Good morning. I'm Mike Carroll with RBC Capital Markets, and this is the Ventas Fireside Chat with Bob Probst, CFO, and Justin Hutchens, EVP of Seniors Housing. Now, this will be an interesting conversation, mainly given the recovery trends that we're tracking in the seniors' housing space right now. So we have Justin on the video, and we have Bob on the phone. So I'll flip it over to Bob first to provide a quick introduction regarding Ventas, then we'll go straight into the Q&A.
Thanks, Mike, and thanks for inviting us to your conference. Hope you have a great day. If I could just start with a few of the key themes, three of them, in fact, from our earnings call a little over a week ago. Number one, it feels great to report that we believe we've turned the corner in our business. The pandemic is finally behind us after what feels like a very long time for everybody, I'm sure. Some evidence of that to prove that point is certainly, number one, in senior housing, the dramatic improvement we've seen in health and safety. We've only had approximately one resident with a positive test per day out of 40,000 residents, which is a remarkable positive turnaround from really the depths of the pandemic only in January.
As a result, occupancy in senior housing and SHOP in particular in the U.S. grew 280 basis points from our low in mid-March in the U.S. to end of April, which is a remarkable number. In fact, March and April saw two of the first consecutive months where move-ins exceeded move-outs, driving up. In fact, move-ins were ahead of pre-pandemic levels. So whether leading indicators are actual occupancy growth, we're really starting to see the rebound that we've been hoping for. Second point I'd say is on the back of that, we're very focused on winning the recovery. That takes multiple different forms. The first is new investments for growth with a focus both on development and in acquisition. Development, I'd highlight, in both life science and in senior housing with the Groupe Maurice. We're also focused on optimizing our portfolio.
Justin is busy at work on his plans for our senior housing portfolio. Dispositions are certainly on the table both in senior housing and MOB. Transitions, CapEx, and other operational excellence initiatives are underway across our business, and we believe our positioning is well to win this exciting recovery, and really third, Mike, what that means for us is we're back on our front foot, and that feels really good after what has been a very tough year, and the Ventas team is fired up and ready to go, so that's the context of where we are today. We put some materials on the website for your review as well, but we welcome questions, Mike.
Great. Thanks, Bob. Let's first talk about the seniors' housing space. I guess, Justin, the company has been highlighting a big uptick in new resident leads over the past four or five months. Can you provide some color on what's driving this improvement, and what particular lead sources were the first to come back since the pandemic started kind of slowing down?
Sure, Mike. I'd highlight that really throughout the pandemic, there's been resilience in the senior housing space, and there's been ongoing demand. The leads that really held up over the past several months have been derived from referral agencies. They've been derived from company internet sites, as you would expect given the circumstances. What was missing, not entirely, but mostly, were three sources: respite, which is short-term stays, which are usually accessed when the primary caregiver at home needs to take a vacation or have a medical break or needs like that, and typically, respite picks up in the spring and the summer and around holidays. The other was professional referrals. Those are medical referrals from the hospital, from physicians, from skilled nursing facilities. Respite was running at about 25% of pre-pandemic run rate during the pandemic. Professional referrals were running at 50%.
Personal referrals were also running around that same kind of 50%-60%. And those are important because that's where residents and relatives are referring their friends to move in. Now, what's coming back in March and April is really that personal referral. That's up at almost two pre-pandemic levels. Professional referrals haven't moved yet. And then the internet and the referral agency referrals continue. So that's really contributing to the growth in leads.
So those professional medical referrals, I guess, how far are they lagging behind? And I know that the leads that you guys have been reporting are above pre-pandemic levels. I mean, will those leads jump meaningfully when those come back? And I guess, when can we expect those to start to come back?
The leading, first of all, the professional referrals are only still running at about 50% of pre-pandemic run rate. The leading indicator for those leads is healthcare activity. That's when elective surgeries will start up, and that's when there'll be other needs that our prospective residents access healthcare. And so that is a big part of the business. That is a very highly converting lead as well. They usually convert around 20%-25% versus just the other lead sources I mentioned. The internet and referral agency leads are under 10%. So you could really see a circumstance when those come back where the leads even get higher than pre-pandemic levels. And we wouldn't rule that out.
We actually highlight that in our business update so you can see that there's certainly potential to see a higher lead volume.
