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.

The Department of Labor this morning issued a final rule that will change how senior living companies and other employers determine who is an employee and who is an independent contractor.

The rule is effective March 11.

“The misclassification of employees as independent contractors may deny workers minimum wage, overtime pay and other protections,” the Labor Department said in an online post. “This final rule will reduce the risk that employees are misclassified as independent contractors while providing a consistent approach for businesses that engage with individuals who are in business for themselves.”

The rule also ensures that “employers that comply with the law are not placed at a competitive disadvantage when competing against employers that misclassify employees,” the department said in an email. 

According to the DOL, the final rule:

• Restores the multifactor, totality-of-the-circumstances analysis to assess whether a worker is an employee or an independent contractor under the Fair Labor Standards Act. 
• Ensures that all factors are analyzed without assigning a predetermined weight to a particular factor or set of factors. 
• Uses the longstanding interpretation of the economic reality factors. Those factors include opportunity for profit or loss depending on managerial skill, investments by the worker and the potential employer, the degree of permanence of the work relationship, the nature and degree of control, the extent to which the work performed is an integral part of the potential employer’s business, and the worker’s skill and initiative.

The new rule also rescinds one issued during the final days of the Trump administration in January 2021. The Labor Department under the Biden administration had sought to delay the rule, and then withdrew it in May 2021, believing that it was inconsistent with the FLSA’s text and purpose. A district court, however, in March 2022 determined that the rule had taken effect on its original effective date and remained in effect.

That rule, Solicitor of Labor Seema Nanda said at the time, “legally risked increasing instead of reducing misclassifications because it narrowed the facts and basis for determining whether a worker is an employee under the FLSA” and was ”out of sync” with what the courts had been saying for decades.

In June 2022, the DOL announced plans to hold public forums to gather feedback on writing a new rule. A proposed rule was issued in October of that year.

Tuesday, the Labor Department said it had received “thousands of comments from a diverse array of stakeholders that helped inform the regulatory updates” during a comment period that was open through November 2022.

The rule issued Tuesday has not been published in the Federal Register yet but is available as a PDF. Read it here.

Editor’s note, Jan. 10: Read the follow-up story with industry reaction here.

Completion of changes to a 35-community Brookdale Senior Living portfolio owned by Westlake Village, CA-based LTC Properties has resulted in 17 communities being re-leased to Brentwood, TN-based Brookdale, eight communities being sold, the operation of five communities being transferred to Oxford Senior Living, and the operation of five other communities being transferred to Navion Senior Solutions.

The real estate investment trust, which announced the changes late Monday, said it expects net proceeds of $23 million and an anticipated net gain of $17 million related to the property sales.

“We are pleased to have reached a favorable outcome,” LTC Chairman and CEO Wendy Simpson said in a statement. “Importantly, rent from the previous portfolio has been fully replaced, and we’ve generated sales proceeds to pay down a portion of our debt, which was incurred to pre-fund accretive investments earlier this year.”

The transactions resulted in three new master leases. Revenue from the portfolio will be fully replaced through a combination of new leases, interest related to seller financing, and pre-invested proceeds at a weighted average yield of 8.5%, according to the REIT.

LTC’s portfolio still will contain Brookdale communities but said the moves reduce its revenue concentration from Brookdale by 40%. In April, LTC Chief Investment Officer and Co-President Clint Malin said that the REIT would “welcome the opportunity to reduce operator concentration.”

As of Sept. 30, LTC’s senior living and care portfolio included 29 operators and 208 properties. Of them, there were 42 ALG Senior communities, 35 Brookdale properties, 24 Prestige Healthcare communities, 13 HMG Healthcare properties, 12 Anthem Memory care communities, seven Ignite Medical Resorts properties, seven Ark Post-Acute Network facilities, six Genesis Healthcare properties, five Fundamental facilities, four Carespring Health Care Management properties, and 53 settings managed by other senior living and care operators, according to a presentation posted on LTC’s website.

