Brookdale Senior Living Q1 2023 Earnings Call Transcript

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Provided by Quartr
May 9, 2023

There are 7 speakers on the call.

Operator

Good morning. Thank you for attending today's Brookdale Q1 2023 Earnings Call. My name is Cole, and I'll be your moderator for today's call. All lines will be muted during the presentation portion of the call with an opportunity for questions and answers at the end. I would now like to pass the conference over to our host, Jessica Hazel.

Operator

Please go ahead.

Speaker 1

Thank you, and good morning. I'd like to welcome you to the Q1 2023 earnings call for Brookdale Senior Living. Joining us today are Cindy Beyer, our President and Chief Executive Officer And Dawn Cusseau, our Executive Vice President and Chief Financial Officer. All statements today, which are not historical facts, may be deemed to be forward looking statements within the meaning of the federal securities laws. These statements are made as of today's date, And we expressly disclaim any obligation to update these statements in the future.

Speaker 1

Actual results and performance may differ materially from forward looking statements. Certain of the factors that could cause actual results to differ are detailed in the earnings release we issued yesterday as well as in the reports we file with the SEC from time to time, including the risk factors contained in our annual report on Form 10 ks and quarterly reports on Form 10 Q. I direct you to the release for the full Safe Harbor statement. Also, please note that during this call, we will present non GAAP financial measures. For reconciliations of each non GAAP measure from the most comparable GAAP measure, I direct you to the release And supplemental information, which may be found at brookdaleinvestors.com and was furnished on an 8 ks yesterday.

Speaker 1

Now I will turn the call over to Cindy.

Speaker 2

Good morning to all of our shareholders, analysts and other call participants. I hope that you and your loved ones are well. Welcome to our Q1 2023 earnings call. At Brookdale, our overarching priority is the health and well-being of our residents and associates. For this reason, I want to start with an update on an overnight tornado that hit our Shawnee, Oklahoma community a few weeks ago, Causing significant damage to the building.

Speaker 2

Let me say that I am immensely proud of our team who acted with incredible bravery, Remaining calm in the face of danger and executing the community's crisis and evacuation plans flawlessly. As a result, I am grateful to report that none of our residents or associates were severely injured. We have experienced prior natural disasters and every time our on-site associates have quickly and appropriately responded. With Brookdale size and scale, we were able to mobilize teams across the organization quickly to help ensure the safety and security of our residents. I'd like to take a moment to express my heartfelt gratitude to our dedicated associates who tirelessly worked to care for our residents, Both those who helped ensure their safety during the tornado, who stepped in to care for them following the destruction or who worked hard to make them feel at home in our Our team's resilience and commitment to our residents demonstrate the true spirit of Brookdale And I am honored to work alongside such compassionate and courageous individuals.

Speaker 2

At present, we are still gathering reconstruction estimates And information regarding insurance reimbursement. Recognizing this uncertainty, we have incorporated our best possible estimate into our Q2 guidance range. We have begun reconstruction and look forward to reopening our Shawnee community in the coming months. Like all years, 2023 is an important year for Brookdale and I am incredibly grateful for all of the hard work and leadership I have seen our teams exhibit. In February, I spoke of several 2023 plans and our key strategic priorities including get every available room in service at the best Profitable rate attract, engage, develop and retain the best associates and earn resident and family trust And satisfaction by providing value, high quality care and personalized service.

Speaker 2

These strategic priorities not only paved the way for a strong start as evidenced by Q1 results surpassing expectations, but they also support the health and well-being of our residents and associates. It is with this overarching priority in mind that I'd like to provide an update on the progress of a long term strategic program We have been working on and are very passionate about here at Brookdale. In early 2020, we launched a community based technology enabled proactive care coordination pilot program called Brookdale Health Plus. Health Plus is designed to help Improve residents' quality of life through evidence based preventive care coordination. It works by providing each HealthPlus community with access to a registered nurse care manager who helps promote residents' health and wellness.

Speaker 2

These care managers use the latest technology and communication tools to enable responsive, effective care coordination With residents primary care providers, other specialists and family members. Throughout the pandemic, we continue to focus on this innovative new program, Refining our efforts and measuring success. During the pilot, to ensure we were delivering value based outcomes, we engaged an independent third party To assess this program's results. The results of the pilot were extremely promising. The data revealed that residents in Health Plus communities Had fewer urgent care or emergency room visits and fewer hospitalizations than similar residents in private housing.

