The assisted living sector touts itself as the most cost-effective option to provide quality-of-life care and services for the nation’s older adults. But that value comes at a cost, according to a new report.

Seniorly set out to determine how much assisted living communities actually cost and how those costs stack up against other options, including in-home care, by analyzing the average cost to consumers in all 50 states.

The price of assisted living, as with most business offerings, is increasing. Between 2021 and 2023, 30 states saw average costs for assisted living rise — with Wyoming (a 53% increase), West Virginia (46%) and New Hampshire (46%) seeing the biggest average increases, according to the report. The 2023 national average monthly cost of $4,401 is an 8% increase over 2021.

Costs charged to consumers actually fell in 15 states — Washington saw the biggest decline, at 16% — and remained relatively flat in six states, according to the report. 

The average monthly rent for assisted living communities ranged from $2,946 in Louisiana to $8,248 in New Hampshire, where it was almost double the national average. Average monthly costs were more than $5,000 in 10 states, most of them concentrated in New England and the Mid-Atlantic, whereas the most affordable states included Indiana ($3,695), Iowa ($3,420) and South Dakota ($3,378).

Middle market highlighted

The cost of senior living is shining a spotlight on options for the “forgotten middle,” those whose incomes are too low for them to be able to afford current private-pay senior living options but too high for them to qualify for federal assistance.

A recent Milken Institute report, released in partnership with the National Investment Center for Seniors Housing & Care and CVS Health, projected that almost three-fourths of the estimated 16 million middle-income older adults who will be aged 75 or more years will be financially unprepared to afford housing to meet their needs in 2033. Even with home equity, the Milken researchers found, only 39% of those middle-income older adults will be able to afford assisted living.

Another recent study from the Harvard Joint Center for Housing Studies, released last month, found that only 13% of adults aged 75 or more years who are living alone across 97 US metro areas can afford to move into an assisted living community without starting to cash in their assets.

A NIC-funded 2019 study by NORC at the University of Chicago found that 54% of middle-income older adults will lack the financial resources to pay for senior housing and care in 2029, calling for a combination of public and private efforts to address the looming crisis.

The Seniorly study in part used data from the US Census Bureau’s 2022 median annual household income for states and savings rates from the Bureau of Economic Analysis. In doing so, Seniorly estimated that it would take the average American 17.2 years to save for one year of assisted living. 

Using those data to look at the affordability of assisted living, Seniorly found that New Hampshire residents would need to save for 26.8 years to cover a single year of assisted living, with West Virginia (26.1 years), Mississippi (24.8 years), Wyoming (24.6 years) and Delaware (21.7 years) rounding out the top five states as far as timing. 

Maryland came out at the other end of the spectrum, with residents needing to save an average of 11.7 years to cover one year of assisted living costs, followed by Utah (12.3 years), Minnesota (12.3 years), Georgia (13.3 years) and Washington (13.4 years). 

In comparing assisted living with home care costs, Seniorly pointed to a report from Genworth Financial that put the monthly cost of a home health aide at $5,462, although wide variation exists between states. Minnesotans will pay the most for home care, with a median monthly cost of $7,333, compared with $3,472 for assisted living. West Virginia was the least expensive state for home health aides at $3,793 per month, compared with $4,846 average monthly rent for assisted living.

Some question value

The assisted living industry’s pricing structure and providers’ for-profit status were two topics examined in a New York Times and KFF article package in November. Costs also were discussed in a December Washington Post article package looking at the deaths of residents who had eloped from communities. 

Those and other lay media investigations into the assisted living industry led the US Senate Special Committee on Aging to launch a review of the industry, including questions to three large providers, and to schedule a Jan. 25 hearing based on “significant concerns” about costs, staffing levels and resident safety.

It’s no secret that the largest population of older adults is about to come knocking on senior living’s door. What worries dementia care expert Teepa Snow is how unprepared operators may be to handle the incoming “dementia shockwave.”

