
Thanks, Pete. In my remarks today, I'll cover our 2020 enterprise Q4 results, our expectations for the Q1 of 2021 and our recent liquidity, balance sheet and capital activities. Let's start with our 4th quarter financial performance. Ventas reported 4th quarter net income attributable to common stockholders of $0.29 per share and normalized funds from operations of $0.83 per share or $0.74 excluding the $0.09 in HHS grants received in SHOP in Q4. Other sequential 4th quarter drivers to highlight include $0.04 of income recorded in our unconsolidated entities, offset by a $0.05 Q4 sequential decline in NOI, principally in SHOP.
Meanwhile, office and triple net healthcare was stable on a sequential basis in the 4th quarter. That's a good segue to our Q1 guidance as Q4 is an appropriate start point for our Q1 2021 expectations. The key components of our Q1 guidance are as follows. Net income attributable to common stockholders is estimated to range between minus 0 point diluted share. Normalized FFO is forecast to range from $0.66 to $0.71 per share.
The midpoint of our FFO guidance, dollars 0.68 per share, represents a $0.15 sequential decline from the 4th quarter. This change can be largely explained by a $0.09 reduction in HHS grant income and income from unconsolidated entities. The balance is driven by a $0.05 reduction in organic SHOP NOI performance. A few of the key SHOP Q1 assumptions include q1 twenty twenty one average occupancy ranging from 250 to 325 basis points lower versus the 4th quarter average sequential growth in RevPOR as a result of the annual in place rent increases implemented at the start of 2021 and continued elevated levels of operating expenses driven by COVID labor and testing. Outside of SHOP, we expect our property NOI to be stable on a sequential basis in the Q1.
A normalized FFO per share bridge from our Q4 to our Q1 2021 guidance midpoint, together with key assumptions, can be found in our press release and our business update presentation posted to our website today. I'll close with our balance sheet and capital activity. I'm proud of the actions the Ventas team has taken to manage our balance sheet leverage and liquidity. We have navigated the disruption created by COVID and kept Ventas strong and stable while protecting shareholder capital. I'd highlight a few of our most recent actions and results.
First, some key stats from 2020. We finished 2020 with full year net debt to EBITDA of 6.1 times, maintained a strong maturity profile with duration exceeding 6 years, had held total debt to gross asset value at 37%, reduced our net debt at year end by over $500,000,000 year over year and retained robust liquidity exceeding $3,000,000,000 In 2020, we also took advantage of the strong bid for healthcare real estate and realized over $1,000,000,000 in asset sales at a blended 5.3% cash yield. In 2021, we're targeting an additional $1,000,000,000 in asset sales across our verticals in the second half of the year. Proceeds from dispositions are expected to be used to reduce debt and to fund future growth through development and redevelopment capital spend. In January 2021, we closed on a new 4 year $2,750,000,000 unsecured credit facility.
We had great demand from 24 new and incumbent financial institutions and were able to realize better pricing. I'd like to personally thank our banking partners for their support of Ventas. They are critical to our success. And finally, in March 2021, Ventas will use cash on hand from recent dispositions to reduce our near term maturities by fully repaying $400,000,000 of our 3.1 percent senior notes due January 2023. As a result of these and other actions, we're positioned to capitalize on the powerful upside across our business once the pandemic is finally in the rearview mirror.
That concludes our prepared remarks. Before we start with Q and A, we're limiting each caller to 2 questions to be respectful to everyone on the line. With that, I will turn the call back to the operator.
Question today comes from the line of Juan Santabria with BMO Capital Markets. Please proceed with your question.
Hi, good morning. Good morning. Good morning. I was just hoping, Debbie, maybe you could provide a little color on the acquisition pipeline. You talked about it being robust across your various verticals.
So I guess I'm curious what asset types are of the most interest? You've been kind of quiet on the seniors housing acquisition front for a while. It seems like Arden might have some new opportunities if it merges with LifePoint. I'm curious if that acquisition pipeline is more focused on balance sheet or through the fund.