Speaker 2

Importantly, the data also showed higher resident retention as health spans are improving, Which results in favorable occupancy rate increases. Health Plus communities also have more move ins and higher associate retention, Meeting 2 of our operational focus areas. We expect this program will further improve our resident satisfaction and quality of life, While reducing cost to residents, their families and the overall healthcare system. Now it is time to build on the success. In April, we expanded Health Plus from 16 communities to 31, and we will be integrating this proactive and innovative program into teen additional communities before the end of the second quarter.

Speaker 2

I see tremendous opportunity for Brookdale Health Plus And I'm optimistic that we will produce favorable outcomes for our residents, associates and shareholders. As we demonstrate continued success, We expect to roll out this differentiating program to additional communities in 2024 and beyond. The introduction of Brookdale Health Plus not only creates an integrated benefit for our residents, it creates value For many stakeholders and further establishes Brookdale's position as the market leader and industry innovator. Pivoting now to Q1 results. When I consider our first priority to get every room and service at the best profitable rate, One of the most critically important considerations in the Q1 is the January 1st in place resident rate increase.

Speaker 2

From an overall business standpoint, just like any other service provider, it's important to ensure that we are charging a fair rate For the services that we provide. The rate must balance affordability for residents with the costs that are necessary to provide high quality services, Including providing a return on the capital needed to operate our communities. The rate setting process becomes even more challenging In an inflationary period when the macroeconomic environment is rapidly changing, we entered the first Quarter with both optimism for the plans we laid out and uncertainty following this historic rate increase. I couldn't be more grateful to our executive directors and field teams for their leadership throughout this process. An increase in controllable move outs was expected as is typical for any rate increase, but we have never been in an environment like this And didn't have the data to predict the net result of the rate increase with as much certainty as historically has been the case.

Speaker 2

Importantly, Q1 move in volume remained very strong, outperforming both last year and our pre pandemic history, Which I believe is evidence of the outstanding work of our sales, marketing, operations and clinical teams, Combined with the benefit of compelling supply and demand conditions. Stepping back and looking at our decisions with the benefit of hindsight, I believe the pricing action was appropriate and translated into strong first quarter results. During the Q1, We also successfully executed our strategic and operational plans to increase the number of shifts that are filled by Brookdale Associates Working on regular time as opposed to contract labor or overtime. When it is necessary to fill shifts with premium labor, It significantly increases the cost of service. With dedicated cross functional support providing insights and analysis, Our community leaders identified areas of opportunity where we could improve premium labor expense, while ensuring That we continue to meet residents' needs, offer high quality care and services, and remain in compliance with applicable regulations.

Speaker 2

Coupled with the successful execution of our January 1st rate increase, the continued diligence of our cross functional teams Supported our year over year adjusted EBITDA growth. Looking ahead, we are emphasizing a growth mindset With our executive directors and field leaders, while providing opportunities for them to learn and strengthen important competencies And grow in their careers. We are committed to winning locally and leveraging the benefits of scale To drive revenue growth and improved financial performance. Our local teams, which include executive directors, Health and wellness directors and district leaders are essential to this mission as they are closest to their local markets. In particular, our executive directors and district leaders are responsible for positioning their communities appropriately And managing our service offerings effectively.

Speaker 2

We will continue to support them in growing their business, And we'll provide appropriate rewards for their success as they aim to achieve consistent operational excellence And enrich the lives of more seniors in the quarters and years to come. I am incredibly grateful to those who have embraced Capturing the significant opportunity that lies ahead for top line growth and margin expansion through providing valued, High quality care and personalized services. Reflecting on the start to our year, we are firmly on the path to continued recovery And have gained momentum. With each quarter of successful execution, we are building confidence in our course to achieving long term success. Our strategic plans, sales forward posture and operational execution are translating into sustainable growth And we believe this growth will return us to positive adjusted free cash flow in the near future.

