Everywhere you turn these days, there’s talk of senior living occupancy returning to pre-pandemic levels. And the general view among the industry’s closest observers is that this is going to be a good year to raise rents, as that rare combination of higher consumer demand and a paucity of new startups works its price-point magic.

Then there’s this: A tough financing environment marked by higher interest demands and more restrictive capital access is starting to get better and could improve dramatically in the second half of the year.

The source for this latest prediction is none other than the world’s largest healthcare symposium, which concluded last week in San Francisco. Compared with a year ago, the mood was decidedly more upbeat at the J.P. Morgan Healthcare Conference, which brings together investors, bankers, scientists and various other high-level movers and shakers.

Their general consensus was that capital access will steadily improve. That will no doubt be good news for senior living operators looking to tackle overdue repairs, indulge in renovations or upgrade services. Not to mention possible mergers or acquisitions. (Which are expected to see a notable uptick this year, according to the most technologically advanced Ouija board operators.) No doubt, available funding at reasonable rates could be a game changer for many operators, maybe even the larger senior living field.

Let’s not forget there’s that little matter of whether the Federal Reserve will cut interest rates as a way to spur things on. Last month, Fed Chairman Jerome Powell indicated that as many as three rate cuts could happen this year. Of course, that markdown assumes inflation holds steady. Or better yet, declines.

So, all things considered, it’s easy to feel pretty good about where things stand for senior living operators right now, and where they might be heading. Or as Buffet might remind us, this is probably a good time to start stressing out.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.

Newly released research forecasts another coming demographic trend that operators will want to get ready for: The number of centenarians is expected to more than quadruple by 2054, according to data from the US Census Bureau analyzed by the Pew Research Center.

“Centenarians currently make up just 0.03% of the overall US population, and they are expected to reach 0.1% in 2054,” according to Pew. That percentage may not sound like much (and some of the proportion change is partially due to an expected lower birth rate), but looked at another way, the population of those aged 100 or more will grow from 101,000 this year to approximately 422,000 over the next three decades.

By comparison, look back to 1950 and only 2,300 Americans were centenarians, Pew pointed out, citing Census data. What a difference!

Exactly what can senior living expect? It’s difficult to say for sure. Other changes involving older adult health, medical advances and related issues may be in store as well.

But it’s easy to imagine an increased length of stay for the types of individuals who typically are moving into senior living communities now. Or, the average move-in age range may be pushed higher — some older adults currently are able to stay in their homes until they pass away, but as life spans increase, they may age to a point at which they need the services and care found at a senior living community.

Prepared operators should have new opportunities.

It’s worth noting that many baby boomers will be part of this demographic trend, too — they will be aged 90 to 108 in 2054. So maybe this trend simply will represent a progression of the wave, at least at first.

One thing is certain: While preparing to meet the needs and wants of baby boomers today, operators will need to start thinking about how to evolve to serve those boomers, and the generations that come after them, as more of them live more than 10 decades.

Lois A. Bowers is the editor of McKnight’s Senior Living. Read her other columns here. Follow her on X (formerly Twitter) at Lois_Bowers.

Tuesday’s release of a final rule on worker classification standards surely will trigger many a call to HR for a policy rewrite. And perhaps to legal counsel for advice on how to react.

According to federal regulators, the updated standards promise to bring clarity to the often murky distinction between independent contractors and employees.

Clearly, regulators feel that too many senior living operators — and employers in general, for that matter — are using the “independent” label to identify workers who should rightfully be considered employees.

Specifically, the new rule adjusts the method of analysis and adds criteria for determining which bucket a worker should be placed into.

The Labor Department asserts that the new rule will take a more “holistic” approach that encompasses additional factors and weighs them more evenly in the decision-making process.

But as so often is the case, operators are pushing back against an official narrative that seems to promise help while ignoring burdens.

“We are concerned that the rule, coupled with other proposed federal regulations, will only serve to exacerbate the workforce shortage and wipe out some of the recent modest gains communities have made in recruiting individuals to help care for our seniors,” Argentum Senior Vice President of Public Policy Maggie Elehwany told McKnight’s Senior Living.

Additionally, the changes may place greater legal and financial burdens on senior living operators, suggested Gerald Maatman Jr., partner and chair of the class action practice group at legal firm Duane Morris.

Maatman suggests that implementation of the rule may well prompt more wage and hour misclassification class action litigation in the sector.

Remember that famous line: “I’m from the government and I’m here to help you”?

I guess you could say it took on a whole new meaning this week. Or that at the very least, the old meaning was freshened up.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.

The effort queried 2,000 US adults in October. That the survey was sponsored by The Vitamin Shoppe and dietary supplement brand Ancient Nutrition probably doesn’t surprise you, given that so many of our annual promises to ourselves revolve around health and wellness.