The 17 communities that LTC re-leased to Brookdale are located across four states — Colorado (six), Texas (six), Kansas (four) and Ohio (one) — and have a total of 738 units. The new master lease, which was effective in January, has a duration of six years at an initial annual rent of $9.3 million.

On the REIT’s first-quarter 2023 earnings call, Malin said that the Brookdale properties that LTC planned to keep have “much higher” EBITDAR (earnings before interest, taxes, depreciation, amortization and restructuring or rent costs). Rate growth and occupancy trends in LTC’s Brookdale portfolio were similar to those that Brookdale has publicly disclosed for its overall portfolio, he added.

The eight communities that were sold are located across three states — Florida (four), South Carolina (three) and Oklahoma (one) — and have a total of 341 units. LTC said they were sold for $28 million, that REIT received $23.2 million in proceeds net of transaction costs and seller financing, and that it anticipates recording a gain of $17 million related to the sales. 

LTC provided financing to the seller, with two of the Florida properties, with a total of 92 units, serving as collateral. The $4 million seller-financed mortgage loan term is two years, with a one-year extension, at an interest rate of 8.75%.

As for the communities for which management was transferred to new operators, the five communities now operated by Oxford are located in Oklahoma and have a total of 184 units. Oxford already operated senior living communities in LTC’s portfolio.

The new master lease, which began in November, has a duration of three years, with one four-year extension, at an initial annual rent of $960,000.

The five communities now operated by Navion are located in North Carolina and have a total of 210 units. Navion did not previously have a relationship with LTC. The master lease, which began in January, has a six-year duration at an initial annual rent of $3.3 million.

In the first half of 2023, LTC Properties had announced plans to sell approximately half of the 35 Brookdale communities it owned and re-lease the other half after Brookdale opted not to renew its lease with the REIT. LTC reported in October, however, that it would be re-leasing 17 of the 35 properties back to Brookdale under a new six-year master lease beginning Jan. 1.

The exact fates of all 35 communities previously had not been announced.

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.

This Friday, Jan. 12, is the final nomination deadline for the 2024 McKnight’s Women of Distinction awards program. All submissions must be received by 11:59 p.m. ET.

Nominations for the Rising Star, Veteran VIP and Hall of Honor categories (described below) during this extended nomination period carry a $119 entry fee. Nominations for the Spirit award are being accepted at no charge.

The program, now in its sixth year, is coordinated by McKnight’s Senior Living, McKnight’s Long-Term Care News and McKnight’s Home Care. Nominations opened Nov. 7, and the standard nomination period ended Jan. 5.

Since the program began in 2019, 252 women in the fields of senior living, skilled nursing or home care have been honored across multiple award categories.

Eligible for recognition are women working as direct care providers, managers, executives, corporate executives and owners in independent living, assisted living, memory care and life plan communities, as well as those working in those capacities in skilled nursing facilities and in home care, home health, hospice and palliative care. 

Women who serve the fields indirectly — for instance as association staff members, academicians or thought leaders — also are eligible for recognition. Individuals working for vendor companies serving the industry are not eligible.

The nomination categories:

• Hall of Honor: Candidates should be senior-level professionals in the C-suite or at a level equivalent to vice president or higher and should have made a significant impact on their organization or the industry.
• Veteran VIP: Candidates should have more than 15 years of experience making an impact in long-term care and should be at a level lower than vice president or its equivalent. Whether as a community/facility administrator or executive director; or as a director of nursing, health/wellness or activities; or through some other position, they must have demonstrated an exceptional commitment to the senior living and care industry through their accomplishments.
• Rising Star: Candidates must be aged 40 or fewer years or have fewer than 15 years of experience in the profession. Also, they must have demonstrated an exceptional commitment to the senior living and care industry. Those achievements/accomplishments may include, for example, managing a project, developing a campaign or contributing to the field via research or thought leadership.
• Spirit Award: This award recognizes inspiring caregiving and service provision efforts. Eligibility is open to women who have demonstrated acts of bravery, courage, perseverance, dedication, determination — or other noble gestures.