Well, it's great to hear from you. I would say that we have a lot of options now as we look at investment opportunities, not only can we look across the 5 asset types, but also we have a number of tools we can use to acquire assets either on balance sheet or in our management business. So I'd say we're really looking across the board. We've got obviously a lot of life sciences and research and innovation, both ground up development as well as acquisition activity. We've got some senior housing possibilities in the pipeline.
Ardent is obviously doing well and we continue to look for similarly high quality opportunities in that space. And so it really is quite interesting and across the board. And as I mentioned, we're continuing to invest with LGM. They have done just an incredible job both on the management of the stable portfolio, but also in developing and leasing up very quickly these Class A assets. And we're looking forward to doing more of that with LGM as well.
Okay. Thanks. And then just for my follow-up on the disposition front, switching to the opposite side, the $1,000,000,000 for 'twenty one that you've targeted for the second half, could you provide any color on the types of assets you're selling? If I think about this time last year, you talked about maybe joint venture Eclipse. You had some Atria assets that were on the block.
So if you could just give us a little bit more color on the flavor there?
Good one. I mean I gave a little clue when we talked about Justin and Keith really optimizing the portfolio. So while we're really looking across the board, I would say that senior housing and maybe some select MOBs could fall within that disposition pipeline.
Thank you.
Thanks, Juan.
Your next question comes from the line of Nick Joseph with Citi. Please proceed with your question.
Thank you. Maybe just following up on that question. I know you said it's the back half of the year, but just curious what the timing is and then the cap rates on any of those asset sales and trying to get a sense of any potential dilution in the back half of this year into 2022?
Yes. I mean, obviously, we're going to look to be smart about when and how we do it. I would basically just refer you to kind of the back half and you can make a weighted assumption around timing. It's obviously TBD and cap rate also TBD, but we would love really to find lower cap rate assets that we could dispose of. And obviously, you can see in the market, there's a really strong bid across the board in these asset classes.
And that is a very good sign for our ability to execute in a really effective way.
Thanks. And then maybe just on the senior housing side, I'm looking at your business update with the move outs trending higher at least through January, what percentage of those were voluntary? And then how have voluntary move outs trended over these past few months?
Yes. I'm going to turn it over to Justin. I mean, as we've mentioned, I mean, the key points are really around the clinical results because you really have to think about leading indicators being cases and mortality. And then when those start to improve significantly as we've seen, the lagging indicators of NOI and occupancy tend to follow. So I'll turn it over to Justin so he can really address your question in specific.
Hi, Nick. In regards to the recent trend upwards in move outs, that's mostly clinically related hospitalizations, deaths, the voluntary move out questions come up. We really haven't seen a high number of discretionary move outs that are for reasons other than clinical purposes.
Thank you.
Thank
you. Your next question today comes from the line of Omotayo Okusayo with Mizuho. Please proceed with your question.
Yes. Good morning, everyone. Hope everyone is safe and healthy. Oh, my pleasure. Two quick ones for me.
RevPAR growth in the quarter was kind of down meaningfully. I think was negative 3.3% or so. Could you talk a little bit about kind of what caused that? I think you had made some comments about kind of concessions and discounts and things like that. And kind of how is that trending in the early stages of 2021?
Yes, I mean, we are projecting positive RevPAR sequentially and I'll turn it over to Bob to elaborate.
All right, cool. So Q4, you're right to say, down on RevPAR tile, really 2 drivers there. One is simply discounting in the effort to get occupancy, definitely seeing that in the marketplace. The second is mix. With Canada continuing to perform really strongly, Canada has a lower Rev 4.
You see a mix impact. It is a combination of those two things on a sequential basis, which drives the number you see on Rev 4. Positively looking at the Q1, we're expecting growth and again that in place increase very much in line with what we've seen historically, which is quite positive. And so expect to see that as a tailwind in the Q1 on revenue.
