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

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

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

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

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

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

Recommendations

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

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

DEIB trends

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

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

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

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

Other findings:

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

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

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

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.

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.”

Senior living industry leaders stressed their belief in the importance of quality, safety and accountability Sunday in response to a package of articles in the Washington Post titled “Memory Inc.,” about assisted living and memory care community residents who had eloped and died. Many communities are “dangerously understaffed,” an article in the report alleged.

“Since 2018, more than 2,000 people have wandered away from assisted-living and memory-care facilities unnoticed or been left unattended for hours outside,” according to another article in the report, published Sunday, which counted 98 deaths among whom the authors described as “walkaways.” The writers said that their calculations were based on an “exhaustive search of inspection results, incident reports and media accounts nationwide” but that because they were unable to obtain records in all states, “the data … is certainly an undercount.”

“The bulk of the official records came from 29 states that make current reports public online. Two additional states said they had no incidents; 10 did not provide records nor do they make them available online; some provided only partial records,” they wrote. The article detailed several instances of residents wandering outside and subsequently dying after spending too much time in excessive cold or hot temperatures or under other circumstances.

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

‘Nothing more important than safety’

Argentum President and CEO James Balda told McKnight’s Senior Living: “Nothing is more important than our residents’ safety, and any fatality is one too many. Any community in which an incident occurs is subject to appropriate state regulatory penalties, up to, and including, loss of license.”

Argentum was one of the major national associations that advocates on behalf of providers and was quoted or mentioned in the report. The National Center for Assisted Living, the American Seniors Housing Association and LeadingAge also were included.

“To be clear, LeadingAge has no tolerance for bad care, and quality is a top priority for our nonprofit, mission-driven members,” LeadingAge President and CEO Katie Smith Sloan told McKnight’s Senior Living.

Older adults and their families, she added, “deserve a strong national aging services system that supports and sustains providers of high-quality assisted living, including adequate and well-trained staff,” and elected officials and other stakeholders should “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.”

The report shared factors known by those active in the field — that assisted living mainly is regulated at the state level, that care and services primarily are paid for via residents’ private funds, that retaining staff members remains a challenge and that pay for aides averages “less than most Starbucks baristas.”

It also maintained that, in elopement cases, “[f]acilities and senior managers largely have not faced serious consequences,” that “regulatory fines seldom exceed $10,000,” and that “[t]he biggest financial risk facilities face usually comes from lawsuits,” which are “typically covered by operators’ insurance.”

‘Multiple efforts’ related to quality

State oversight of the industry “is often weak in several areas,” the authors wrote. For instance, they said, their analysis found that only 13 states mandate a minimum number of on-duty caregivers per resident, that only nine states require caregivers to obtain at least six hours of training about caring for residents living with dementia, and that information about violations is incomplete or not available to the public online in 21 states. Overall training requirements, the authors added, vary from five to 90 hours across states where an amount is specified, although many states mandate training but do not specify an amount.

“Our association has participated in multiple efforts to build sector consensus on assisted living quality measures and other topics,” Sloan said. “Our engagement in those, as well as our advocacy, educational and research efforts to improve care throughout  aging services, are ongoing and, given the stresses of our country’s current approach to long-term care financing, increasingly urgent.”

In one effort this year, 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. Infection prevention and control was the initial focus of the effort, called the Quality in Assisted Living Collaborative. The work “will help the sector collaboratively address the most urgent issues,” Sloan predicted at the time, and Balda said that the initiative ultimately could lead to greater consistency across the states.

“Assisted living will continue to evolve with our country’s changing needs. Regulations, staffing needs and training requirements must evolve with them,” Sloan said Sunday.

In a statement to McKnight’s Senior Living on Monday, NCAL said: “The assisted living profession remains steadfast in constantly improving and adapting to meet the needs of their residents, including those living with dementia. We will continue to seek out opportunities to work with policymakers and stakeholders to advance high-quality, personalized assisted living care.” 

‘Overwhelmingly popular’

Balda pointed out Sunday that “[a]ssisted living and memory care communities are overwhelmingly popular with residents and their families. Our communities offer choice and dignity to 1.4 million seniors each day, and surveys find that 94% of residents report good or great satisfaction, and 91% say they feel safer than living on their own.”

In a recent J.D. Power satisfaction study, he added, assisted living and memory care communities were found to be “overwhelmingly popular with residents and their families,” scoring 837 on a 1,000-point scale.

“Professionally managed communities have security procedures such as exit/entry logs, wearable tracking devices, and cameras in place to keep residents safe, and unless an independent physician has deemed them a risk for their own safety, they are free to come and go from their home as they choose,” Balda said.