Nominators for the Rising Star, Veteran VIP and Hall of Honor categories should be prepared to share detailed qualitative and quantitative information about nominees’ work histories, exceptional achievements and contributions or service, and anything else the judging panel should consider. Nominators for the Spirit Award should be prepared to detail the actions that qualify the potential honoree for the recognition. 

A Lifetime Achievement Award winner also will be named.

All honorees will be celebrated at an in-person event on Tuesday, May 14, in Chicago that also will recognize inductees from previous years. Some information about the event, which also will include educational sessions, is available now at mcknightswomenofdistinction.com. Additional details will be announced at a later date.

For more information about the awards, or to submit a nomination for them, visit mcknightswomenofdistinction.com.

Questions should be directed to Anna Naumoski, senior event manager for Haymarket Media, the parent company of McKnight’s, at anna.naumoski@haymarketmedia.com.

Read about previous award winners here. See lists of previous classes of honorees here and here.

Sponsors of the 2024 awards program include Curana Health, DirecTV for Business, Healthcare Services Group, PharMerica, Priority Life Care and ShiftKey.

The late George Chapman, along with Marilynn Duker and Robert G. Kramer, are the 2024 inductees into the Senior Living Hall of Fame, the American Seniors Housing Association announced Thursday.

ASHA awards the annual honor to recognize “visionaries who have distinguished themselves through uncommon foresight and ground-breaking innovation.” Inductees, the association said, “are industry leaders with an unwavering commitment to community lifestyles that enhance choice, independence, dignity and personalized service.”

ASHA President and CEO David Schless said: “We are very grateful to them and their commitment to senior living.” 

The honorees will be inducted in January at ASHA’s annual meeting in Aventura, FL. They will join 24 others previously inducted in 2018, 2019, 2020, 2021, 2022 and 2023.

George Chapman

Chapman spent 31 years investing and running companies in the senior living space, during which time, according to ASHA, “one constant, core principle” was “developing longstanding, mutually rewarding relationships built on loyalty, trust and spirited friendship.”

Chapman joined Toledo, OH-based Health Care REIT (now known as Welltower) in 1992 as executive vice president and general counsel, then became chairman and CEO in 1996 and added the title of president in 2009.

After Congress passed the RIDEA Act in 2007, which gave REITs the ability to share in the net operating income generated by their assets, Chapman quickly recognized how this would better align the interests of owners and operators, ASHA said, adding that Health Care REIT was the first to close a RIDEA transaction. 

Chapman retired from Health Care REIT in 2014 after having assembled a portfolio of senior living, skilled nursing and medical office properties with an enterprise value of more than $25 billion in the United States, Canada and the United Kingdom. After Welltower, Chapman founded ReNew REIT in 2018.

Chapman, who passed away in 2023, was a longtime board member of ASHA and a Chairman’s Circle supporter of the Seniors Housing PAC. Over the course of his career, he also served on the boards of Benchmark Senior Living, Sunrise Senior Living, OnShift, National Storage Affiliates and the National Association of Real Estate Investment Trusts, among other organizations.

He “had a profound impact on the senior living industry both as a pioneering investor and as a mentor to hundreds of next-generation leaders,” Schless said.

Marilynn Duker

Duker, Schless said, “helped create one of the industry’s finest organizations with a culture and a commitment to caring that has been recognized for excellence by consumers, team members, and investors alike.”

Duker joined Brightview Senior Living’s predecessor, The Shelter Group, a privately held real estate development and property management firm, in 1982. She was The Shelter Group’s second employee and has been involved in every phase of the company’s operations and growth.

By 1996, she and her business partner, Arnie Richman, were ready to capitalize on a new opportunity by branching out into senior living. Richman led the creation of Brightview, while Duker continued to lead the multifamily side of the business until becoming president of Brightview in 2007. She subsequently became CEO.