So no additional discounting concession thing is not kind of providing to the Q1 of 2021?
I think that will likely carry on at least in the short run, but you see the lift of the in place rent, which happens Jan 1 across a good part of the population. So that really benefits the Q1.
Okay, great. And then on the government reimbursement side, any thoughts or any estimates in regards to how much more is that grant you may be due under kind of like the Phase 2 and Phase 3 programs from last year? And generally, what are you hearing about future government support, just kind of given the change in administration?
Right. We've had with our industry partners a really effective public outreach on this exact point of really the impact of COVID-nineteen on these communities and on seniors and we have made so much progress Tayo, as evidenced by the willingness of HHS to mitigate some of the COVID-nineteen impact by the amounts that we've received to date, which for us has been, I think, about $48,000,000 or so. And we're very grateful for that as Justin mentioned. What we're focused on going forward is there continues to be significant billions remaining in the HHS funds. Well, first of all, Phase 3 could result in additional funding.
That's an unknown. There's also multiple tens of 1,000,000,000 remaining in the HHS fund, which hopefully can be utilized beyond Phase 3 to support the healthcare providers writ large, including senior housing. And then in terms of additional COVID relief packages, we would endeavor to make the case that some of those funds should be either earmarked for or certainly available to be used to mitigate the continuing impact of COVID-nineteen on the 1,000,000 to 2,000,000 seniors who are cared for in senior living. So that's the framework and we'll continue to try to make be a fact based advocate with policymakers to produce a favorable and I think very justifiable outcome on a public health and priority basis.
Got you. Keep fighting the fight. Thank you.
Thank you.
Your next question comes from the line of Michael Carroll with RBC Capital Markets. Please proceed with your question.
Yes, thank you. I wanted to see if
you could provide some color on the occupancy expectation going into the Q1 of 'twenty one. I guess the 250 to 3 25 basis point decline in average occupancy, occupancy. I mean, what does that trend look like on, I guess, the week to week or month to month basis on the low end versus the high end? I mean, do you expect declines to continue at this pace through February and then start to moderate in March? Or how should we think about that?
Yes. Good question. I'm going to turn it over to my colleagues. And again, I think in light of the conditions in January, we are feel that our portfolio is really hanging in there in terms of leads and occupancy. So I'll turn it over to the team to answer the specific question that you're asking.
Sure. I'll take that. So Mike, you can see on Page 12 of our investor presentation some of the most recent data on the trends in the quarter on occupancy. If you look at a quarter to date average, we're down about 2 10 basis points quarter to date, really driven by that January result. If you just extrapolated that to the full quarter, I.
E, kind of baked what we have and held from there, we'd be at the better end of the guidance range of 250 basis points down. If the trend continued down, as we've seen in the Q1 to date and carried on, that would be the lower end, I. E, the worse end of the range. And so it's really kind of that's the guardrails, if you like, stabilization versus continuation of the trend, if you want to think about it that way.
Okay, great. And then I guess on the move ins, obviously, there was an uptick on an absolute basis in January, but it still looks like the percentage compared to 2019 actually dropped. I mean, is a good way to think about that is that the seasonal nature of leads probably is not holding right now just given the COVID impact and you're just more optimistic because the absolute number is actually increasing?
I think what is incredibly encouraging is that the clinical conditions in January were the worst that they've been really since the beginning of the pandemic and you can see that on the slide, yet we are getting incredible demand in my opinion in January nonetheless through both leagues and move ins. And that to me is an incredible combination and one that is just really heartening about this being a kind of need based business that is going to be resilient and that happens during the toughest time. And so that's what that is the key point, Mike. Thank you for raising it.
Great. Thank you.
Your next question comes from the line of Nick Yulico with Scotiabank. Please proceed with your question.
Thanks. Good morning, everyone. I guess just first off, maybe if you wouldn't mind providing the you gave the vaccine data, which was good on number of residents, number of staff. Do you have that in terms of a percentage of the residents and of the staff who've gotten the vaccine so far and atria?