In a recent webinar on the state of dementia care hosted by workforce education provider Relias, Snow, an occupational therapist and CEO of Positive Approach to Care, said that there are 120-plus types, causes and forms of brain change under the dementia umbrella. 

In 2020, approximately 7 million people aged 65 or more years were living with dementia. That number is anticipated to increase to 9 million by 2030, and 12 million by 2040. And Snow said that 60% to 70% of people moving into long-term care have cognitive changes consistent with the early signs of various forms of dementia. According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, 42% of assisted living residents have Alzheimer’s disease or another form of dementia.

Communities are unprepared

Senior living communities are missing the signs of the disease because they aren’t preparing staff members to recognize them at the earliest stages, Snow said. 

In most cases, she added, certified nursing assistants are required to have the most dementia training of staff members, but that requirement averages only six hours. Most skilled care providers are not required to have any dementia care training, she said. 

“The challenge is, when we’re talking about somebody whose brain is dramatically shifting and abilities are variable, we are asking people to step forward into this role without preparation,” Snow said, adding that the situation sets up staff members for job dissatisfaction. “If we can’t get people to want to work with us, we can’t serve the population.”

The brains of people with dementia change over time, taking an average of 10 years to change from a neurotypical brain to a brain with Alzheimer’s disease, Snow said. And 80% of cases of individuals experiencing brain changes are not identified in the early stages, when interventions would be most effective, she said.

Providing truly person-centered care involves supporting the right culture and environment, building competence through education and training and practice, and working with families, Snow said. The “state of dementia care” is not where it needs to be, she added, but she said she knows it can get to where it needs to be — with collaboration. 

Adding family to the care team

Senior living communities may be admitting people who have more complex care needs than anticipated, resulting not only in untrained and unprepared staff members but unprepared families, Snow said. 

The baby boomers aging into long-term care, she added, will be moving in at a more advanced age than members of previous generations, will have more chronic conditions and will be at higher risk for dementia.

“Not only are there more of us getting older; there are more of us getting older and having brain changes,” Snow said, opining that society already is poorly equipped to understand what aging typically looks like, let alone understand the brain changes that come with dementia.

Educating residents’ family members about the progression of dementia is just as important as training staff, she said. 

“Somewhere around 75% to 80% of family members have little to no awareness that the diagnosis of dementia is going to lead to somebody’s gradual decline no matter what we do,” Snow said. “It will change their ability to live their life.”

Family members are additional team members and need to be involved and engaged with creating a care plan for their loved ones, she said.

The LCS Foundation has announced a partnership with the Granger Cobb Institute for Senior Living to provide an annual scholarship to add more professionals to the senior living industry.

The institute was announced for Washington State University in 2017 and dedicated in 2019 to focus on building the future senior living workforce through academic programs, industry partnerships and research. It is named for the senior living industry executive who helped build the Washington State University senior living curriculum and taught a course in senior housing administration before he died in 2015. The senior living management program, launched in 2020, offers industry-driven courses, immersive learning, community operations expertise and industry-expert connections before graduation. 

In December, the program celebrated its first graduate, who earned the degree through the institute’s global campus. Six students have completed the senior living minor, which began in fall 2021, and 25 students are in the pipeline working on a senior living major or minor, according to GCISL founding director Nancy Swanger, PhD. Since offering an elective class in senior living management in 2010, almost 800 students have taken the course, with many now working in the industry. 

“Our program is quite unique in that it is housed in a hospitality school within an accredited college of business. The industry loves the business acumen and relationship-building foci in our curriculum,” Swanger told McKnight’s Senior Living. “The program at Washington State University is relatively new, and having such generous support for our students from LCS lends tremendous validity and credibility to what we are trying to build.”

Swanger added that many industry providers have given their “time, talent and treasure to help the program grow,” and that the LCS scholarship is one of three specifically for students studying senior living.

Swanger is on the board of trustees of the Vision Centre, which is supported by several industry associations — including the American Health Care Association / National Center for Assisted Living, the American Seniors Housing Association, Argentum, LeadingAge and the National Investment Center for Seniors Housing & Care — and working to create university and college programs and facilitate internships to prepare future generations of aging services leaders.

