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.

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.

The Joint Commission is planning to revise its infection prevention and control requirements for assisted living community accreditation as infection prevention and control regulations for the setting become more common at the state level.

The commission’s proposal focuses on the structures deemed essential to supporting quality and safety and outlines a framework for infection prevention and control programs. The suggested changes also more closely align with the the Centers for Disease Control and Prevention’s core infection prevention and control practices for safe healthcare delivery in all settings, according to the commission. 

A Joint Commission spokeswoman told McKnight’s Senior Living that the proposed revisions are a continuation of the wider infection prevention and control chapter rewrite initiative that spans all areas of accreditation.

“Broadly speaking, the goal of the IC [infection prevention and control] chapter rewrite is to align the IC standards and elements of performance more closely with law and regulation, eliminate the requirements that do not add value to surveys, and streamline the chapter,” the spokeswoman said. “The proposed revisions are currently in field review. Once approved, the revised IC chapter will replace current IC chapter requirements.”

Once the new requirements are implemented, commission-accredited assisted living communities will receive access to a new assessment tool that will outline the specific actions and processes they will need to take to meet them.

The Joint Commission is accepting comments on the proposal until Feb. 21 through an online survey.

The changes

Specifically, the changes cover assigning management responsibilities for infection prevention and control, including developing policies and procedures, coordinating competency-based training and risk management. They also require organizations to have written policies and procedures guiding infection prevention and control, including reporting duties to local and state public health authorities.

The Joint Commission also is deleting an existing performance improvement component of the accreditation program requiring assisted living organizations to provide incidence data to key stakeholders — leaders, licensed practitioners, nursing and staff members — about multidrug-resistant organisms, because it was determined to be out of scope.

The Joint Commission launched its assisted living community accreditation program in 2022 to bring “national, consensus-based standards” to the industry. Its standards address the environment, staffing, emergency management, dementia care, medication management, the provision of care and services, process improvement and more. The program also requires organizations to track and report on five standardized performance measures: off-label antipsychotic drug use, resident falls, resident preferences and goals of care, advanced care plans/surrogate decision-makers, and staff stability.

The Joint Commission also launched an assisted living community memory care certification program last year in collaboration with the Alzheimer’s Association, to promote consistent, high-quality dementia care in assisted living. 

Industry efforts

Indicative of the growing importance of infection control in assisted living, regulatory requirements related to infection control and emergency preparedness were an addition to the National Center for Assisted Living’s 2023 regulatory review report, released last week. The report noted that such regulations now are in place in a majority of states.

Industry groups devised their own guidance for infection control and prevention in 2023.

NCAL, Argentum, the American Seniors Housing Association and LeadingAge 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.

Other existing infection control efforts available to providers include the CDC’s Project Firstline training program for infection control and prevention, a certification for infection prevention and control professionals via the Certification Board of Infection Control and Epidemiology, and an infection prevention and control document produced by Argentum during the pandemic. Other than the Argentum document, however, most of those efforts are not focused on assisted living, and they are not strictly guidance.

And assisted living was an area where such focus was needed, according to a study published in December 2022 in JAMDA – The Journal of Post-Acute and Long-Term Care Medicine. That research found that infection control and preparedness in assisted living during the pandemic was hampered in part by limited clinical expertise and medical oversight of staff members and conflicting regulations and guidance for federal, state and local health agencies.

And in memory care settings, according to a study published in the June 2022 edition of the Journal of the American Geriatrics Society, a need existed “to bolster infection prevention capacity when caring for this especially vulnerable population.” 

Regarding overall quality, NCAL has its own National Quality Award Program, based on the Baldrige Performance Excellence Framework, that recognizes assisted living providers that meet certain goals.

NCAL also has a voluntary quality initiative for assisted living communities, with goals related to staff stability, customer satisfaction, hospital readmissions and the off-label use of antipsychotic medications.

The persistence of a pandemic-associated increase in antipsychotic, antidepressant and anticonvulsant medication use in assisted living residents — and a greater increase in antipsychotic use in dementia care settings — raises concerns about the risks for residents, say the authors of a study published in the January issue of JAMDA–The Journal of Post-Acute and Long-Term Care Medicine.