Speaker 2

In her remarks, Dawn will provide additional color on both the Q1 financials and our 2nd quarter expectations. And I'll now turn to recent decisions we have made about our portfolio and leases. In February, we provided LTC Properties a notice of non renewal for a 35 community lease, Representing less than 3% of our total unit count. While we have had a long and productive relationship with LTC, We do not believe extending this lease under the terms of the renewal option would be to the long term benefit of Brookdale and our shareholders. We will operate these communities through the lease term date of December 31, 2023 and we'll work with LTC on the smooth transition of these communities.

Speaker 2

No material impact to our 2023 financials is expected as a result of this non renewal. Another asset disposition we have spoken about is the sale of our last entry fee community. Last week, we successfully completed the transaction. It will result in the 2nd quarter gain on sale of assets, strengthening our liquidity position. Since I joined Brookdale, Dale, we have been very diligent in the management of our portfolio and this transaction further simplifies our business and operations.

Speaker 2

Lastly, we completed a beneficial transaction with Welltower to amend our triple net lease agreements. We believe this transaction is favorable to Brookdale and our shareholders by improving our long term position in several ways. The amended leases eliminate a unique net worth covenant. As part of this transaction, we extended a lease containing 39 communities that was due to mature in 2026 and Welltower has agreed to make available a pool of $17,000,000 For additional landlord funded CapEx investments across 2 of its leased portfolios. The portfolio of communities within the lease That was extended had positive lease coverage when annualizing the first quarter results and has Additional opportunity from the continued occupancy recovery.

Speaker 2

By extending the lease with negotiated additional CapEx funding, we can Prove the near term cash flow of these portfolios and bolster our liquidity over the next few years. We are pleased to have reached a mutually beneficial transaction. Our corporate development team led by Teddy Hillard and Todd Kessner has done an Excellent job in navigating these transactions to support a portfolio of communities that provide the best recovery and earnings potential And I am proud of their work. While we are always opportunistic about the possibility to engage in transactions that create value for our shareholders, We have no additional near term lease amendments or transactions planned. In summary, Brookdale has had a remarkable start to the year With first quarter results exceeding guidance and plans to deliver continued year over year adjusted EBITDA growth in the second quarter And for the full year.

Speaker 2

I am filled with gratitude for our Brookdale associates and their unwavering commitment to deliver our strategic priorities While providing high quality care and personalized services to the seniors we serve. This has been a key factor in our success. We are grateful for the opportunity to serve our residents and their families and remain steadfast in our dedication In the future, with a strong leadership team and a passionate community of associates, we are confident Our company will thrive, end the year even stronger than we started and achieve long term success in the years to come. I will now turn the call over to Dawn.

Speaker 3

Thank you, Cindy. Good morning, and thank you for being here today. I'd like to speak to our strong Q1 results, provide insights to our Q2 guidance and close by adding to a few of Cindy's comments. Beginning with Q1 results, senior housing revenue increased 12% over the prior year Q1. This growth was driven by a 290 basis point increase in occupancy and 8.6% RevPOR growth.

Speaker 3

Occupancy was largely in line with expectations, even with the elevated controllable move outs that Cindy spoke to. RevPOR was favorable to our expectations, thanks to the judicious rate management and the diligence of our community leaders As they work with residents and communicated the need to incorporate recent unprecedented labor and inflationary costs into this year's rate increase. We were pleased with this performance, which drove 12.9% year over year RevPAR growth, well above the guidance range we initially provided. We also recognized approximately $2,000,000 of other operating income from state grants during the quarter. Our teams remain diligent in pursuing available government support As we continue to recover lost occupancy from the pandemic, we anticipate reporting modestly higher grant income in the second quarter.

Speaker 3

Moving on to expenses. Our first quarter facility operating expense was approximately $531,000,000 These results demonstrate improved expense management, including our focus on reducing premium labor By filling shifts with full time and part time Brookdale employees, while ensuring that we continue to meet our residents' needs, Provide high quality care and services and remain in compliance with applicable regulations. Excluding the benefit from other operating income, Same community operating margin was 26.1 percent, a 640 basis point improvement over the prior year. I am very proud of this operating margin improvement resulting from the continued focus and dedication of our teams to be fiscally responsible And balance mission and margin. 1st quarter general and administrative expense, excluding transaction and organizational restructuring costs And non cash stock based compensation expense was approximately $42,000,000 Cash operating lease payments were $57,000,000 which is consistent with our previously provided expectations.