Since 2017, the LCS Foundation has awarded more than $450,000 in scholarships and professional development programs. The foundation also has collegiate partnerships with the University of Northern Iowa, Northwood University and the University of Wisconsin-Eau Claire. Those partnerships have placed senior living experts on advisory boards, developed curricula and helped provide students with interactions to advance their learning.

Other senior living-focused academic programs include an assisted living/senior housing administration concentration at George Mason University, a Master of Arts degree in senior living hospitality at the University of Southern California Leonard Davis School of Gerontology, an undergraduate degree in senior living management in University of Central Florida’s Rose College of Hospitality Management, and Boston University’s concentration in senior living in the Masters of Management in Hospitality degree program.

A significant number of senior living companies have implemented diversity, equity, inclusion and belonging programs in the past year, indicating that more owners and operators are “leaning in” to those initiatives to meet strategic goals, according to new industry research.

But the authors of the report about the results of the 2023 Senior Living DEIB Survey, which was released Wednesday, say it’s time for operators to focus on actions aimed at improving retention in addition to recruiting.

“Organizations should establish a holistic vision for what they are trying to achieve through their DEIB efforts,” they wrote. “It is time to move beyond the focus of just recruiting diverse talent. Companies must foster inclusive work environments that provide a sense of belonging, so that they can retain the talent that they work hard to attract.”

The survey, which continued to track the industry’s progression addressing DEIB initiatives, was conducted by Ferguson Partners and sponsored by the Senior Living DEIB Coalition, a two-year-old partnership among Argentum, the American Seniors Housing Association and the National Investment Center for Seniors Housing & Care.

Although more work lies ahead, Argentum President and CEO James Balda said that it is important to acknowledge the progress to date.

“It is exciting to note that this year’s survey showed an increase in the percentage of companies with formal DEIB programs, from 27% to 40%, which indicates a growing recognition within the industry of the importance and positive impact of promoting diversity, equity, inclusion and belonging among employees and residents,” Balda said in a statement. “A formal DEIB program is an important step to foster a culture of diversity, equity, including and belonging, which also bolsters employee engagement.”

Recommendations

The survey, however, also revealed that well more than 80% of executive positions are held by white employees, presenting a “huge opportunity” for racial/ethnic parity at the executive level with employees of color. More work also is needed at the mid-management level, with women of color leaving at twice the rate of their promotion, according to the report. 

“Senior living is about creating communities where everyone feels welcome and valued,” NIC President and CEO Ray Braun said. “The results of this survey provide us with a roadmap for furthering our DEIB initiatives and creating an industry that is truly inclusive for all.”

DEIB trends

The results also provide a market overview of how the senior living industry is addressing DEIB, according to ASHA President and CEO David Schless. 

“The data collected provides valuable insights into current industry trends, best practices and areas of improvement for those looking to further their DEIB efforts,” he said.

Survey participation increased 36% — from 44 to 60 companies — from 2022. 

According to the results, 40% of respondents have a formal DEIB program in place — up from 27% in 2022 — and 37% have implemented some DEIB initiatives or policies. In addition, 93% of respondents said they are taking steps to recruit potential employees from underrepresented groups, and 95% said they are taking steps to increase retention and promotion rates of members of underrepresented groups.

Other findings:

• The majority of organizations focus on gender (91%), race/ethnicity (98%), sexual orientation (89%) and age (83%) as dimensions of diversity.
• 73% of senior living professionals are women.
• 50% of employees are white, and 46% are people of color.
• 14% of executive management is people of color, and women make up 50% of executives.

In most cases (57%), DEIB initiatives originate in the C-suite (57%), although some initiatives are developed by the human resources department (17%) or by a dedicated DEIB committee (13%).

An executive summary of the survey results is available on Argentum’s website.

A senior living community’s approach to finding the best wellness technology should begin with an examination of the needs of its residents and staff members, according to a new report developed with a group of providers and other experts.