Okay. Great. Now, I know that, again, Bob mentioned this a little bit, and we see it in the results that these stronger leads have translated into improving move-in trends. And we've actually exceeded pre-COVID levels in March and in April, I believe. I mean, will this above-average move-in pace continue? And could we actually see it grind higher, especially that leads continue to grind higher, which is obviously the leading indicator for new move-in?
I would answer the question this way. The leads certainly support the move-in volume that we've been seeing. The other important point is what's happening with move-outs. Move-outs are running at really around the same rate of move-out that they did pre-pandemic, but off a lower occupancy. You get a natural just netting effect that's happening, and that's contributing to a good portion of the growth that we're seeing. Then to your point, we're also seeing some outsized move-in activity as well. Whether it persists or not in the future, that's not clear, but certainly we're encouraged by what we're seeing early in this recovery.
Okay. And I know that you guys haven't, or I know, Justin, you haven't liked the term pent-up demand that's growing the marketplace. But could we see, I guess, move-in, could pent-up demand come in and drive move-in higher? Is that something that we shouldn't even think about? And is there a point where we're seeing that pent-up demand coming in and we could see move-in activity starting to moderate, or is this all an unknown right now, and it's difficult to predict what will happen in the future?
So the reason we shy away from pent-up demand is because it sounds temporary. And as we've been studying our lead gen and thinking about the vaccine execution and the post-pandemic environment, what we were encouraged about is that the aging demographic's going up, construction starts and deliveries going down, and there's really good support for our services in general. So whether that was pent-up or not, we've spoken to our operators. They're not really talking about residents that necessarily have been waiting to move in. They've moved in as needed. If the healthcare activity picks up, maybe there's a surge. But it does look like we have a pretty good runway ahead in terms of strong demand for our services for the next few years.
Okay. Great. And we're going to get to that in a little bit. I want to talk about Canada because obviously that has legs just given the outbreaks that they've had over the past few months. But as that country reopens, I mean, should we expect to see greater occupancy gains within your total SHOP just because Canada won't be lagging behind your U.S. portfolio? Is that a fair expectation?
Yeah. So a little bit about Canada. Throughout the pandemic, it performed better. There's a few reasons for that. One is it has a longer length of stay. It's primarily independent living. Two is that early in the pandemic, there just wasn't as much COVID activity. So it wasn't as impactful on the business and the demand for the business. And then currently, they're behind on vaccines. So there's been a little bit more COVID activity, a little bit low. It does affect the ability to move in in certain cases. So we would anticipate that when the vaccines are executed, that we would have a similar result that we do in the U.S. And also, Canada benefits from really less competition as well. So that's why they support a 90% plus occupancy level.
Okay. Great. Now, let's talk a little bit about the demand trends over the next few years. And I know the biggest thing that people—and we've been always pointing out too—is the demographic backdrop of the space. I mean, if you look at over the next three years, it should be a lot stronger than the prior three years. I mean, how much will that translate into new demand? Because it seems like the growth of that demographic trend is really in the early '80s. I mean, do your expectations of the resident moving in, does it really spike in the early '80s, or do we really need to see that when they're into their sort of mid-'80s? I guess, when will those demographic tailwinds start to be realized?
Yeah. So there's significant growth in the 80-plus population, and penetration rate's typically measured on that population. Penetration rate really only experienced a dip in 2020. But otherwise, it tends to grow every year. So should that continue, we're looking at an aging population that's going to grow really two times the rate that we witnessed post-financial recovery. So we'll see about 17.5% growth in that population over the next five years. So from an aging demand standpoint, it looks really good over the next five to 10 years and starting really now. From a supply standpoint, we have fewer starts and fewer deliveries. And the starts are really the important stat because that opens a window for the next few years as well. So absorption should be supported over the next few years, and then we'll see how new supply enters the space again at that time.
Yeah. Let's talk a little bit about the supply. It does seem like starts have dropped in 2020 and have steadily dropped in the beginning of this year. I mean, is it fair to say that new deliveries will continue to wind down or moderate through the end of 2022, maybe the beginning of 2023, just given the construction timelines of those?
That's certainly what it looks like. Yeah. We do think there's a window where with the deliveries being lower, that it'll support more absorption.
Then how do we think about, I guess, construction costs? It seems like construction costs across the real estate industry is increasing, including in the seniors' housing space. I mean, is it fair, or are you seeing developers being more cautious breaking ground on new projects given that their overall costs are up pretty significantly? I mean, is this going to just delay these developers starting new projects despite fundamentals improving over the next, that's hopefully 6 to 12 months or so?