Prescriptions for antipsychotic medications in assisted living communities increased during the first two years of the COVID-19 pandemic, especially in residents living with dementia, according to the researchers. They examined the proportion of assisted living residents in Alberta, Canada, who were prescribed an antipsychotic, antidepressant, benzodiazepine, anticonvulsant or opioid medication between January 2018 and December 2021. 

Antipsychotic medication use prevalence increased to a larger degree than antidepressant use and was approximately 8% higher for memory care compared with other assisted living residents during the latter two pandemic waves — wave 3 (March to May 2021) and wave 4 (September to December 2021). Assisted living residents not living in memory care settings also showed a statistically significant but small increase in anticonvulsant use during the pandemic waves 2 (September to November 2020, and December 2020 to February 2021) through 4. 

For both assisted living and memory care residents, the pandemic was associated with a statistically significant decrease in benzodiazepine use and no significant change in opioid use, they found.

The study results revealed that the increase in antipsychotic use among assisted living residents in dementia care (3.5% to 7%) was larger than estimates previously reported for nursing home residents living with dementia (more than 1.7%). 

“The significantly greater increase in antipsychotic use among residents of dementia care was surprising given our hypothesis that the presence of specialized dementia care staff and environments might mitigate behavioral changes and antipsychotic use in this population,” the authors noted.

Lead author Colleen Maxwell, PhD, a professor in the University of Waterloo School of Pharmacy in Ontario, told McKnight’s Senior Living that she and colleagues believe that the substantial challenges and losses faced by assisted living communities and nursing homes during the pandemic partially explain the increase in use of the medications. Those challenges included staffing shortages, declines in services and comprehensive integrated care, loss of family caregivers, an increase in resident pain and mental health conditions due to pandemic-related restrictions, and difficulties in implementing nonpharmacologic interventions to address pain, sleep, mental health concerns and responsive behaviors among residents. 

The researchers also said that the increased use of antipsychotic medications in assisted living likely was “inappropriate.” Although they acknowledged that the mental health distress that assisted living residents likely experienced, as well as the lack of nonpharmacologic alternatives early in the pandemic, might have supported the short-term use of antidepressants and antipsychotics, their use remained elevated throughout the pandemic. 

“Prior to the pandemic, there is strong evidence that once started, these medications tend to persist beyond what might be considered an appropriate period of treatment, leading to an increased risk of polypharmacy / hyperpolypharmacy and medication-related adverse events,” Maxwell said. 

She added that when faced with public health crises, it is important that the senior living industry direct careful attention to implementing strategies for the appropriate oversight and administration of high-risk medications, particularly among at-risk residents and those living with dementia. 

A spokesperson from the American Health Care Association / National Center for Assisted Living told McKnight’s Senior Living that the groups have been active partners in a national effort to reduce the unnecessary use of antipsychotics in assisted living and skilled nursing and has made progress in the past decade, including focusing more on nonpharmacologic interventions.

“Along with prescribing physicians and family decision-makers, we must continue to educate ourselves about these conditions and the proper use of medications, as well as explore and promote innovative memory care techniques to help individuals with dementia thrive,” the spokesperson said.

A continuing challenge in assisted living

More than two-thirds of assisted living residents have dementia or cognitive impairment, and antipsychotics commonly are prescribed off-label for behaviors that include aggression, agitation, anxiety, delusions, hallucinations and sleeplessness, according to a 2023 study also published in JAMDA, by researchers from Brown University and the University of Michigan. 

In the early 2000s, studies showed that the off-label use of antipsychotic medications for older adults living with dementia was associated with a higher risk of early mortality, leading the US Food and Drug Administration to issue a “black box” warning on the use of the drugs in this population.

The Centers for Medicare & Medicaid Services, through the National Partnership for Quality Dementia Care, developed quality improvement efforts related to the use of antipsychotics in nursing homes. But evidence was lacking about antipsychotic medication use in assisted living / residential care facilities, staff training and use of nonpharmaceutical interventions and potential discrimination against older adults whose behaviors were deemed challenging, according to a study published in early 2023. 

Reducing the off-label use of antipsychotics in assisted living communities has been a goal of the senior living industry. One of the performance measures used by an assisted living community accreditation program launched in 2021 by The Joint Commission is medication management, specifically, off-label antipsychotic drug use. The National Center for Assisted Living’s Quality Initiative also lists antipsychotic medication use among its goals. 