A International Council on Active Aging Forum think tank of 60 leaders in senior living, community-based services and technology companies met in the fall to formulate recommendations on helping communities develop a wellness technology, or well tech, vision, as well as implementation strategies. The group’s work was compiled in “The promise of well-tech,” a report released Tuesday by ICAA.

“It was extremely valuable to have both the senior living leadership and the technology companies in the same room,” ICAA CEO Colin Milner said in a press release. “The providers detailed what they look for when selecting a technology, and the companies shared insights from their points of view. Everyone walked away with a better understanding of needs and opportunities.”

Well tech, according to ICAA, includes resident-facing technologies that enable communication, engagement and self-care; technologies that enable staff members to communicate and engage with residents; and technology that helps organizations deliver services and lifestyle opportunities.

The report outlines eight principles that participants said should guide every community’s technology vision, including:

1. Technology strategies should serve the organization as a whole.
2. Involve people who will use the technology in decision-making.
3. Examine the utility and usability of technology for each user.
4. Technology must include troubleshooting, training and long-term support.
5. Long-term partnerships between providers and technology companies are necessary to maximize value.
6. Data should be analyzed to find meaningful patterns and trends.
7. Training on data collection and interpretation for staff members and leaders is a must.
8. Cross-functional teams must analyze data to track wellness outcomes.

Well tech can generate data to prove the value of wellness, personalize services for residents and increase self-care, all while enhancing communication among staff members, according to the report.

The document outlines a planning process that communities can use when considering wellness technology, including discussion question examples and a toolkit of checklists for developing a vision, performing an audit and needs assessment, implementing technologies and evaluating outcomes.

“Technology has tremendous potential to help aging services providers deliver the wellness opportunities that make life worth living,” Milner said. “Grounded by an alignment of mission and values, organizations that buy and companies that sell can develop products and services that benefit the users they are intended for and the businesses themselves.”

A relatively new ordinance in one Michigan city is getting pushback from some senior living communities that are being charged for nonemergency 911 calls. The ordinance, they say, does not distinguish between the offerings of various levels of service and care nor recognize that some settings do not employ caregivers.

The city of Sterling Heights, MI, passed an ordinance last March that charges independent living communities, assisted living communities and nursing homes an $800 fee for a lift assist and a $500 fee for a nonemergency medical response. The Detroit suburb moved to implement the fees after noticing an increase in those types of calls, which they label a “misuse” of 911. The city said that the fees allow some of its costs from these calls to  be recouped.

After adoption of the ordinance last March, the city conducted in-person visits to communities and facilities in April to educate them about the fees before enforcement began on May 1. The ordinance states that nonemergency calls to “residential living facilities that are compensated to maintain staff to assist their residents is an inappropriate and unwarranted drain on city resources, which at times has caused delays in response to true emergencies.”

The city pointed out that operators can buy devices to help staff members lift residents if they fall, according to The Detroit News. 

A city attorney told the media outlet that the fire department handles more than 240 lift assists annually, on average, in assisted living communities and an average of more than 400 nonemergency medical responses, including calls to transfer residents to the hospital because they ran out of medication. 

The ordinance further states that nonemergency ambulance transports are regularly provided by first responders due to “a lack of facility staffing, a disinterest by the facility in addressing these needs for their residents, a lack of proper equipment at the facility, or other reasons that do not warrant or justify the use of city emergency responder resources.”

No caregivers employed

Waltonwood Senior Living contends that the ordinance should not apply to the independent living community at its Waltonwood Lakeside campus in Sterling Heights, which also offers assisted living and memory care. Waltonwood Director of Operations Steven Tyshka told The Detroit News that he agrees with the city of Sterling Heights on charging assisted living communities, but he argued that the ordinance should not be applied to unlicensed independent living, where caregivers are not employed.

A Waltonwood spokesperson told McKnight’s Senior Living that it is committed to transparent communication with residents and their families, “ensuring they understand the specifics of the services we provide at each level of care.”