Yeah, so on the construction costs, material costs are really high, also, pricing has pressure because you have a sector that's rebounding, and it's really volume-focused, and so a developer that's looking to do a project has pressure on both sides. The price that's going to support the construction plus the cost of materials, which has skyrocketed really across the board, now, one thing that I'll point to is that post-financial crisis, that was a financial crisis. Capital availability was scarce for a period of time. This is a health crisis, and so there's plentiful access to equity. And capital tends to see through fundamentals, there's a lot of exciting demand that I described, so in time, we would fully expect that developers will start bringing in supply to meet this demand, but there does seem to be a window of opportunity over the next couple of few years.
Yeah. I mean, I guess, and I don't know if Ventas has been looking at new developments, but I mean, do you expect to see the ability to push rents at these facilities just given higher labor costs, higher construction costs? Is that something that you can do today, or is that something that you probably need to wait until occupancy builds back up into that mid-80% range?
Yeah. So the first thing, the sector will go for volume first. And so I would expect occupancy to recover first. And that's going to vary by market. I mentioned on our earnings call that we already have 16% of our communities that have achieved their pre-pandemic occupancy levels. So I'd expect those communities to start pushing on pricing a little bit. And the sector should behave that way as well. So you would expect occupancy and then pricing. And then ultimately, that's where we get a lot of questions around margin and margins that last, the operating metric that we would expect to recover once those things happen over time.
Okay. And then just lastly on the seniors' housing space for now, how has the pandemic changed, I guess, your views on seniors' housing? Is there different types of assets that you want to own, or do you need different features in these buildings to kind of have better infection control protections for your residents? I mean, how do you look at the business, and does it change the type of assets that you want to buy given what we've seen over the past 12-plus months?
The one thing it did do is it delayed some of the plans that we would have had. We had to deal with the pandemic last year. When I joined the company, I was asked to evaluate the portfolio, help make decisions in terms of how to really position senior housing within Ventas. Now I've had a chance to take a good look. One thing I'd point out, going back to the last recovery in the sector post-financial crisis, most of the development was geared towards assisted living and memory care. The reason for that is because it did recover a little faster post-financial crisis. As I mentioned, this is a health crisis. Independent living's done well. Half our business is exposed to independent living. We feel good about that. As we look across the markets in which we operate, we're 70% exposed to high barrier markets.
We have an aging demographic that's consistent really across most markets. There's certain pockets that have a little bit more supply that tends to phase it over time and currently. But we like the opportunity to grow really across the asset classes: independent living, assisted living, memory care. And we'll be selective and thoughtful about the markets in which we're focusing.
Okay. Kind of off of that, I mean, it seems like the investment strategy for Ventas over the past few quarters was really focused on the R&I platform. I mean, is that fair that the investment strategy is going to stay on the R&I platform, or can we see some seniors' housing opportunities popping up? I guess, when would you be willing to kind of invest in both of those major property types that the company invests in?
Sure, Michael. We're certainly going to continue to focus on the R&I space. We've built a formidable business there now with over nine million sq ft in life sciences. We're in three of the top five cluster markets in the world and really have a right to play there in a strong position. So we'll continue to invest there both through development and through acquisition as we have done. That said, backing our front foot in terms of investment means interest in investing across the asset classes and a growing and active pipeline indeed across the asset classes, including senior housing.
So part of the portfolio in senior housing is both develop, which we're doing today in Canada with LGM very successfully, and also acquire and look for ways to enhance that portfolio while complementing what is the most powerful organic opportunity we've seen in a very long time with senior housing recovery.
Okay. And then on the R&I investment strategy that you guys have, I mean, I kind of view that there's kind of two prongs. You have the Wexford focused on those major academic institutions with UPenn and Brown, and then you have a few larger top life science cluster acquisitions like in Boston and San Francisco. I mean, how do you view those strategies? Is that one and the same, or are those different strategies with different risk return profiles, or how should we think about that?
Yeah. We view it as one space really, Michael, called life science, which is a huge market. And the entry for us into that space, as you know, was through the university-based business. We've grown that business now. We're partnered with over 15 of the leading research universities in the world and have an aspiration to grow that portfolio of partners. Meanwhile, and this is more recent, we've entered the cluster markets, more traditional cluster markets, starting in Cambridge, then South San Francisco, and most recently the D.C./Maryland cluster, and therefore have a presence in those markets and both the capital access and the expertise in our view to be able to grow that portfolio. And what is really, as you know, a tremendously exciting space with tons of tailwinds and one that we now have scale and a presence in, and we want to grow that.