In fact, the top categories for goals, according to a Talker report on the survey, include relationships and friendships (51%), physical health (49%), socializing (44%) and mental health (39%).

Making resolutions is popular, survey results show. Three-fourths (75%) of respondents said they set at least one resolution each new year, and another 12% said they set resolutions, but not necessarily every year.

“The New Year can be an ideal time to set resolutions and goals, because it’s a chance for a fresh start and a clean slate,” said Josh Axe, DNM, DC, CNS, co-founder of Ancient Nutrition and a member of The Vitamin Shoppe’s Wellness Council. “Lots of people are setting goals at this time, so you can feel supported and part of something bigger than just yourself.”

Forty percent of poll-takers said that the way to keep a resolution is to “start small,” even though 42% of respondents said they preferred to make long-term goals; 27% said they preferred to make short-term goals.

Respondents said that goals, on average, should be attained within five months, but if not successful, 54% of respondents said they would just start over. Most of the adults taking the survey said they viewed resolutions as a motivator (63%), a tradition (50%) or a way to improve their health (44%).

Axe said that it’s important for people to tailor their resolutions to their own health and lifestyle, because everyone is different.

“Resolutions and goals, whether long-term or short-term, can be powerful motivators for each of us to work towards improving our health and sense of well-being,” Axe said. He recommended that resolutions be specific, measurable and achievable. “Wellness is a lifelong journey, and resolutions and goals can be helpful reminders and incentives along the way,” he added.

Wishing you much happiness and success on your journey.

Lois A. Bowers is the editor of McKnight’s Senior Living. Read her other columns here.

What’s especially significant here is Judge Douglas L. Fleming Jr.’s searing words — and their unmistakable implication. Boiled down, he said that assisted living communities are not qualified to call themselves healthcare players.

His reasoning for such a rejection? Because senior living communities are not licensed as nursing homes or hospitals, nor do they employ licensed healthcare providers to “primarily” render healthcare services.

“One only has to look at the statutory distinction between an assisted living facility and nursing homes,” Fleming wrote. “[W]hile each facility renders healthcare services, only a nursing home primarily does so.”

Well, I guess that’s one way to kick a budding movement in the pants.

These days, fewer senior living communities simply describe themselves as a choice-driven, nonmedical setting for the aged.

Sure, maybe senior living (especially assisted living) might have aligned with that description a few decades ago. But times have changed.

Some assisted living settings now accept Medicaid payments (so much for the old private-pay-only requirement).

More notably, they no longer shy away from acknowledging the evident truth: healthcare is occurring within their walls.

Trade shows in recent years have showcased more operators proudly proclaiming to be healthcare providers. More than a few actively are competing against nursing homes (and to a lesser extent, home health settings) for residents being discharged from hospitals.

That’s why Judge Fleming’s ruling could become a real buzz kill.

Not only does the decision come as an eye opener; it also could give ammunition against the sector to at least two notable groups.

One is other plaintiffs who may believe that they were misled by marketing promises of more care than actually was delivered.

Another is nursing homes, which may believe that an unqualified — as in nonmedical — foe is unfairly restricting their access to people requiring post-acute care.

All of which could leave senior living operators with two obvious but uncomfortable choices.

One is to ramp up their medical care standards and pursue licensure.

The other is to revert to the official stance that healthcare is not really happening, despite overwhelming evidence to the contrary.

Care to pick your poison?

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.

• In discussions, lead off by talking about the more popular flu vaccine.
• Be consistent in your messaging about the safety and effectiveness of both vaccines.
• Address people’s vaccine-specific beliefs, such as the limits of protection from prior COVID infections. 

The research, which included a July survey of more than 2,000 adults, including 659 of whom were aged 50 or more years, 71% of the older adults said it was “very likely” or “somewhat likely” that they would get the flu vaccine, and 64% said it was very or somewhat likely that they would get the updated COVID vaccine. Forty-nine and 50% of the older adults, respectively said they thought that the flu and COVID vaccines were “very effective,” and 65% and 51%, respectively, thought that they were “very safe.”

The survey results also reveal the most common reasons that some respondents said they are hesitant about vaccination, which can help you with your talking points.

Among those 50 and older who said they were “not very likely” to get the flu vaccine, the top three reasons were that they would prefer to get natural immunity from becoming ill (35%), that they don’t trust the government agencies that promote vaccination (33%) and that they feel as if people are expected to get too many vaccines in general (31%).

Among those 50 and older who said they were “not very likely” to get the COVID vaccine, the top three reasons were that they want to see more research done on the vaccine (62%), that they are worried about the vaccine’s safety (59%) and that they don’t trust the government agencies that promote vaccination (55%).