Brightview opened its first senior living community in 1999 and over the years has grown to 47 independent living, assisted living and memory care communities in eight states along the East Coast. She has been responsible for directing strategy, operations and long-term growth of the business. In 2022, she began transitioning to the role of co-chair.

Under Duker’s leadership, Brightview has been rewarded for impressive accomplishments. Recently, for instance:

• The company was the only senior living operator listed among employers on the Best Workplaces for Women lists in 2019 and 2022.
• Brightview topped the Best Workplaces in Aging Services list for large-sized companies in 2019, 2020, 2021 and 2022.
• 2022 was the company’s second consecutive year earning a spot on People’s Companies that Care list, and it was the only senior living company to make the list, as it had been in 2021.
• Brightview also was the only senior living company to land a spot on Fortune’s 100 Best Companies to Work For list, in both 2021 and 2023.

Duker serves on the Mercy Health Systems Board of Trustees and until October 2022 also served on the National Investment Center for Seniors Housing & Care’s Operator Advisory Board. She was recognized as the Loyola University of Maryland Sellinger School of Business Leader of the Year in 2019 and received the McKnight’s Women of Distinction Lifetime Achievement Award in 2023.

Before joining The Shelter Group/Brightview, she was a Presidential Intern at the US Department of Housing and Urban Development.

She is a graduate of The College of Wooster, Wooster, OH, and holds a master’s degree from the Massachusetts Institute of Technology, Cambridge.

Bob Kramer

Kramer, Schless said, “played an instrumental role in the creation of the National Investment Center for Seniors Housing & Care and their efforts to educate potential lenders and investors about the senior care continuum.”

His “commitment to advancing innovation for older adults in housing, community and healthcare,” ASHA said, can be traced to 1991, when he co-founded the organization, where he was president and CEO through 2017. Today, he continues to serve NIC as board member and strategic adviser. 

Under Kramer’s leadership, ASHA noted, NIC pioneered the development of data and analytics that the capital markets relied on as they turned their attention to the emerging senior living industry and powered its subsequent growth. 

Kramer also was instrumental in compiling and naming “The Forgotten Middle,” a landmark study funded by NIC and published by the journal Health Affairs in 2019. It examined the health and socioeconomic status of middle-income adults who will be 75 years old or older in 2029, their ability to afford private-pay senior housing, and potential solutions to meeting their needs.

According to ASHA, the mission of one of Kramer’s most recent endeavors, the Nexus Insights think tank, “neatly sums up his prolific, multi-faceted and highly influential role in senior living: Rethink aging from every angle.” He founded Nexus Insights in 2020, where he works with a network of senior living leaders to identify and track trends in aging as well as promote innovative models for services, housing and care for older adults. It is merging with the new Aging Innovation Collaborative of the Milken Institute’s Center for the Future of Aging thanks to $3 million in funding from NIC.

Kramer also received the inaugural McKnight’s Pinnacle Awards Career Achievement Award in 2023.

He also is a former county government official and Maryland state legislator. After graduating from Harvard University, he went on to Oxford University and earned a Master of Divinity degree from Westminster Theological Seminary.

This year’s inductees were chosen by the Senior Living Hall of Fame Selection Committee, which is led by former ASHA Chair Larry Cohen, CEO of Trustwell Living. Committee members include Lois Bowers, editor of McKnight’s Senior Living, and Steve Monroe, Tim Mullaney and Matt Valley.

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Senior living operators will continue to face inflationary pressures and capital market challenges in 2024, but some effects may lessen before the year is out, according to industry experts. Expect the workforce-related issues that have dogged providers for years to persist, however, they said.

“The elevated interest rates driven by the Federal Reserve efforts to bring down inflationary pressures had a profound impact on the sector in 2023,” National Investment Center for Seniors Housing & Care President and CEO Ray Braun told McKnight’s Senior Living.