Speaker 3

These results culminated in Q1 adjusted EBITDA of approximately $89,000,000 which far exceeded our guidance range And represented a 138% increase over the prior year Q1 and a 90% Quenchal increase over Q4 of 2022. Versus our initial guidance, adjusted EBITDA favorability was driven primarily by 3 things. 1st, higher than expected RevPOR 2nd, the government grant assistance I just noted. And 3rd, improved expense management, particularly the ongoing premium labor reductions that Cindy spoke to. Adjusted free cash flow was negative $21,000,000 for the quarter, a meaningful improvement from our 2022 quarterly run rate.

Speaker 3

Capital expenditures in the Q1 were elevated, primarily as a result of $16,000,000 in remediation spend, primarily related to Hurricane Ian and Winter Storm Elliot. We estimate that $13,000,000 of this is reimbursable, of which we received only $6,000,000 of insurance recoveries during the Q1. While the quarterly timing will vary, we anticipate a relatively net neutral full year cash flow impact related to these natural disaster reimbursable Costs and expected insurance recoveries. Aligned with our previous guidance, we anticipate approximately $200,000,000 of non development In 2023, excluding the expected $20,000,000 of full year reimbursable remediation costs. Moving to liquidity.

Speaker 3

Throughout the pandemic and recovery period, we have successfully executed plans to support liquidity as it is the fuel that supports our continued recovery. As of March 31, total liquidity was $439,000,000 In connection with the recent closing of an asset held for sale that Cindy spoke to in the Q2, we expect to recognize $12,000,000 of a net Cash inflow. I'll now pivot to our Q2 guidance. In yesterday's press release, we guided to year over year Rev par growth in the range of 11.5% to 12% and 2nd quarter adjusted EBITDA in the range of $72,000,000 to $77,000,000 Driven by continued recovery, 2nd quarter occupancy is expected to improve versus the Q1 Despite normal pre pandemic seasonality, which generally results in lower second quarter occupancy. Importantly, our April weighted average occupancy improved 10 basis points relative to March.

Speaker 3

Additionally, we believe we can maintain much of our Q1 RevPAR. April financial move outs are still elevated, But are improving from the levels we experienced in the Q1, and we believe weighted average occupancy will sequentially increase each month of the quarter. It's important to note that compared to the Q1, our Q2 adjusted EBITDA guidance reflects some normal Seasonality factors which are unfavorable sequentially versus the Q1. We estimate that the sequential impact to adjusted EBITDA From these normal seasonality factors, which are provided on the last page of our investor presentation, is approximately $13,000,000 With continued progress on our key strategic priorities, including anticipated growth in occupancy as well as diligent and appropriate We expect the impact of these 2nd quarter factors to be partially mitigated. In addition to these normal seasonal factors, The transaction with Welltower that Cindy spoke to results in the reclassification of leases from financing to operating treatment, much like a separate lease amendment we spoke to in our February earnings call.

Speaker 3

Similar to that, this new lease amendment will impact Specifically, in the current Q2, cash facility operating lease payments We'll increase approximately $5,000,000 lowering adjusted EBITDA. Offsetting will be a decrease And payment of financing lease obligations of approximately $4,000,000 and a decrease of interest expense of approximately $1,000,000 These three reclassifications will offset one another and will result in no impact to cash rent payments or adjusted free cash flow. This 2nd quarter amount I just spoke to represents a prorated portion of the quarterly impact based upon the transaction date. Beginning in the Q3, this reclassification quarterly impact will be approximately $7,000,000 While this lease accounting change will decrease adjusted EBITDA, it is important to note that it will have no impact on adjusted EBITDAR, A standard and widely used valuation metric. We have provided this information on the adjusted EBITDA and adjusted free cash flow side in the supplemental deck.

Speaker 3

Looking beyond the Q2, we would expect adjusted EBITDA to step back up as occupancy continues to grow And we deliver continued improved expense management in 2023. Finally, I want to share thoughts on our Capital structure, given the recent banking crisis and the consequential tighter credit availability as well as continued volatile and rising interest rates. Over the years, we have been proactive and thoughtful in our financing plans. Thanks to this diligence, which is led by our Treasurer, George Hicks, Approximately 60% of our debt portfolio is at a fixed interest rate, just over 90% is non recourse asset backed mortgage debt, and just over 90% of our variable rate debt is subject to interest rate cap or swap agreements With a weighted average fixed interest rate of 4.14 percent, our 2022 refinancing Further strengthened our current financial position, especially considering the current lending environment. Additionally, With our solid Q1 adjusted EBITDA results, our annualized leverage decreased from 19.8 times at the end of 2022 To 15.0x at the end of the Q1.