“We are working to proactively address the Sterling Heights ordinance, emphasizing the clear distinction between independent and assisted living in our communities and navigate these changes effectively,” the spokesperson said. “We are dedicated to upholding the highest standards of care and compliance while also ensuring our residents are informed and supported every step of the way.”

The Michigan Assisted Living Association agreed, saying that independent living residents are “clearly not contracting for any personal care or assistance,” adding that those residents often sign up strictly for room and board.

“It is frustrating that Sterling Heights does not acknowledge the difference between independent living and assisted living,” MALA General Counsel Robert L. Stein told McKnight’s Senior Living.

Not a statewide trend

Fortunately, the Sterling Heights ordinance is not a statewide trend, Stein said, adding that MALA is hopeful that the issue will be resolved “favorably and fairly” for independent living residents. 

“We are aware of providers using private ambulance companies in lieu of calling the city responders for these types of services,” Stein said. “This approach is not a permanent solution but offers some flexibility and cost savings.”

In response to the fees, Waltonwood Lakeside informed its independent living residents in November that it would institute an $800 charge to residents who receive a lift assist from the city to recover its costs, according to the Detroit News.

Tacoma, WA, implemented a similar ordinance in 2019. The Washington Health Care Association and LeadingAge Washington partnered with city safety forces to decrease the number of 911 calls for lift assistance for long-term care facilities. The organizations educated first responders on the training and staffing requirements of assisted living communities compared with skilled nursing facilities, and provided education to community and facility staff members.

The US Senate Special Committee on Aging is launching a review of the assisted living industry following recent articles in the Washington Post, which reported on the deaths of residents who wandered from communities, as well as the New York Times and KFF, which scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of most providers.

Committee Chairman Sen. Bob Casey (D-PA), who has scheduled a hearing for Jan. 25, sent letters dated Monday to the leaders of Brookdale Senior Living, Atria Senior Living and Sunrise Senior Living, asking them to address his “significant concerns” about costs, staffing levels and resident safety.

“Despite these high costs, residents in assisted living facilities have been put in harm’s way, leading to avoidable injuries and death,” Casey wrote in his letter to the large providers, detailing points made in the November Times/KFF articles and December Post articles. 

Assisted living communities primarily are regulated at the state level, but the committee frequently has used its authority to “examine private companies when concerns arise about potential health and safety, as well as financial risks posted to older adults,” the senator said.

“The Senate Special Committee on Aging has jurisdiction over the problems older adults face, including matters of maintaining older adults’ health, their ability to secure proper housing, and their ability to obtain care or assistance when needed,” Casey wrote. “As chairman, I have an interest in ensuring that older adults and people with disabilities are receiving high quality care, have access to proper housing and receive good value for their hard-earned dollars.”

Specifically, Casey asked the companies to provide information and documents no later than Feb. 5 detailing how they communicate the cost of services to residents and their families, rates they charge in each state, and their schedules of services and costs. Additionally, he asked them to provide information on average revenue per occupied unit for the past seven years, figures on the number of residents who have eloped or sustained injuries due to being left unattended, information about the accessibility of information about complaints and citations received by their communities, their policies and procedures for informing residents and families about accidents, applicable staffing requirements, and job titles and associated pay rates at their companies. 

“We look forward to reviewing and responding to Sen. Casey’s letter on the assisted living industry with candor and transparency,” Sunrise Senior Manager of External Communications Heather Hunter told McKnight’s Senior Living. 

Atria Senior Living provided a similar response.

“Our top priority is our residents’ well-being and safety,” an Atria spokesperson told McKnight’s Senior Living. “We look forward to providing information in response to Sen. Casey’s letter.”

Brookdale said it is aware of the letter from Casey.

“Brookdale values the relationships we have created with our hundreds of thousands of residents at communities across the country over the last decade, and we are committed to providing high quality care,” a spokesperson said. “We take seriously our mission of enriching the lives of those we serve with compassion, respect, excellence and integrity.”