Yes. In general, the uptake with the residents has been really, really high in and around the 90% range and probably even higher if you take out people who were ineligible either because they had just had COVID or something like that or another medical condition. And amongst the staff, it's really in that 40 ish plus or minus at the beginning on the first clinic, but we're seeing way higher uptake of employees getting that first shot at the second clinic. And so those numbers are going much higher, both because of an increasing comfort level with the vaccine and also some operator, we'll call it incentives and requirements. And Justin, maybe you can touch on what the operators are doing in the vaccine to make the uptake better?
Absolutely. So there's been the standard practice across the sector is communication, incentives, bringing a lot of attention and quite frankly celebration around the vaccine. That's been very successful. We have operators that have mandated vaccine as well. Where that's happened, we've seen the employee numbers tick up significantly.
And we know at least 2 that have made the decision to mandate. There's several others that where we know it's under consideration and it's been met with a lot of success where those employee numbers are closer to 80%. Having picked up.
I guess, having picked up. I guess, are you getting any information from your prospective tenants about at what point they're going to increasingly convert that lead into a move in? Does it have something to do with the percentage of people in the facility that are vaccinated or a reduced rate of COVID in the facility. I guess we're just trying to sort of understand at what point if leads are down still around 20%, moving down around 20%, at some point you get closer to 100%. But what are you getting any information from prospective tenants about that?
Thanks.
Yes. I can definitely give you some color. One point about our leads is that leads are actually stronger in our U. S. Portfolio, but our move ins have been stronger in Canada.
So when you think about a higher conversion rate Canada, there's less dependency on external agencies to get move ins. But if you focus in on the U. S, one thing that we found interesting is that the lead volume is very high,
as Debbie mentioned, in spite of
the clinical backdrop, but we're also still missing out on some typical sources for leads. And that includes respite, that includes personal and professional referral
sources, which are
all our highest converted leads. So as the our operators are fairly bullish on the outlook, but that remains to be seen, obviously.
Thank you.
Your next question comes from the line of Connor Seversky with Brennanberg. Please proceed with your question.
Good morning, everybody, and thank you for having me on the call.
You had mentioned in the prepared remarks, just switching gears to the R and I portfolio that u City was attracting some significant leasing interest. I'm just wondering if you can quantify at all how this is progressing and then what the path looks
up to stabilization on that
Good to have you. I'm going to turn that over to our team to talk about the significant leasing interest there in the East City market.
John, did you want to take that or Sure.
Yeah. This is John Cobb. I think we have a lot of good leads. I think we're swapping a lot of LOIs back and forth, but the interest is high. But But it's a when you start building the interest and you start going vertical, the interest is much higher when you're doing that.
Okay. Thanks for that. And then just related to the development
of the independent living communities in Quebec
with the group Maurice. I'm just wondering if that occupancy metrics you guys provided, does that take into account the 800 units that have just recently opened?
Yes. Well, that is I believe is those 800 units. So this is what is remarkable and we're trying to have it rub off on us here south of the border. As LGM builds these large, but we hope to take you there someday And then they have a really significant pre marketing effort, a lot of pre leasing and
Your next question comes from the line of Daniel Bernstein with Capital One. Please proceed with your question.
Hi, good morning.
Hi, Derek.
Glad to hear an upbeat tone and outlook. The question I do have though, and I think the move ins are kind of rather simple math, demographics going up, construction going down, COVID levels going down. But I'm trying to understand a little bit better the move outs and particularly if you have any color on average entrance age of residents coming in and thoughts on length of stay and whether that's going to offset some of the improvement that seems likely to come on the moving side?
Hi, Dan. It's Justin. You mentioned I'll start with the second part of your question. Length of stay has actually gone up. And the reason for that is because of less respite stays over this past year, far less.