Okay, so how do you think about, I guess, growing in those cluster markets? I know a lot of it has been acquisitions. I mean, are you looking at buying redevelopment opportunities or some available land to actually do some ground-up development in the cluster markets, or is it still going to be focused on that acquisition side?
It's all on the table, but I think acquisitions is the most likely base case for sure. We've grown through acquisition in South San Francisco and D.C., as I mentioned. Those are trophy assets in super attractive markets. We've been able to fund that and finance that with third-party capital as an attractive means to enter that space. And that gives us some strategic optionality from a funding perspective. And so whether on balance sheet or in partnership with third-party capital, we look to continue to grow that presence.
Okay. Let's talk a little bit about the third-party capital, some of your joint venture partners to grow the R&I platform. How should we think about the plans to continue to grow that space? I mean, how do you differentiate between using your joint venture partners that you've created or doing it on balance sheet? I guess, what's the give and take there?
Let's step back just for a second and look at the third-party capital platform we have. We've built over $3.8 billion of assets under management. The two largest components of that are the Perpetual Fund, which was launched last year, and the GIC Joint Venture. Two different ways of accessing third-party capital, different remit for each. Let's talk about the GIC Joint Venture. That's a development-focused joint venture really with four underway developments together with an aspiration to grow that pipeline. We've identified $1 billion beyond that already underway. What that joint venture relationship allows us to do, among other things, Michael, is accelerate that pipeline and really invest and pull forward those opportunities as well as a partner that we could grow with strategically over time.
Meanwhile, the Perpetual Open-End Fund, that's been the source of acquisition, as I mentioned, in two cluster markets. Investors and private capital see the opportunity to partner with Ventas to leverage our relationships and our expertise and to invest in this exciting space, much more of a core-type portfolio, and therefore a really attractive proposition not only for our investors where we get enhanced returns, we can participate in those acquisitions through the fund, but also for those partners. So again, a unique opportunity, a competitive advantage I would suggest for Ventas and has been successful beyond our expectations in only a year under management.
Yeah. And can we talk a little bit about the Wexford development outlook? I know the company has announced several new projects, I think, over the past few quarters. I mean, how did those opportunities come about? I mean, is it correlated with the NIH budget? I mean, obviously, I think Biden and his administration is planning on or proposing a potential big increase in the NIH budget next year for fiscal 2022. Does that make it a better market for these academic institutions that need more lab space so that creates and expands the development of subset or for Ventas to pursue within that Wexford platform?
Sure. Well, first of all, just for context, our partners are university partners that we do business with. I mentioned 15 of the leading universities. These are the cream of the crop as far as research goes, university-based life science research in particular, and therefore are in the top 1% effectively of NIH funding recipients. And the one thing that Congress has been able to agree over time, and this may be the only one, is continued investment behind life science research, seeing the need effectively from a public policy perspective to continue to find cures, including for things like COVID. So that financing has been there, that funding has been there, it has grown, and we'd expect that to continue from a public policy perspective. And that will benefit our university partners, no doubt.
That said, the other part of that portfolio is really the private capital that is attracted to that research, looking to monetize the research that's going on, spawning new businesses, growing employment, which is helping the university. It's helping the local community. It creates what we call this knowledge community and is really mutually beneficial, and other universities see that opportunity. To answer your question of how do new opportunities then come up, universities see those case studies. They see what's happening in Philly, for example, in that what I would argue is now a cluster market, and see therefore the opportunity in partnering with us, with Wexford, with our expertise to be able to build a similar type of proposition. We just opened, for example, a new building in Arizona with Arizona State in Phoenix, already over 50% leased with nice momentum.
We're seeing the same on our four developed in the USA, including in Philly and in Pitt, and again, an opportunity pipeline of $1 billion that sits behind that, hopefully more to come this year in unveiling those opportunities, but very much of the same flavor. So that's a space and a competitive advantage that we really like.
Great. I think that with that, we have to end it. We're out of time. But Bob, Justin, I thank you for participating and providing us an update on the Ventas story.
Thank you.
Thank you.
Thanks.