It’s been a rough few months for the assisted living sector as lay media reports put a spotlight on the varying — or a lack of — regulations covering operators, a situation they said has led to tragic outcomes for some residents.

Georgia assisted living operators are the latest to come under scrutiny.

In 2019, the Atlanta Journal-Constitution published a series of stories critical of assisted living and Georgia’s enforcement of state regulations. In the wake of that series, the state Legislature adopted a reform package that increased fines and requirements for assisted living operators in the state. A recent follow-up story, however, alleged persistent shortcomings and a seemingly “unhurried approach” in the state’s oversight of assisted living and personal care facilities.

Industry advocates say that it is unfair to paint all providers with one brush, but they acknowledge that the attention is a reminder that “good policies and procedures, routine staff training, and oversight to ensure staff are following the policies are vital for providing great care.”

This latest media spotlight on senior living providers follows the New York Times / KFF “Dying Broke” series in November about the cost of assisted living and the Washington Post’s “Memory Inc.” story package in December focusing on resident elopements at assisted living and memory care communities. 

Telling assisted living’s story

In a message to members that was shared with McKnight’s Senior Living, LeadingAge Georgia President and CEO Ginny Helms said that the latest AJC article brought awareness to a serious problem in a large personal care home in Greensboro, GA, including the deaths of two residents and a sexual assault of another resident. But she added that she knows that member communities “demonstrate commitment to quality, person-centered care” daily, and she said she finds it unfortunate that those providers are “lumped in with communities cited for poor care.”

Helms shared several resources that members can use to create strong policies, including an upcoming webinar by the state’s quality improvement organization, Alliant Health Solutions, on an effective process for identifying the root causes of problems. 

And although LeadingAge Georgia has met with legislators and consumer advocates about their desire to tighten legislation and regulations due to media stories about poor care in some settings, Helms encouraged operators to invite lawmakers into their communities to “see for themselves the great quality of care our members provide.”

“Legislators and aging advocates are really focused on ensuring great care for older adults. Our members provide great care,” Helms wrote. “It’s important that the legislators and aging advocates come to your communities and see for themselves what great care looks like so that we can help influence policy rather than be dealt overly burdensome legislation and regulations.”

Balancing safety with resident wants

Any instance of poor care, neglect, abuse or exploitation is “unacceptable,” according to the Georgia Center for Assisted Living, the state affiliate of the National Center for Assisted Living. But GCAL Communications Director Devon Barill told McKnight’s Senior Living that assisted living provides “life-affirming care for elderly Georgians every day, and residents and families are consistently satisfied with the care they receive.”

“We regularly hear from happy and satisfied residents and their loved ones regarding their enriching assisted living experiences, and the vast majority of caregivers that work in assisted living do so because they have a passion for serving seniors,” Barill said. “We recognize there is more work to be done, and we continue to evaluate how we can advance the care provided in all of Georgia’s long-term care settings and foster a workforce that is well-trained, dedicated and passionate about the sacred mission of caring for our elderly.”

Balancing safety and security with resident and family wants, GCAL said it has worked to enhance assisted living in Georgia through member participation in the American Health Care Association / NCAL National Quality Award program. The association said it also regularly updates policy recommendations, provides education opportunities and has supported past state policies on developing administrator licensure and implementing criminal background checks for workers.

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.

A wrongful death lawsuit alleging failure to comply with COVID-19 protocols can move forward after a circuit court judge ruled that assisted living communities are not healthcare providers and therefore not entitled to immunity from such legal action.

In a decision issued last month, Judge Douglas L. Fleming Jr. of the Loudoun County (Virginia) Circuit Court denied a motion to dismiss a Jan. 19. 2021, complaint filed against Tribute at One Loudoun and parent company Cadence Living, according to Virginia Lawyers Weekly. Cadence combined with Cogir Senior Living in late 2022.

According to the complaint, Frances Hamilton moved into Ashburn, VA, senior living community in 2019 and died from complications from COVID-19 on Jan. 19, 2021. The complaint alleged that Hamilton contracted the virus at a Dec. 31, 2020, New Year’s Eve party at the community due to understaffing, substandard care and the community’s failure to follow COVID-19 protocols. 

The community moved to dismiss the complaint on the basis that an expert opinion was not obtained by the plaintiff before bringing the wrongful death lawsuit against a healthcare provider as required by Virginia law. The community also claimed emergency COVID-related immunity as a healthcare provider under the COVID-19 public health emergency. 