So that averages up without the short term stays of respite. In terms of the type of resident moving in, we also haven't seen a lot of change there either. There's the age group demographic, the type of resident, care needs, everything's been relatively consistent. We just need more of them. And as we mentioned, leads are certainly on their way up.
Okay.
And then the other question I had on shop, I don't know if you can give a kind of a general idea of what the rent increases are in 1Q versus maybe historical and whether those are kind of what we should be thinking about when we model that versus historical 1Q increases?
Well, since that's a modeling one, Bob, do you want to take that?
Yes, I love the modeling ones. So again, nearly every year. And that's again sort of an overarching number to think about. From there though, a few considerations. There's always a percentage of the population to whom that does not apply.
And that could be those who are on an anniversary renewal or those who came in, moved in late in the year and aren't subject to it, things like that. So all of that said, it blends in on a sequential Q4 to Q1 Rev 4 basis to improve Rev 4 overall. And that is one of the powers of having the occupancy in place in December is to have that benefit.
Your next question comes from the line of Rich Anderson with SMBC. Please proceed with your question.
Thanks. Good morning, everybody. Hi. So if investment activity can be used as a proxy for perhaps your level of confidence in to protect the balance sheet like a lot of your peers, but I remember that in particular. You now have $1,000,000,000 of asset sales.
You refer to paying down debt with that at least in part, but then you also talk about this pipeline of activity. So I'm not I can't get a good sense of where you are at on a net disposition or net acquisition perspective? Or are you kind of still in the point where you're sort of hedging your bet? You could go one direction or another? Or are you sort of thinking along the lines of sort of a neutral impact?
Well, we are thank you. It's really good to hear from you. I mean, we are continuing to invest very actively. As I mentioned in life science in these LGM developments, we do have an acquisition pipeline. So it really is a case by case basis and we continue to evaluate conditions very carefully and are really in a great position given all the things that we've done and all the pieces we've put in place to be able to really act opportunistically as and when we believe circumstances are appropriate based on risk adjusted return.
And so where we are and we have a long history as you know of doing $2,000,000,000 or $3,000,000,000 a year of investment activity and we're in the market in all the verticals and have the team and the capital options. And so it will be based upon what opportunities become available.
Fair enough. Okay. And then the HHS grants, you guys were perhaps earlier than some others in terms of getting your hands on it. But nonetheless, it impacts the assisted living side more, obviously. I think you're 60% elf and 40% independent.
May correct me if I'm wrong on that, I could have that backwards. But does this inform you about where the opportunities might exist going forward in terms of that specific debate between ILF and ALF?
Well, I think we would base our investment decisions and our portfolio composition really on the fundamental opportunities that we see and rather than what I'll call bridge support for the pandemic impact. So I think you're roughly in the ballpark on the sixty-forty, but I'll turn it over to Justin really to talk about how he thinks about those asset classes and the differences in opportunities there.
And before you do that, Justin, I was thinking in terms of perhaps seeing there some disruption in the ILF side, which would make you more interested today just from the standpoint of there being better opportunities because of the lack of HHS? Anyway, was the basis of my question. Go ahead. Sorry.
Hi, Steve.
Hi, Justin. Yes, in terms of the disruption, ILs really held up okay. It held up an early going based on having lower move outs, longer length of stay. Move ins have continued in the IL setting. They're generally a higher margin business, so they had a little more room to work with as occupancy has fallen.
They don't benefit from HHS funds. So a little later to the scene from a vaccine standpoint, but vaccine clinics are being set up in the IL setting. So that's on that point. And then in general, the first thing we're always going to look at is the market. And we have within our data set over 800 MSAs that we study.
Within those, we can determine which products will work, which price point is appropriate, could be IL, AL, memory care, but we would always start there. And then look, so market, and then it's quality of property, and then it's opportunity for successful execution.
Okay. Good. Thanks very much.
Thanks.
Your next question comes from the line of Jordan Sadler with KeyBanc Capital Markets. Please proceed with your question.
