Heightened state regulation, dementia care support, the rise of active adult communities and the increased provision of home- and community-based services to Medicaid beneficiaries are among the top trends that will shape the senior living industry in the coming year, according to a panel of industry experts.
Health Dimensions Group, a management and consulting firm serving senior living and care providers, hosted a panel discussion Tuesday ahead of the release of a white paper on the top trends in aging services for 2024.
State regulation ‘ramping up’
In many states, assisted living has shifted from an apartment setting offering meals and minor assistance into a comprehensive care environment, according to HDG CEO Erin Shvetzoff Hennessey. With the increasing service and care needs of residents, however, comes an increase in state regulations for providers.
“Regulation is ramping up,” Hennessey said, adding that one-third of the states updated their assisted living requirements between 2020 and 2022, and some states are looking at assisted living the way they look at skilled nursing facilities.
“This puts a lot of pressure on providers to continue the lifestyle our assisted living residents desire — that dignity and freedom; we have to balance that with our regulatory requirements,” she said.
Among the strategies Hennessey recommended for addressing residents’ increased needs and resulting regulation in assisted living? Be proactive and conduct third-party mock surveys, implement new technology to monitor and respond to clinical needs, and identify the health-related requirements of residents and staffing levels required to meet them.
With the increasing number of people living with Alzheimer’s disease and related dementias, she added, some assisted living operators might consider specializing in providing memory care and services.
She suggested that providers evaluate the financial feasibility of using the Guiding an Improved Dementia Experience (GUIDE) Model initiated by the Center for Medicare & Medicaid Services to improve quality of life for residents living with dementia, reduce strain in their unpaid caregivers and enable individuals to remain in their senior living communities or homes.
The rise of active adult
On the other end of the spectrum is the active adult category, which was defined by the National Investment Center for Seniors Housing & Care in 2022. The definition, Hennessey said, triggered a turning point for the rental property type, moving it from a trend to a sustainable product.
The active adult community type, she said, represents an opportunity for operators to extend stays in the continuum of care while meeting consumer demand for communities that support an active lifestyle. A surge of development of active adult communities, she said, has been created by those already immersed in the model, senior housing providers eager to offer housing options earlier in the continuum and housing owners not traditionally associated with senior living. Some operators are repurposing existing housing and independent living units into active adult communities, she said.
“Significant changes in the later average age of entry and subsequent shorter length of stay [on other parts of the continuum] is driving the move to active adult for senior living providers,” Hennessey said, adding that operators need to tailor active adult environments to younger, more active individuals looking for social and physical engagement in a maintenance-free setting with resort-style amenities.
“I think consumer demand, mixed with developer, owner and industry interest, will combine to see a lot of growth in this space in 2024,” she said.
Medicaid HCBS increasing
The movement from care in institutional settings to HCBS settings, including assisted living communities, has been a trend over the past 20 years that escalated with the COVID-19 pandemic, according to panelist John Capasso, HDG executive adviser of senior care.
Several factors have converged to lead to the increase in HCBS, including increased Medicaid funding, decreases in labor availability, changing consumer preferences and increased Medicare Advantage plan use.
The American Rescue Plan Act of 2021 devoted $37 billion to states, which used the funding to transition care from institutions to the home. Many states also are implementing managed long-term services and supports, which aim to improve care coordination, enhance beneficiary choice and promote community integration through case management, personal care assistance and home health services.
In response to the shifting funding to HCBS, Capasso said, long-term care providers must educate themselves on the national and state level changes to HCBS funding and conduct demand and feasibility studies to understand how that shift in funding will affect occupancy. He also suggested that providers partner with Medicaid managed care programs to provide services.
“Take stock of the services you can provide, and approach a Medicaid managed care organization to see if you can contract with them for those services,” Capasso said.
HDG will release its white paper later this week.