But in his Dec. 4 ruling, Fleming found that assisted living communities are not healthcare providers because they are not licensed as nursing homes or hospitals, nor do they employ licensed healthcare providers to “primarily” render healthcare services. The decision meant that an expert opinion was not required to bring the lawsuit, nor was Tribute at One Loudoun covered under the statutory immunity provided to healthcare providers under the COVID-19 public health emergency. 

Fleming denied the senior living community’s motion to dismiss the case in its entirety.

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

Cogir Senior Living told McKnight’s Senior Living it could not comment on ongoing matters.

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.

Wage growth has declined but remains elevated, according to a December report from Fitch Ratings. Wage inflation at continuing care retirement / life plan communities is higher than at assisted living communities, but favorable rate and occupancy growth are offsetting higher staffing expenses. Providers, the ratings agency said, will “continue focusing on efficiency and productivity efforts in 2024 considering the tight labor market and high cost of increasing headcount in the current environment.”

Good news as 2023 comes to a close is that senior living occupancy is on its way to 10 consecutive quarters of positive growth, according to a November report from NIC MAP Vision. The positive growth trend in senior living (independent living and assisted living) marks the longest period of uninterrupted gains since the National Investment Center for Seniors Housing & Care and NIC MAP Vision began reporting data in 2005.

Year-over-year inventory growth remained relatively modest compared with pre-pandemic times, but sustained supply-demand trends could drive senior living occupancy rates to return to pre-pandemic levels in 2024, according to NIC and NIC MAP Vision.

Some providers, such as Maplewood Senior Living, are seeing healthy occupancy across their portfolios. Westport, CT-based Maplewood recently reported that occupancy averages 95% across its senior living portfolio, with multiple communities currently at 100% occupancy. In August, Thrive Senior Living reported that three of its communities in Georgia had reached 100% occupancy, with one community at full capacity for the past 19 months. Pegasus Senior Living and Watercrest Senior Living Group were two other organizations reporting 100% occupancy news in 2023.

Here are some of the other major stories in senior living in 2023.

Federal regulation

Senior living provider groups in 2023 continued to work to maintain regulation of the industry primarily at the state level, with leaders from the National Center for Assisted Living and Argentum addressing the topic at various gatherings.

Provider groups, however, continued to advocate for passage of the federal Expanding Veterans’ Options for Long Term Care Act, which would establish a three-year pilot enabling some veterans to have their care needs met in assisted living communities rather than a Veterans Affairs home. The bill was reintroduced earlier this year after going nowhere last year. Its fate in 2023 appears to be the same, although at a House Committee on Veterans’ Affairs Subcommittee on Health hearing in June, the US Department of Veterans Affairs expressed support for the legislation — with conditions. 

Meanwhile, provider advocates said that a proposal that the Centers for Medicare & Medicaid Services says is meant to “support and stabilize the direct care workforce” in home- and community-based settings, if it becomes final, ultimately could lead to fewer jobs, stagnant pay for caregivers and a reduction in older adult access to home- and community-based services — the exact opposite of what the government intends.

The American Seniors Housing Association, Argentum, LeadingAge and the NCAL were among the more than 2,000 groups and individuals submitting comments to CMS on a rule it had proposed in April titled “Medicaid Program; Ensuring Access to Medicaid Services.” The proposed rule — with an overall goal of increasing access to HCBS — in part would require that providers spend at least 80% of Medicaid payments for personal care, homemaker and home health aide services on compensation for direct care workers as opposed to administrative overhead or profit. It also proposes quality measures, which some of the associations said have the potential to burden assisted living providers financially and administratively. A final rule has not been published.

2023 also saw CMS propose a minimum staffing mandate for nursing homes that provider groups say would affect assisted living communities because providers would be competing for nursing staff.

Federal agencies also proposed an overtime pay rule and issued a new definition for “joint employer.”

The proposed overtime rule, under which most salaried workers earning less than $1,059 per week, or about $55,000 per year, would be eligible for overtime pay, was introduced in August. The Labor Department said that 3.6 million salaried workers would be affected. Senior living industry representatives said that the proposal was “ill-timed” and would worsen workforce issues for providers, threatening access for residents.