Speaker 3

Our next mortgage debt matures in September of 2024 And we've already begun evaluating our refinancing options. We are actively monitoring the markets, which are ever evolving and we are fully focused on the performance of the asset pool in this master loan agreement. A number of factors will be weighed in determining the timing and approach we take to this maturity, Including the interest rate environment, the continued recovery of the assets within the loan and our liquidity needs at the time of refinancing. Most importantly, I'm confident we will be able to address this loan maturity at or before September of 2024. I'd like to end by saying we've targeted significant forward progress in 2023, and the Q1 results Take us one step closer to achieving our goal.

Speaker 3

Impacting our adjusted EBITDA expectations for the 2nd quarter Our normal seasonal factors, which increase costs between the 1st and the second quarter, as well as the impact of the new lease reclassification. But by remaining focused on both mission and margin through strong operational execution and a growth mindset, We are confident that at the end of 2023, we will be pleased with our solid progress this year. I'll now turn the call back over to Cindy.

Speaker 2

In closing, we have established a strong foundation for success through the tremendous dedication of our passionate team. There is a significant and increasing demand for our communities from an aging demographic and this demand has proven to be robust. Brookdale scale, clinical expertise and innovative healthcare services like Brookdale Health Plus set us apart from competitors And we plan to leverage our strengths and maximize compelling demographic tailwinds to create significant value for our shareholders. Operator, please open up the call for questions.

Operator

Thank you. We will now begin the Q and A session. Our first question is from Steven Valiquette with Barclays. Your line is now open.

Speaker 4

Thanks. Good morning. Congrats on these solid results. One question I have is just on Page 3 in the supplement, where every quarter you show the occupancy bands for the consolidated communities. Not to nitpick on the suddenly negative thing, but I was a little surprised to see the number of facilities with under 70% occupancy jumped up to around 200 facilities this quarter versus 180 in the 4th quarter.

Speaker 4

I know there's seasonal factors there. But really, I guess, the bigger question is, I Target for the number of facilities that you think would be kind of permanently maybe under 70% and would there be a strategic review? Just kind of just curious on your thoughts big picture around kind of the bottom end of

Speaker 2

We're really excited about our Q1 results. When you look at the occupancy bands in the first Supplement Page 3. We do have our results come down sequentially from Q4 to Q1 Because of the normal seasonality of our portfolio, we do have a number of communities that are under 70% and we have plans to improve the occupancy in those communities. Now there are some complications about how you might adjust the portfolio. As you know, most of our leases are Structured as master lease agreements.

Speaker 2

And what that means is we need to renew a pool of assets together. We can't cherry pick and take the best assets. That said, we do enter into discussions with our landlords about whether it might be possible to sell certain assets that we think Could be better suited outside of the Brookdale portfolio. I also think it's important to note that Brookdale is largely a private pay business. Unlike other competitors, we don't have as much Medicaid and Medicaid communities are often a higher occupancy.

Speaker 2

I also think it's important to note that we have focused on driving RevPAR. And if you look at the results of our RevPAR, Our adjusted EBITDA, our facility operating income and our absolute margin rate, I think our performance As a whole compares very favorably to our peers.

Speaker 4

Okay, great. Just one quick follow-up question. It's regards to the Welltower lease, the pool of $17,000,000 will be available for CapEx funding. Is there any sense already on how that's going to be spent? Is it more Refurbishments, are you looking to increase some of the acuity, maybe in Alzheimer's offerings, etcetera?

Speaker 4

Just curious any just high level color on how that might be spent, if there's any You're marketing for that already. Thanks.

Speaker 2

Yes, that's a good question, Steve. Let me just say that the Welltower transaction is a great transaction for us. As you know, it's a reclass in terms of the rent payments. We will not have an increase in cash rent. There will not be any change to our adjusted free cash flow.