(You can read about the other concerns of respondents, including those aged 18 to 64, here.)

Other recent research also provides motivation for staying current with vaccines:

• For instance, an analysis of more than 10 million cases of COVID-19 in adults between May 2020 and February 2022, published in December in the Journal of the Royal Society of Medicine, found that among adults aged more than 50, the case fatality risk was 10 times higher in the unvaccinated compared with those who had been vaccinated within six months before testing positive for COVID-19.
• Research published in December in Lancet Infectious Diseases indicates that people hospitalized with seasonal flu also can end up with “long flu,” long-term, negative health effects, especially involving their lungs and airways.

See the Centers for Disease Control and Prevention’s website for more information and resources about COVID and flu vaccination for long-term care residents or workers — long-term care workers have relatively low vaccination rates compared with other healthcare personnel.

Lois A. Bowers is the editor of McKnight’s Senior Living. Read her other columns here.

Howard added that “a lot of these assisted living facilities have been bought by Wall Street crowd types, private equity outfits that are just trying to squeeze as much money out of desperate families as they can.”

“There are perfectly wonderful, good people and facilities in this industry,” he noted. “And then there’s the dirt.”

That caveat emptor reminder was practically a wet kiss when compared with two earlier developments. One is a series of articles appearing Sunday in the Washington Post that link “dangerously understaffed” assisted living communities to thousands of elopements and nearly a hundred deaths.

“In case after case examined by The Post, inspectors cited evidence of too few people on duty to care for the number of residents, of staff ignoring alarms, of skipped bed checks and staff sleeping on the job, of general neglect and, in a few cases, falsified records,” the paper reported.

Not exactly a glowing review, is it?

Prior to that report, KFF and the New York Times published a “Dying Broke” series. The headline probably tells you all you need to know about where the series went. While the reporting generally focused on the general nature of the nation’s long-term care crisis, senior living operators were painted with a less-than-flattering brush.

Those critiques are troubling for many reasons, but two stand out.

One is that the concerns they collectively raised are valid. The second is that such revelations hardly support  the industry’s long-held position that there’s no real need for federal oversight.

Who knows? If people keep reading about problems of and by senior living, they might start wondering whether senior living is well enough to be left alone.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.

According to the Post’s research, more than 2,000 residents wandered away from or were “left unattended for hours outside” of senior living communities from 2018 to 2023, and 98 of them died. (Read this article to learn more about the response of industry advocates.)

It isn’t the first time the industry has been scrutinized by the national lay press, of course, and it won’t be the last.

In fact, the Post articles follow the November publication of a package of articles by the New York Times and KFF. That report, titled “Dying Broke,” scrutinized an industry pricing structure that adds fees on top of basic charges, to cover additional services such as help with activities of daily living, insulin injections and blood pressure checks. It also cited the growth of rate increases, the for-profit status of most providers, and the operating margins they see.

Other examples of somewhat recent unflattering coverage of the industry include a 2017 report by CNN that counted more than 16,000 cases of sexual abuse in assisted living communities and nursing homes since 2000 and, on a more local level, articles about the senior living industry in the Minneapolis Star Tribune and Atlanta Journal Constitution in 2017 and 2019, respectively.

Although such attention can lead to efforts to try to increase state regulation of operators, in a recent interview I conducted with Nexus Insights and National Investment Center for Seniors Housing & Care founder Bob Kramer (not about these media investigations), Kramer said he believes that the government’s “desire to invest the money to set up a federal regulatory apparatus is still going to be lacking,” although “there will be a lot of noise” about it.

A 2018 report by the Government Accountability Office certainly generated some “noise” when some federal lawmakers and consumer advocates said they would push for changes in assisted living because of the report’s findings. But the report’s to-do list primarily was for the Centers for Medicare & Medicaid Services and state Medicaid agencies related to state reporting of deficiencies in care and services provided to some assisted living residents.

Still, at a time when demographics mean that a larger number of older adults will be in the market for senior living in the coming years, operators can expect the scrutiny to continue.

As Kramer told me: “The reality is that there are good operators and not-so-good operators.” Even well-intentioned providers may find themselves challenged by staffing shortages, although many have limited move-ins in an effort to better align staffing and resident needs.

“The more the industry can articulate and, in a sense, hold itself accountable for higher standards of care, the better off the industry will be, because we don’t want to go the direction of skilled nursing,” Kramer said as I interviewed him on the occasion of McKnight’s Senior Living’s 20th anniversary. (If you haven’t seen the cartoon of him on the first-ever cover of our print magazine in 2003, you can see it here.)

And therein lies the opportunity.

Possible solutions are suggested in the Post coverage, among them training, increased vigilance and more accurate risk assessments. Industry advocates also point to their efforts to attain and maintain quality among providers.