Noting the “significant demographic wave on the horizon,” he said that the past year also saw record absorption of new senior housing inventory as it hit the market. “At the same time, we experienced a marked decline in new construction as well as transaction activity in 2023,” Braun said. “The lending environment and overall cost of capital has been prohibitive and has been a definite headwind.”

Capital still will be constrained early this year, he said, “but we are also hopeful that as the year progresses, we will start to see some improvement on this front.”

National Center for Assisted Living Executive Director LaShuan Bethea singled out inflation as the top issue faced by the industry over the past year.

“Inflation has caused soaring labor costs, in addition to other expenses, and made it difficult for assisted living providers to compete for caregivers,” she told McKnight’s Senior Living. “As a result, assisted living communities have been forced to use more contract nurses and staffing agencies, many of which are charging two or three times more than they charged prior to the pandemic.”

As 2024 dawns, Bethea said, the financial challenges will continue.

“Inflation makes all other expenses in assisted living more expensive, from food to cleaning supplies,” she said. “Additionally, the entire industry is still facing the ongoing ripple effects of skyrocketing costs from the pandemic.”

Assisted living providers, Bethea said, managed their COVID-19 response with little support from the government. According to some estimates, assisted living communities collectively received approximately $1 billion in relief funds, compared with the $12.5 billion received by nursing homes, despite the fact that assisted living providers serve about the same number of older adults and incurred more than $30 billion in pandemic losses and expenses.

“Federal and state policymakers provided little support to these communities in terms of personal protective equipment, testing and staff support,” she said. “Those COVID-related expenses continue today.”

Senior living providers, American Seniors Housing Association President and CEO David Schless said, continue to be confronted by “inflationary pressures across several key expense categories and a significant and rapid increase in interest rates.”

“Ultimately, the top challenge in 2023 was related to the capital markets and liquidity challenges,” he told McKnight’s Senior Living, adding that he expected those issues to continue this year.

“While inflationary pressures appear to be moderating somewhat, the interest rate environment and overall capital market environment for all real estate-based assets will likely remain challenging,” Schless said. “And we know there are many owners facing debt maturities in the upcoming year, which may prove to be extremely challenging with an ongoing liquidity crisis.”

NIC believes that the industry will reach an inflection point this year and that a “reset” will occur, Braun said.

“There will be some distressed inventory and underwater loans that the market is going to have to work through,” Braun said. “We think this reset is going to force a narrowing of the bid-ask spread and some reconciliation around equity contributions to stabilize outstanding debt.”

A ‘patchwork’ system

From a broader perspective, LeadingAge President and CEO Katie Smith Sloan told McKnight’s Senior Living, operators are challenged by “the shortcomings of our current patchwork system of delivering and financing long-term care.”

The association for nonprofit providers across the continuum of aging services is “doing all we can to raise up and urge policymakers and other stakeholders” to address the issue, she said.

“America is experiencing a massive demographic shift with implications for every aspect of society,” Sloan said. “Accessing quality long-term care is very often challenging, for many reasons. There is little political will to address these issues systemically, but policymakers are quick to criticize. Too often, aging services and providers are the scapegoat.”

Policymakers and members of the public must be educated about the industry as a whole as well as the differences between provider types, Sloan said.

“Ensuring that the public understands how long-term care is delivered and paid for — in a patchwork, inefficient system — and that the public appreciates the support that is needed, is critical,” she said. “And then advocating for long overdue change. We’re committed to doing everything we can to achieve that goal.”

Issues related to access and affordability also are on NIC’s radar screen, said Braun, who called them “an ongoing challenge for the sector.”

“NIC has been committed to defining and finding solutions for the middle-market consumer segment, and this work is more important than ever,” he said. “We need to be creative in finding solutions and models that are scalable and will bring forth greater access and options for the wave of baby boomers ahead.”

NIC funded a 2019 study by NORC at the University of Chicago that found that 54% of the 14.4 million middle-income older adults in 2029 in the United States will lack the financial resources to pay for senior housing and care, and a combination of public and private efforts will be needed to address the looming crisis.