Thank you and good morning. Good morning. I wanted to good morning. So, Justin, I was I wanted to just get your take on sort of historical seasonality. I know how familiar you are with this business in terms of SHOP.
What percent of annual move ins take place in December, January, February in the SHOP portfolio generally?
Hi. So there's a little bit on the seasonality. When you look at it on a quarterly basis, there's not a big change in ins or outs. You tend to have relatively higher move outs in the 4th quarter and the Q1 and then lower move outs in the 3rd and 4th. And then move ins will they'll move within quarters.
Some months that jump out to me are January, August, September, where you get a little bit of like April, May or usually some good move in months. But on a quarter over quarter basis, it's only like a percent change from 1 quarter to the next. And you just kind of usually you have opportunities to net significantly during those times when move outs are lower. I'm not sure if helpful. And I'm sure
your call is better than that.
Yes, that helps. Okay. Go ahead. Finish. Sorry.
Yes. I was just going to
say in this setting, seasonality hasn't really held up because the clinical impacts have been so severe at times. That's had impact on demand. And then of course, I mentioned the difference in our lead bank and that there's a lot more opportunity for that to get back to a normalized level. And so it's really hard to point to seasonality in this current environment.
It sounds like typically you're saying you see higher move outs in 1Q and 4Q, but move ins generally are more steady.
Yes, that's about right.
Okay. And then as a sort of non sequitur follow-up, Of the disposition guidance for 2021, Debbie or Bob, is any what portion of that is scheduled or expected loan repayments?
What's the mix of debt reduction versus other investments, in other words, Jordan?
Yes. I think you said
$1,000,000,000 of disposition guidance for the year. Like is any of that loan repayments?
I see Richard. I see the question. Yes, no, it's majority asset, asset sales. The majority loan repayments or would that be over and above or you just don't expect any? Maybe some, but as a significant majority will be asset sales as it was in 2020.
Okay. Because I know you have some maturities in 2021, but those could be extended?
Yes. Okay. Thank you.
Thanks.
Your next question comes from the line of Vikram Malhotra with Morgan Stanley. Please proceed with your question.
Thanks for taking the question. Just maybe first one on senior housing overall. Now that you have high percentage vaccinated, you've got your rents in place in January for SHOP and you sort of pointed at some light at the end of the tunnel. I'm just wondering higher level, is there a initial sort of preliminary strategy you can lay out for us in terms of how you're thinking to start gaining back this occupancy and demand will come when it is. But just in terms of flexing rents versus occupancy, high level kind of is there a strategy that you can lay out that differ by product type or geography?
Yes, and different operators take different views as well based on the particular conditions in markets, as you point out. So Justin, do you want to address Vikram's question, please?
Absolutely. So I mentioned I'd probably like to step back for a second and just reiterate the underlying demand that the operators are facing and how they're trying to play into that. I had mentioned before that leads are very strong and we're missing parts of the typical lead bank that can help bolster things. But if you look back a little bit, you look back into September, October, if you look at our leads and our move ins, you can see that we're running 80% 90%, respectively, no vaccine in sight at the time. So the underlying demand remains really strong.
Our operators are well aware of that. We even had, at that time in October, almost 60% of our communities that were achieving 100% or more of their prior to COVID typical move in run rate. So all of that bodes well. And as operators have tried to play into that and with the backdrop of, of course, the clinical trends they were facing throughout the end of last year, beginning of this year, approaches. One I'll highlight, is Atria.
I mentioned that they've bolstered our overall lead growth and volume and they've done that with the help of discounting and it's worked because they've had higher occupancy, higher leads as a result. We've had others that have been a little more local market focused, holding back a little bit to preserve rates and that worked as well. Moving ahead, I think what every operator is focused on is the wide variety of different referral sources that they've relied in the past, how to rejuvenate those moving forward and to play into that, that the optimistic kind of supply demand outlook I gave as well as the trends that are positioning our communities to accept move ins again.