Atria, Brookdale and Sunrise are some of the largest senior living operators in the country. On the 2023 ASHA 50 list issued by the American Seniors Housing Association, Brookdale topped the list of operators, and Atria came in at No. 2. Sunrise was No. 3. On Argentum’s 2023 list of largest providers, Brookdale was No. 1, Atria was No. 2 and Sunrise was No. 5.

This isn’t the first time that senators have called for an investigation related to assisted living. In one of the most recent actions, a bipartisan group of US senators, all members of the Aging Committee, in 2015 asked the Government Accountability Office to report on Medicaid oversight and quality of care in assisted living communities. Their request resulted in a 2018 GAO report.

That report contained a to-do list for the Centers for Medicare & Medicaid Services related to state reporting of deficiencies in care and services provided to Medicaid beneficiaries in assisted living communities. Some federal lawmakers and consumer advocates, however, said that they would push for changes in assisted living because of the report’s findings.

‘Isolated incidents’

Senior living industry groups have called the number of deaths reported in The Post’s story a small fraction of the total number of assisted living and memory care residents, most of whom report high satisfaction with their communities.

“The Washington Post’s reporting featured isolated incidents that assisted living communities take very seriously,” Argentum President and CEO James Balda told McKnight’s Senior Living, adding that the elopement-related fatalities highlighted in the Washington Post stories are “exceedingly rare,” occurring with 0.0015% of more than 6.2 million residents served during the timeframe of the reports.

“Our communities look forward to demonstrating to the committee that as the nation grapples to care for our aging population, assisted living provides independence and dignity for seniors,” he said.

Argentum, Balda added, “strongly supports” state regulations already in place to investigate incidents and punish any wrongdoing, and he said that any fatality is “devastating for our staff, our residents and their families.”

Calling elopements rare while acknowledging that any resident injury is “truly tragic,” National Center for Assisted Living Executive Director LaShuan Bethea said she welcomes the opportunity to engage with the committee to “further their understanding of the assisted living profession, its oversight and our deep commitment to providing quality care.”

“The assisted living profession is committed to continuing to learn all that we can about dementia and the disease process to meet the ever-changing needs of our residents,” Bethea told McKnight’s Senior Living. “Policymakers, providers and other stakeholders should come together to find ways to advance memory care while honoring why seniors and their families love assisted living — by supporting their independence and autonomy in a home-like environment.”

Assisted living will continue to evolve with the nation’s changing needs, and regulations, staffing and training requirements must evolve with them, LeadingAge President and CEO Katie Smith Sloan told McKnight’s Senior Living.

“Our elected officials and other stakeholders must prioritize policies to support older adults and the professionals working in aging services to ensure equitable access to high-quality care in assisted living, as well as other care settings,” she said.

In a response to the original package of Washington Post stories, American Seniors Housing Association President and CEO David Schless said the stories “inaccurately” suggest that elopements in assisted living or memory care settings would not occur if there were federal oversight of the setting. He also said that the articles failed to recognize the contributions of the vast majority of frontline caregivers and other senior living professionals.

Schless called assisted living “highly regulated” by states that impose strict requirements, including licensure, and cover a broad range of provisions such as those Casey asked about in his letter to providers. Schless added that states are actively involved in updating and modifying regulations and statutes on an ongoing basis.

“The states are far more responsive than the federal government in addressing the needs of residents and their families to ensure innovative services and programs are available to meet their needs and those of a rapidly aging population, including those with Alzheimer’s and related dementias,” Schless said. 

ASHA, he said, also plans to respond to the committee with a rebuttal of the Post’s “misrepresentation” of the industry, providing information he said was overlooked in the reporting as well as information about the benefits and value of senior living.

Association leaders previously submitted letters to the editor to the New York Times and the Washington Post in response to their articles. Although The Post has not published letters from the associations, it did post a letter from Andrew Carle, lead instructor in senior living administration at Georgetown University. He said that the more than 6 million Americans affected by dementia and prone to wandering would be “exponentially safer” in assisted living communities than at homes in the greater community.

Industry quality initiatives

The industry has launched several initiatives focused on building consensus around assisted living quality measures, as well as infection prevention and control efforts. NCAL last week released its 2023 regulatory review report, which highlighted regulatory requirements across all 50 states. 