More recently, Braun noted, NIC provided funding for the Housing for America’s Older Adults 2023 report, prepared by the Joint Center for Housing Studies of Harvard University. According to findings shared in that report, 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.

NIC also has partnered with CVS Health to support a soon-to-be released report from the Milken Institute, “Innovative Financing and Care Models to Scale Affordable Housing Solutions for Middle Income Older Adults,” Braun added.

Intertwined with staffing issues

Access and affordability issues are intertwined with senior living’s perennial challenges related to staffing, Braun indicated.

“​​Staffing-related expenses continue to pressure margins, and there is sensitivity to how much of this expense can be passed along to the consumer,” he said, noting that in the first quarter of 2023, the percentage of assisted living rent increases surpassed the percentage of wage escalation.

“We went several years where wage increases consistently exceeded rent increases,” Braun said. “This is an ongoing challenge for operators, who need to ‘read the tea leaves’ and determine how far they can go in rent increases to cover some of these expenses without pricing themselves out of the market.”

Sloan cited labor issues — specifically, recruiting and retaining workers — as the top challenge that has faced senior living owners and operators over the past year. And those issues affect access, she said.

“These challenges are particularly acute in senior living communities that provide skilled nursing and home healthcare,” such as continuing care retirement / life plan communities or assisted living communities where home- and community-based services are provided, she said. “Insufficient reimbursement rates, coupled with a highly competitive labor market, make for a very tough operating environment. Members are having to make hard choices — which service lines to continue, what to reduce — in order to maintain operations. That prospect of limiting older adults and families’ access to much-needed care is really antithetical to our members’ mission. Yet without staff, there is no care.”

NCAL’s Bethea noted that assisted living providers and those they could serve are feeling the pain as well.

“While the assisted living workforce has recovered in many areas, workforce shortages still remain a top challenge, especially in rural areas,” she said. “ Rural areas do not have as many people in general, let alone the qualified caregivers needed to support the communities’ seniors. As a result, assisted living providers are having to compete with other healthcare sectors for new hires or make the tough decision to limit admissions.”

Limiting move-ins, Bethea said, “leaves vulnerable residents displaced from their long-standing communities, as well as reduces their options for quality care. …Families are left scrambling to find new care options and often must travel farther to visit their loved one.”

NCAL, she added, is working with its state affiliates and individual providers to try to find solutions to address workforce challenges so that older adults’ access to assisted living is protected.

Mandate effects outside of nursing homes

Both Sloan and Bethea cited the federal government’s proposed minimum staffing mandate for nursing homes as a potential challenge for other types of providers along the long-term care continuum.

“There’s a bit of irony here. I’ve spent my career in this sector and finally — a true first in a long time — the federal government is focused on aging services and older adults’ access to quality care,” Sloan said. “But the Biden administration is not making the right choices.”

At LeadingAge’s annual meeting in November, Sloan said that even though the staffing mandate proposed by the Centers for Medicare & Medicaid Services directly would apply only to nursing homes, senior living and other providers would be affected because they are “fishing from the same pool” of workers and “there are just not enough people to hire.”

In December, she told McKnight’s Senior Living that “decisions are being made that will have far-reaching impact and potentially negative unintended consequences.”

Bethea predicted that the proposed mandate will be senior living’s top challenge this year.

“With the impending Biden administration’s staffing mandate for nursing homes, assisted living communities are at risk of losing staff,” she said. “No matter where an assisted living community sits on this continuum, a federal minimum staffing mandate threatens to take away the essential staff on which these communities depend to provide high-quality care for millions of residents.”

And because labor shortages can lead operators to curtail admissions, Bethea said, another top challenge for the industry will be to rebuild the capacity to accept new residents.

“As [the] workforce slowly recovers, assisted living providers must do everything they can to effectively communicate that they are willing and able to accept new residents,” she said. 