Speaker 2

There will be no impact to adjusted EBITDAR, which is a Standard and widely used valuation method. When it comes to the CapEx pool itself, one of the communities that we will use CapEx on is Brookdale Shawnee. That's the community that I referred to at the beginning of the call that was impacted by the tornado. We are still in the early stages of deciding where and how that CapEx What I'm excited about is that that CapEx pool will improve both The profitability and the liquidity of the communities over the near term and drive even stronger performance.

Speaker 4

Okay, great. Okay, thanks.

Operator

Thank you, Stephen. Our next question is from Josh Raskin with Nephron Research. Your line is now open.

Speaker 5

Hi, thanks. A couple here. Just a first quick one. Do any of the other larger leases that you have outstanding have any net worth covenants or was I know you mentioned Welltower was unique, but I don't know if there's others that have that.

Speaker 2

No. They're not. It was only in the Welltower lease.

Speaker 5

Okay. And then just looking back sort of pre pandemic, if you think about occupancy The levels by segment, assisted living is about 570 basis points off the Q1 of 2019, but IL is still over 1100 basis points. So I'm just curious, is there an opportunity to convert Some of those IL beds into something more acute like AL or memory care and just help us understand the CapEx requirements, regulatory approvals, landlord approval, Things like that, that would be needed.

Speaker 2

It's a really good question. And if you go back, before the pandemic, I would say that Brookdale was Incredible when it came to development CapEx. And what we often found is that we could take IL units And convert them to a higher acuity, particularly early stage dementia or Alzheimer's care and that was very successful. Now the regulatory environment varies greatly. We do have a community in New York, for instance, that has been built where we're still awaiting Regulatory approval to open it a long time after the community has been operated.

Speaker 2

So we'll look at those Probably in 2024 and beyond, but what we thought in 2023 was the best near term opportunity For improvement in revenue, adjusted EBITDA and cash flow was to really look at those short term improvements that could drive Our improved recovery and that's why you haven't seen those programs this year. But looking forward, I do think that's a wonderful opportunity for us.

Speaker 1

Gotcha. And then just if

Speaker 5

I could sneak one more in, just Brookdale Health Plus, I thought the commentary was interesting there. Is that a revenue opportunity in terms of Was it rate add on or is that sort of part of the overall rate and help support the increases that you guys are getting?

Speaker 2

We do not charge separately for Brookdale Health Plus. If you think about the value proposition for our residents, What that does is that allows them to increase their health span, which will increase length of We also have seen that it attracts more residents to our communities, so we accelerate move ins. So from us, That really helps drive sort of the revenue growth, which I think is really attractive. Now if you think about sort of the transition to value based Care, we've demonstrated that our outcomes are better than residents who live outside Brookdale communities and live in private residents. They've got fewer ER visits, fewer hospitalizations and urgent care visits.

Speaker 2

And so that will create value for the healthcare system overall. We're still working on how we will capture more of that value for the Brookdale shareholders.

Speaker 5

Okay. Thank you.

Operator

Our next question is from Ben Hendricks with RBC Capital Markets. Your line is now open.

Speaker 6

Hey, thank you. Appreciate all the commentary about the leases. I just wanted To follow-up on kind of the covenant side, you mentioned that the unique covenant was removed from the Welltower leases. But can you kind of talk about kind of where we go from here from a balance sheet perspective, where your next pressure points are and how we think about kind of your strategy going forward from

Speaker 2

Yes. Our balance sheet is in good shape, right? One of the things that we were able to eliminate From this Welltower lease, all three Welltower leases is the unique net worth covenant and that has been replaced with a tangible net worth covenant. And if you calculate the tangible net worth under the lease at March 31, our covenant would have And $4,400,000,000 of tangible net worth, that's what our calculation would have been. And that compares to a covenant of $2,000,000,000 So more than $2,000,000,000 of cushion in that covenant.

Speaker 2

So I think that's in really good shape. We've been very proactive throughout the pandemic looking at our Upcoming maturities and our next maturities are in the fall of 2024. And Dawn and George Hicks, our Treasurer, are already looking at opportunities to think about how we would handle those.

Speaker 6

Thank you.

Speaker 2

Thanks, Ben.

Operator

There are no additional questions waiting.

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Brookdale Senior Living Q1 2023
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