Under the final joint employer rule, from the National Labor Relations Board in October, “an entity may be considered a joint employer of a group of employees if each entity has an employment relationship with the employees and they share or co-determine one or more of the employees’ essential terms and conditions of employment,” the NLRB said.

Long-term care providers that use temporary or contract workers, as well as operators that are part of franchises, are among those that could be affected.

The rule will have a “particularly negative impact on senior living arrangements,” the top Republican member of the Senate Special Committee on Aging and three other Republicans on the committee told NLRB Chairman Lauren McFerran in November.

The NLRB has extended the effective date of the rule by two months, to Feb. 26.

Crime and punishment

In December, the US Supreme Court declined to hear an appeal from former assisted living community and nursing home owner Philip Esformes, clearing the way for federal prosecutors to retry him on six charges in a case that the federal government once described as “the largest healthcare fraud scheme charged by the US Justice Department.”

It was the second time in 2023 that the high court denied appeals from Esformes. In April, Justice Clarence Thomas rejected an emergency appeal seeking to stay a decision from the 11th US Circuit Court of Appeals affirming his 2019 conviction on 20 charges.

Esformes was convicted on charges including conspiracy to defraud the United States, money laundering, paying and receiving kickbacks, bribery, wire fraud and obstruction of justice. The jury, however, did not reach a verdict on six counts.

Former President Donald Trump comminuted Esformes’ 20-year prison sentence in December 2020 but left intact the remaining parts of his sentence, including three years of supervised release, the payment of $5.5 million in restitution and the forfeiture of $38.7 million equivalent to property traced back to Esformes’ money laundering offenses.

In other news, Billy Chemirmir, convicted in 2022 for two murders and suspected in the deaths of more than 24 older adults in Texas, most of whom were women residents of senior living communities, was murdered in prison in September.

Mergers, acquisitions and affiliations

Several notable mergers, acquisitions and affiliations were announced in 2023. 

In early February, for instance, Newton, MA-based AlerisLife, parent of Five Star Senior Living, announced that it was being acquired for almost $44 million by a subsidiary of ABP Trust, where Adam D. Portnoy, a managing director of AlerisLife and chair of the company’s board of directors, was the sole trustee and controlling shareholder as well as an officer. The deal was finalized in March, at which time AlerisLife became a private company.

In October, Denver-based real estate investment trust Healthpeak Properties, with a portfolio that includes 15 continuing care retirement communities operated by Life Care Services or Sunrise Senior Living, announced plans to merge with Milwaukee-based Physicians Realty Trust in an all-stock deal valued at approximately $21 billion.

And as the year was drawing to a close, Roanoke, VA-based Retirement Unlimited Inc., announced that it was acquiring Mt. Laurel, NJ-based Brandywine Living’s senior living management platform, forming a combined company that will consist of 59 communities with more than 6,739 independent living, assisted living and memory care units.

Some other activity:

• The year started with Westerville, OH-based Ohio Living and Grand Rapids, MI-based Brio Living Services (formerly UMRC & Porter Hills) announcing that they were exploring a potential strategic affiliation aimed at expanding aging service offerings in the Great Lakes region by the end of the year.
• Westminster Communities of Florida in August announced an affiliation agreement with Florida Presbyterian Homes, a CCRC in Lakeland, FL.
• Also in August, California-based HumanGood and Pleasant Spring Communities, based in Massachusetts, announced plans to affiliate.
• Lancaster County, PA-based Garden Spot Communities and Montgomery County-based Frederick Living announced their planned affiliation in September, saying that the decision was driven by a belief that “the era of the single-site and small-system organization is coming to a close.”
• In October, CCRC Mease Life of Dunedin, FL, and Fort Washington, PA-based Acts Retirement-Life Communities announced the finalization of their affiliation after signing a letter of intent in April to explore the possible arrangement.
• Also in October, Louisville, CO-based Balfour Senior Living became an affiliate of Carlsbad, CA-based Kisco Senior Living.
• Minnesota providers Three Links and St. Francis Health Services of Morris were set to merge Nov. 1.

But just as newsworthy as the deals that were announced were the deals that fell through.

In July, for instance, the planned merger of the parent companies of two of the largest not-for-profit senior living and care organizations in the country was called off for good after being delayed several times. Sioux Falls, SD-based Sanford Health, which includes the Evangelical Lutheran Good Samaritan Society, discontinued the merger process with Minneapolis-based Fairview Health Services, which includes Ebenezer Senior Living, Minnesota’s largest senior living operator.