ASHA continues to pursue a variety of legislative solutions to workforce challenges, including immigration reform, Schless said. “Of course, the politics of immigration reform are extremely challenging,” he added, noting that, with 2024 being an election year, “getting any significant legislation enacted is unlikely,” although “ASHA will continue to look for any opportunities that may add new foreign workers to the workforce.”

Although the situation has improved from the previous two to three years, Braun said, labor issues continue to be a “pressure point” for operators.

“We have seen year-over-year wage increases come down from record highs, and a number of operators are reporting reduced agency dependency, but the challenges have not gone away,” he said.

Operators, Braun said, “need to be better about reducing turnover and ultimately improving the experience of our workforce, which in the end will pay dividends.”

Workforce issues also are a primary concern for affordable senior housing providers, Sloan said.

“Congressionally appropriated funds are critical to both meet rising demand for homes and support the programs for service coordinators, whose work helps residents to age in place,” she said. “Research — and the experience of our nonprofit members who provide federally assisted homes to seniors with low-incomes — show that residents are better able to age in community with improved health and overall well-being thanks to service coordinators’ work, yet for the past  decade, these programs hadn’t received support, until only recently.”

In December, the US Department of Housing and Urban Development released $40 million in new funding for service coordination programs in affordable senior housing. LeadingAge said it was the first service coordinator funding opportunity in 10 years.

A 2015 study by LeadingAge and the Lewin Group found that the availability of an on-site service coordinator, such as a social worker, at federally subsidized seniors housing reduced hospital admissions among residents by 18%. More recent studies found that service coordinators improved affordable senior housing resident resilience during the COVID-19 pandemic.

But “even with recent support, there are still significant unmet needs,” Sloan said.

Looking to the future

Looking toward the future, Braun said that the industry is “going to have to refine the owner-operator relationship in some cases.”

“We remain a fragmented space with many different owners and operators, and those relationships can be complicated depending on experience in the sector and generally a limited set of industry standards for measuring and defining quality,” he continued. “NIC is working with some others on this very topic. We think it will be critical to advance the sector in this regard as we prepare for the wave of new development that will come once the capital starts to free up.”

Look for the topics to be covered in educational sessions, forums and networking opportunities at the 2024 NIC Spring Conference, Braun said.

Meanwhile, Sloan said that LeadingAge members “are laser-focused on reimagining themselves for the future.”

“We know that the majority of Americans want to age in community, in their homes. That’s an opportunity for providers across the spectrum,” she said. “The big question for our members is determining the path that is consistent with their mission and sets them up to be successful well into the future. It’s really about making the smart and strategic choices and executing on them while at the same time navigating workforce shortages and other pressing issues.”

To educate potential residents and their families about senior living options, Schless said, ASHA will be re-launching a “completely overhauled” version of its consumer website, Where You Live Matters, this year.

Bethea said that quality will remain a top focus for NCAL and its members in 2024.

“Assisted living continues to deliver high-quality care in a safe, homelike setting that offers the ability to meet residents’ needs,” she added. “The only thing the current labor shortage has impacted is access to care, not quality. The caregivers in our assisted living communities are dedicated individuals who are committed to continuous quality improvement.”

Sixty-six percent of respondents to a newly released survey said they expect rental rate increases of 3% to 7% over the next 12 months for active adult, independent living, assisted living and memory care communities.

Participants in the 13th edition of CBRE’s Senior Housing & Care Investor Survey primarily were private or institutional investors, brokers or developers. The survey was conducted in October, and results were released in December.

No respondents said they anticipate rent decreases for any long-term care asset class.

The highest percentage of participants said they expected senior living and care rate increases of 3% to 7% over the next 12 months, with 72% of respondents in this group predicting such increases at continuing care retirement / life plan communities, 63.3% anticipating them at active adult communities, 61.3% expecting them at independent living communities, 56.3% predicting them at assisted living communities and 53.1% anticipating them at memory care communities. By comparison, 47.8% in this group said they expect such increases at SNFs.