“Our association has participated in multiple efforts to build sector consensus on assisted living quality measures and other topics,” LeadingAge President and CEO Katie Smith Sloan said Sunday in response to the Post’s coverage.

For instance, LeadingAge, Argentum, the National Center for Assisted Living and the American Seniors Housing Association in June announced that they had joined with the National Association for Regulatory Administration to develop guidance for the industry and resources for operators, regulators, policymakers and other stakeholders. Infection prevention and control was the initial focus of the effort, called the Quality in Assisted Living Collaborative. The work “will help the sector collaboratively address the most urgent issues,” Sloan predicted at the time.

On top of that effort, NCAL offers its National Quality Award program, and Argentum offers several certificate and certification programs, just to name a few quality-focused initiatives. And providers can pursue efforts outside of those offered by industry membership associations, such as assisted living accreditation and memory care certification through The Joint Commission.

Keep it up. The Post is. The media outlet promises to continue to report on the assisted living industry and is soliciting information from readers about their “experiences with elder care, assisted living and dementia care.”

Lois A. Bowers is the editor of McKnight’s Senior Living. Read her other columns here.

But that’s just part of the story. Looking ahead, operators may have even more cause celebration. Especially those with the inclination and resources to improve the reality of senior living.

Let’s begin with the aforementioned sore spot: staffing. To be sure, this is a perennial challenge. But look around. Increasingly, operators are embracing new ways to attract and keep the best possible talent. And not just by increasing pay, although that is no small matter. Options such as generous training programs, career advancement opportunities and flexible scheduling were considered unusual in the recent past. Increasingly, they are becoming a price of admission. The result? Lower turnover, more motivated staff members and, ahem, happier customers.

Speaking of change, it wasn’t too long ago we were talking about tech tools as a futuristic, someday, novelty item. Now, technology is ubiquitous, touching almost every area of operations and services. From state-of-the-art health monitoring systems to interactive communication platforms, those innovations don’t just make the job of community leaders easier. They also help create a more engaging and connected environment for residents.

One of the most promising emerging trends is a focus on personalized care plans. This was, until recently, often viewed as a concern limited to skilled care. These days, senior living communities increasingly are tailoring services to meet the unique needs and preferences of each resident. This is not only ensuring a better quality of life for residents; it’s also helping operators set themselves apart.

We’re also starting to see unprecedented levels of community integration. As never before, operators are creating senior living spaces that seamlessly blend into the fabric of surrounding neighborhoods. This connection isn’t just fostering a sense of belonging for residents; it’s also opening up new opportunities for collaboration with local businesses and services.

In addition, many communities are beginning to recognize the need for holistic programs that promote not just physical health but also mental and emotional well-being. Initiatives such as art therapy, mindfulness programs and intergenerational activities are gaining traction, contributing to a more vibrant and fulfilling experience for residents while also creating a positive work environment for employees.

There’s no doubt we are witnessing both evolution and revolution in senior living. The payoff of this unique marriage will be better options for consumers and a better future for operators willing to join the dance.

And perhaps as never before, operators will have good reason to kick up their heels.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.

Item: Report: Alternative approaches to senior living, LTSS needed for growing older adult population

The gist: A recent story highlighted a report from the Harvard Joint Center for Housing Studies, revealing that only 13% of adults aged 75 or more years, living alone across 97 metro areas, can afford to move into an assisted living community without depleting their assets.

Why this matters: We’re hearing a lot these days about the need to serve the so-called middle market. (I say “so-called” because industry views on the meaning of that range can vary considerably.) What this report makes clear is that the senior living sector more than has its work cut out here. Success is not just going to be a matter of paring options and operating costs to the bone — although that, too, likely will need to be a part of the equation. Essentially, those findings suggest operators will need to re-imagine how to reach this market. And that, my friends, is going to be a very heavy lift.

Item: CCRCs continue to report higher occupancy than other senior living segments

The gist: Continuing care retirement / life plan communities continued to outpace non-CCRCs in senior living occupancy in the third quarter, according to a data analysis from specialty investment bank Ziegler.

Why this matters: At first glance, the implication is obvious: These are good times to be running CCRC / life plan communities. Part of the advantage is that CCRCs often can charge higher entry fees and monthly rates. So everyone should want to become a CCRC, right? Not so fast. Many of these campuses have a 60-acre or larger footprint, which can be a substantial barrier to entry. Moreover, the full-service aspect of CCRCs can backfire, especially if one component of the portfolio — such as skilled care — hits hard times. Then what? It’s worth noting that the things that make CCRCs formidable also can hamper them when times are tough.

In case you didn’t notice, there is no single silver bullet when it comes to ensuring success in senior living.

Probably best to focus on finding many good bullets instead.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.