And in September, Diversified Healthcare Trust, with a portfolio that includes Five Star Senior Living-branded communities and properties operated by several other companies, and Office Properties Income Trust called off their planned merger. The deal had faced opposition from proxy advisory firms Egan-Jones, ISS and Glass Lewis as well as shareholders Flat Footed and hedge fund D.E. Shaw. Subsequently, as the Newton, MA-based REIT sought firmer financial footing, board changes and a new president and CEO, who will start Jan. 1, were announced.

More company news

Enlivant, with a motto of “Where senior living thrives,” did not thrive in 2023. An audit made public in February found “substantial doubt” about the company’s ability to continue as a “going concern,” affecting a 157-community joint venture with Sabra Health Care REIT and TPG Real Estate. In May, Enlivant announced the layoffs of 248 employees at its Chicago corporate support center. In July, the management of 11 other Enlivant communities owned by Sabra was moved to Inspirit Senior Living, with Sabra CEO Rick Matros saying later in the year that performance was “exceeding expectations.” In October came the news that Enlivant faced eviction from its corporate support center. The company ceased operations on Nov. 17.

The year had more positive news for Brookdale Senior Living, which in December reported its 25th consecutive month of year-over-year weighted average occupancy growth. 2023 also saw the country’s largest senior living company continue to roll out its value-based care coordination program for residents, after a pilot that CEO Cindy Baier said delivered “extremely promising” results.

Meanwhile, Westlake Village, CA-based real estate investment trust LTC Properties announced plans to sell approximately half of the 35 Brookdale Senior Living communities it owned and re-lease the other half after Brookdale opted not to renew its lease with the REIT. Ultimately, however, LTC Properties re-leased 17 of the 35 properties back to Brookdale under a new six-year master lease beginning Jan. 1, the REIT reported in October.

Irvine, CA-based memory care provider Silverado also had good news in late October, when a court dismissed all criminal charges leveled against it by the Los Angeles District Attorney’s Office related to 14 deaths that occurred early in the COVID-19 pandemic. “It’s a great day for the industry as a whole,” Silverado President, CEO and Chairman Loren Shook said at the time.

CVS Health, the parent of long-term care pharmacy Omnicare, in the first quarter recorded a $349 million loss on assets held for sale associated with the Omnicare business. In August, CVS said that it was laying off 5,000 employees but did not identify whether any of the layoffs would affect Omnicare, which CVS said in November 2022 that it planned to sell. In November 2023, however, the company said a sale wasn’t expected “in the near term.”

Newsweek launches CCRC rankings

Newsweek became the latest recognition program for senior living operators when in November, with global market research and consumer data firm Statista, it recognized 250 US continuing care retirement / life plan communities via the announcement of the first-ever “America’s Best Continuing Care Retirement Communities 2024” rankings.

Unlike the US News and World Report “Best Senior Living” results first published in 2022, the Newsweek / Statista effort focuses only on CCRCs, ranks them and includes feedback from surveys that were open to anyone choosing to participate who met certain criteria and were willing to provide demographic information and email addresses for data validation purposes. The US News program, by contrast, rates various types of communities — independent living, assisted living, memory care and CCRCs — as “best” if they meet certain criteria based on the results of consumer satisfaction surveys of residents and their families conducted at participating communities. The communities are not ranked.

Attention from the lay press

Late in the year, the senior living industry was the target of two packages of articles published by the national lay media, and industry advocates responded.

In December, the Washington Post published “Memory Inc.,” about assisted living and memory care community residents who had eloped and died. Since 2018, the authors said, “more than 2,000 people have wandered away from assisted-living and memory-care facilities unnoticed or been left unattended for hours outside,” and 98 had died. Read how the industry responded here.

Those articles came on the heels of a package of articles published in November 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. Read how the industry responded here.

Expect more scrutiny of the industry from the mainstream media as a “silver wave” of older adults thinks about moving into senior living in the coming years.

Stay on top of the news

McKnight’s Senior Living marked the 20th anniversary of its first print magazine issue in October and will continue the celebration in 2024. The magazine has been published every other month since February 2004, with digital and other aspects of the brand starting in 2015.

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