Of those who said they expect rent growth greater than 7%, 28.1% predicted that it will occur in assisted living, 25% anticipated that it will happen in memory care, 19.4% said that it will take place in independent living, 13.3% predicted that it will occur in active adult, and 4% anticipated that it will happen at CCRCs. By comparison, no respondents said that rent growth of this level will take place in skilled nursing.

Of those who said they expect rent growth of 1% to 3% over the next 12 months, 20% said they expect it in active adult, 16.1% said they predict it for independent living, 15.6% said they anticipate it for memory care and 12.5% said they expect it in assisted living. By comparison, 43.5% said they anticipate rate increases of this level for SNFs.

Some respondents predicted no change in rates for CCRCs (12%), memory care communities (6.3%), active adult communities (3.3%), independent living communities (3.2%) and assisted living communities (3.1%). By comparison 12% of respondents predicted no rate increase for nursing homes.

The full report is available here.

Nominations for the Rising Star, Veteran VIP and Hall of Honor categories (described below) that are submitted by that date will have an $89 entry fee. Nominations submitted Saturday, Jan. 6, to Tuesday, Jan. 9, the final deadline, will carry a $119 entry fee.

The program, now in its sixth year, is coordinated by McKnight’s Senior Living, McKnight’s Long-Term Care News and McKnight’s Home Care. Nominations opened Nov. 7.

Since the program began in 2019, 252 women in the fields of senior living, skilled nursing or home care have been honored across multiple award categories.

Eligible for recognition are women working as direct care providers, managers, executives, corporate executives and owners in independent living, assisted living, memory care and life plan communities, as well as those working in those capacities in skilled nursing facilities and in home care, home health, hospice and palliative care. 

Women who serve the fields indirectly — for instance as association staff members, academicians or thought leaders — also are eligible for recognition. Individuals working for vendor companies serving the industry are not eligible.

The nomination categories:

• Hall of Honor: Candidates should be senior-level professionals in the C-suite or at a level equivalent to vice president or higher and should have made a significant impact on their organization or the industry.
• Veteran VIP: Candidates should have more than 15 years of experience making an impact in long-term care and should be at a level lower than vice president or its equivalent. Whether as a community/facility administrator or executive director; or as a director of nursing, health/wellness or activities; or through some other position, they must have demonstrated an exceptional commitment to the senior living and care industry through their accomplishments.
• Rising Star: Candidates must be aged 40 or fewer years or have fewer than 15 years of experience in the profession. Also, they must have demonstrated an exceptional commitment to the senior living and care industry. Those achievements/accomplishments may include, for example, managing a project, developing a campaign or contributing to the field via research or thought leadership.
• Spirit Award: This award recognizes inspiring caregiving and service provision efforts. Eligibility is open to women who have demonstrated acts of bravery, courage, perseverance, dedication, determination — or other noble gestures.

Nominators for the Rising Star, Veteran VIP and Hall of Honor categories should be prepared to share detailed qualitative and quantitative information about nominees’ work histories, exceptional achievements and contributions or service, and anything else the judging panel should consider.

Nominators for the Spirit Award should be prepared to detail the actions that qualify the potential honoree for the recognition. Nominations for the Spirit Award will be accepted at no charge.

A Lifetime Achievement Award winner also will be named.

All honorees will be celebrated at an in-person event on Tuesday, May 14, in Chicago that also will recognize inductees from previous years. Some information about the event, which also will include educational sessions, is available now at mcknightswomenofdistinction.com. Additional details will be announced at a later date.

For more information about the awards, or to submit a nomination for them, visit mcknightswomenofdistinction.com.

Questions should be directed to Amanda Hassler, director of events for Haymarket Media, the parent company of McKnight’s, at amanda.hassler@haymarketmedia.com.

Read about previous award winners here. See lists of previous classes of honorees here and here.

Sponsors of the 2024 McKnight’s Women of Distinction Awards and Forum program include Curana Health, DirecTV for Business, Healthcare Services Group, PharMerica and Priority Life Care.

• 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.