Okay. That's helpful. And it's interesting to your point, even if you look back a year ago, just based on the numbers you gave, doesn't seem like your conversion rates have fallen off dramatically in terms of leads to move ins. It seems like those rates are maybe a little lower, but not dramatically lower. So that's sort of another positive.
I guess just on the triple net side, 2 quick clarifications. So you do have your EBITDAR is probably closer to the low ones, if I'm not wrong. And you have a minimum 4 years left on maturity for a lot of these leases that are kind of in that range or below. So I'm just wondering if is a need or thought or you just to adjust rents or convert some of these to RIDEA? And could you just clarify in that the cash flow coverage, I may be thinking wrong about this, but in the quarter or historically other and just the last two quarters, is there any the provider funds or the relief funds, they're not factored in that coverage, are they?
Yes. I'll take that. So look, I mean, we have been really successful during 2020 since Justin's been here and really having some outstanding resolutions of the bigger relationships we have with partners like Brookdale and Holiday and others and that's been really helpful and we received significant cash upfront as well as participation in the upside through either warrants or conversions to management contracts. So those have been really well received and rightly so. Our operators, as you mentioned, really have been the beneficiaries in some cases of government funding that would principally be in the Q4.
Of course, that would benefit coverage. But our statistics are really through the end of the third quarter, which is always on a 1 quarter lag as you know. So they will be factored in. They'll be called out separately as we have with some of the healthcare providers on the in the supplemental materials. And so you'll be able to do your own analysis.
But again, remember that the funding is really intended to be a bridge, if you will, to replace NOI that would otherwise be there and hopefully will otherwise be there in the future. So that's how we've been thinking about it.
Fair enough. But just to clarify, clarify, you don't anticipate the need given what you did in 2020, you don't anticipate the need for more rent adjustments or conversions near term?
It really depends on COVID just like almost every other answer we could give you on the call today. The operators are really hanging in there. As Justin said, they're doing an incredible job on health and safety. And right now, we're getting all the rent that we expect to receive and the operators are getting government funding in many cases. So that's a good picture.
And it's the leading indicators that we've discussed really take hold and gain traction and result in improved occupancy and NOI as we look forward in the year, then I think we feel okay about where we are.
Great. Thank you, Debbie.
Thank you.
Your next question comes from the line of Steven Valiquette with Barclays. Please proceed with your question.
So I guess first one, just regarding the percent of shop communities open for move ins. That data on the bottom of Page 11, the presentation looks pretty positive with that metric jumping up from around 80 percent in early January to now 95% just in the last month or so of those communities available for open for move ins. So I guess I'm just curious to hear more color. Is that driven more by either voluntary policy changes by the operators? Or is it more just changes in local government guidelines?
And how much of this is simply driven by the benefits of the COVID vaccine if we're able to get any extra color around all that as far as that improvement? Thanks.
Hi, it's Justin. Yes, so what you'll see is the first of all, 95%
of our communities are open to move ins. And then
we segmented them based on just the restrictive environment. And what drives that, from segment 2 and segment 3, Segment 3 is the most open, most consistent with pre COVID lifestyle. Segment 2 has some restrictions, but you can certainly take move ins. And it's the state and local health departments that are really weighing in on how open a community can be. And so those conversations are happening constantly and it's very much driven by recent COVID activity, sometimes in the broader community, sometimes within our own communities.
So that's fluid. But as you can tell from the overall picture that new cases are down and open communities are up. So it's looking good across the board.
Yes. Okay. And one other quick question, since we spend, it feels like half this call discussing leads and move move ins, I think you just confirmed that the definition of a lead hasn't really changed for today versus 2019 when you're showing that data on Page 12? And if there is just a quick one liner on what officially defined the lead for you, it'd be great just to remind us of that as well since that can differ sometimes from one company to the next. Thanks.
Sure. So a lead is defined really, another way to put it is an inquiry and it's distinct and so it's new. So each month when you see our data, all the leads that we're representing are new to that month. We don't carry forward. And it's from it's any source.