The Center for Excellence in Assisted Living, known as CEAL@UNC for the past year, itself was launched in 2003 as a result of a recommendation in the landmark Assisted Living Workgroup Report, delivered to the Senate Special Committee on Aging. 

In a recent podcast interview with McKnight’s Senior Living, Sheryl Zimmerman, MSW, PhD, the center’s executive director, called on all assisted living stakeholders “to be more mindful in a pragmatic, feasible way” across all of assisted living to address resident care needs.

“Most everyone involved in assisted living is aware there are opportunities for improvement,” Zimmerman told McKnight’s Senior Living. “The Senate Aging Committee delved into assisted living 20 years ago with the Assisted Living Workgroup Report, which led to the national Center for Excellence in Assisted Living, and as the executive director, I welcome the opportunity this brings to coordinate efforts to work towards excellence while providing person-centered care and quality jobs.”

LeadingAge, Argentum, NCAL and ASHA 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. The groups, working together as the Quality in Assisted Living Collaborative, first turned their attention to the area of infection prevention and control, an issue brought to the forefront during the COVID-19 pandemic, with plans to address other issues.

NCAL also has its own National Quality Award program, based on the Baldrige Performance Excellence Framework. It recognizes assisted living providers that meet certain goals. The organization’s voluntary quality initiative for assisted living communities also has goals related to staff stability, customer satisfaction, hospital readmissions and the off-label use of antipsychotic medications.

An increase in the number of solo agers — older adults living alone — can provide an opportunity for senior living providers looking to attract yet another demographic.

In a new research brief based on survey responses from 805 individuals aged 55 or more years, the Mather Institute explored how solo agers plan to address their needs and concerns related to aging. 

According to the US Census Bureau, in 2021 there were 22.1 million solo agers in the nation — unmarried and childless adults who live alone and don’t have immediate family to rely on as they age. By identifying the unique needs of solo areas, the report authors said, policy makers, healthcare providers and community organizations can develop targeted long-term services and supports.

For senior living providers, the demographic presents an opportunity to sell “peace of mind” regarding future care needs for solo agers currently living in the general community, according to Mather Institute Director of Research Jennifer L. Smith, PhD. 

“An advantage of moving into senior living for a solo ager is that there is a team of people available to handle things like maintenance, clearing, cooking, etc.,” Smith told McKnight’s Senior Living. “Life plan communities, which offer a continuum of care, can provide peace of mind that there’s a path for receiving additional levels of care if it’s needed — not to mention the wellness benefits senior living communities provide to solo agers by way of socialization and engagement through programming and interactions with neighbors and team members.”

According to the report, solo agers living in the greater community reported lower well-being, including lower life satisfaction and mental health, than their “supported” agers — older adults who are married or in a long-term relationship, do not live alone, and/or have adult children on whom they can rely.

Solo agers also expressed a wide range of concerns, but their most pressing concerns — maintaining mobility and independence — were similar to those of other older adults. Other concerns included maintaining dignity, mental engagement and social connections.

Senior living providers can use the report as a wakeup call to determine whether residents who are solo agers have any additional needs the community can help address, Smith said. Actions can include providing comfortable options for residents who may not always have a dining partner, or examining whether residents who became solo agers later in life due to the loss of a spouse and/or child are receiving the support they need.

When it comes to planning for the future, there are few differences in how solo and supported agers were preparing, except for plans related to identifying caregivers, according to the report. Fewer solo agers had identified future caregivers or planned to make those arrangements, potentially delaying decisions because they plan to age in place and don’t anticipate needing care.

Smith said that it’s important for solo agers to plan for their future housing needs, whether that involves modifications to their current homes or relocating to different residences.

The report includes strategies to support solo agers’ ability to age well, including maintaining and improving physical and psychological health to help delay the need for higher levels of care in the future, cultivating a strong social support network, and creating a plan for the future that includes financial and legal considerations, housing needs and support network.