It could be through the Internet, it could be through referrals, it could be a drive by, for instance, any source that's interested in moving is characterized as the lead.
Okay. All right. That's helpful. Thanks.
And that's remained consistent.
Your next question comes from the line of Lukas Hartwich with Green Street. Please proceed with your question.
Thanks. Just one left for me. So it looks like the majority of your loan investments are maturing or can be repaid early in 2021. So I was just hoping you could provide a little bit color of what you expect around
that? Right now, as you point out, they are open to repayment and some are also open to extension. So our current expectation is extension, but of course that could change and we always like to be repaid. So either way, I think we're in good shape.
Thank you.
Thank
you. Your next
question comes from the line of Joshua Dennerman with Bank of America. Please proceed with your question.
Yes. Thanks, everyone. Maybe
a follow-up on Steve's question earlier on the vaccination COVID cases coming down. When you guys think like big picture, everyone's it seems like by the end of this month, everyone's going to be vaccinated within your SHOP portfolio. Do you think you start seeing a pickup in move ins because of that? Or is the customer's mindset overall kind of COVID level across their community? And then how are your operators, I guess, going to respond to vaccinations?
Like will they be able to increase visits? Because that seems like one of the biggest hurdles to getting people to move their parents in.
Hi, it's Justin. Yeah. So, you know, first of all, just the fact that there has been vaccines available has played a role in some of the uptick in leads. So certainly, there's an expectation that when the vaccines are fully executed, that higher leads, more potential demand that would make perfect sense. In terms of defining the lifestyle moving forward, I mentioned that the health departments play an important role in working with operators to define that.
Certainly, operators want a robust living experience, as I mentioned, for their residents. They're working hard to give the best lifestyle available, but they're going to work within health department guidelines. And I would expect that to continue for a period of time and as they work through this next phase. Okay. And then maybe just a
follow-up from the opening comments. You mentioned that the severe weather that's hitting the country now is in guidance. Have any of your facilities been impacted by the power outages in Texas that you know of at this time?
Yes. I mean, it's been a biblical year when you really want to think about it with COVID and wildfires and hurricanes and now we have this severe winter storms in places you'd least expect it. So yes, I mean, I think everyone many people in the real estate business have significant investments in Texas and almost all of them will be affected by the power outages and related storm impacts and that would include us. And again, our operators are taking extraordinary measures in the case of senior housing to make sure that employees and residents are safe. And often we see in senior housing that after something like this, we see an uptick in interest because a lot of people are alone in their homes and that's storm.
And your last question comes from the line of Mike Mueller with JPMorgan. Please proceed with your question.
Yes. Hi. It looks like the shop occupancy losses have been greater in the primary versus secondary, in what you call other markets. What do you think in terms of recovery? Do you think the primary markets recover faster?
And are you seeing any differences in
the feed trends so far?
Good question. Again, the leading indicators are flashing green and Justin will answer your segmentation question.
Thanks. Hi, it's Justin. So there's been we've studied the performance throughout the pandemic. There's a little bit of a disconnection in terms of our expectations relative to COVID impacts on move ins and geographies because of the virus has really become through the Q4 became more widespread and more impactful. So as we look ahead, we're really just looking into local markets and looking at the fundamentals I mentioned earlier relative to our position in that market.
And there's some of the primary markets are really benefiting from a reduction in construction as a percentage of inventory, which we support as. But I think to get a real good read on to answer your question, I think we're we have to go a little further beyond the pandemic and to get a clear view.
Got it. Okay. That was it. Thank you. Good.
Anything further?
And now there are no further questions in queue at this time. I turn the call back over
to you. Well, you've all been very patient and I want to thank you as always for your interest in and your support of our company. We look forward to seeing you soon and we hope that you and your family stay healthy, happy and optimistic.
And this concludes today's conference call. Thank you for your participation. You may now disconnect.