The association, he added, has “serious concerns about the validity of the Post’s data,” but “even taking it at face value, fatalities due to wandering are 0.0015% of the more than 6.2 million assisted living residents served in the last five years.”

In its statement, NCAL said that the stories in the Post report were “tragic,” and the association expressed condolences to those affected. “However, these rare incidents are not indicative of the life-affirming experience that 99.9% of assisted living residents typically receive,” NCAL said. “Caregivers make the safety and well-being of every resident their utmost priority, and their passion for serving seniors is evident through the high levels of satisfaction that residents and their family members report each year.”

ASHA President and CEO David Schless told McKnight’s Senior Living that the association had not yet issued a statement on the Post’s report.

On Monday, Argentum posted on its website additional information about its reaction to the series as well as links to all of the Washington Post articles.

REITs a focus as well

Senior living organizations were not the only focus of the report. Another article in the story package concentrated on real estate investment trusts, especially Toledo, OH-based Welltower, which, according to the 2023 ASHA 50 list, is the largest owner of senior living properties.

Many assisted living communities, the Washington Post authors wrote, “are now held by investors under pressure to produce profits for shareholders. In some places, a bare-bones approach to staffing and pay has produced a chaotic environment where medications are missed, falls and bed sores go unnoticed, residents are abused and confused seniors wander away undetected.”

One former Balfour Senior Living executive, who was not named in the report, told the media outlet that Welltower, which owned the operator’s buildings, would not let the company give raises “to hire and train more and better workers to improve safety” because it was concerned about the potential effect on profitability.

A Welltower company spokesperson told McKnight’s Senior Living that “[c]ontrary to the allegations … Welltower did not oppose wage increases for Balfour employees at the property in question.”

The Washington Post report, the spokesperson said, “contains numerous inaccuracies, hearsay from anonymous sources and demonstrates a general lack of understanding of the industry.”

The Welltower spokesperson said that the REIT “has continuously supported the investment by its operators in human capital and did so throughout the pandemic and the extreme staffing crisis that the world was navigating. In fact, since 2019, compensation expense per resident has increased over 23% across the Welltower portfolio with compensation at the Balfour properties increasing by a comparable amount.”

The REIT also “is innovating and investing in technology and tools to improve the resident and employee experience,” according to the spokesperson.

“We operate in the competitive private-pay seniors housing market,” the spokesperson said. “Ensuring that our operating partners are able to provide residents with high-quality care and a fulfilling experience are the key factors that result in residents choosing to move into our properties, in turn driving our long-term success.”

A source close to the Washington Post reporting told McKnight’s Senior Living that “well before publication,” the REIT was sent Welltower-related details that were planned for the article and that spokespeople for the REIT “repeatedly” declined to provide a comment. Additionally, the source noted that the article reported that Balfour and Kisco representatives did not respond to “numerous” requests for comment and that a Lavender Farms manager declined to answer questions from a reporter from the media outlet who visited the site.

A Washington Post spokesperson told McKnight’s Senior Living that the publication stands by its reporting.

Another report

The Washington Post articles come 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.

The package also had cited the growth of rate increases, the for-profit status of most providers, and the operating margins they see. And it reported the results of a survey that in part found that 66% of Americans aged 50 or more years are “mostly” or “somewhat” anxious about being able to afford the cost of an assisted living community or nursing home if they need to move to one.

In response, association leaders submitted letters to the editor to the New York Times.

The Washington Post’s “Memory Inc.” package of articles:

Dozens of assisted-living residents died after wandering away unnoticed

Senior homes left dangerously understaffed amid assisted-living boom

How your state regulates assisted-living facilities

Questions to ask before choosing an assisted living facility

Facilities where seniors died after walking away or being left unattended

A coalition of senior living, healthcare and veterans organizations collectively provided their continued support in a letter sent Thursday to House and Senate leadership for an assisted living pilot program geared toward serving veterans.

The American Seniors Housing Association, Argentum, LeadingAge and the National Center for Assisted Living signed a letter advocating for the Expanding Veterans’ Options for Long Term Care Act. The bill would establish a three-year pilot enabling some veterans to have their care needs met in an assisted living community rather than a Veterans Affairs home.

The associations previously voiced their support for the bill, which was reintroduced earlier this year after going nowhere last year. The House Committee on Veterans’ Affairs Subcommittee on Health held a hearing this summer on the bill, which received the support of the US Department of Veterans Affairs — with conditions. 

The VA indicated that having the authority to provide assisted living services would help the agency find a place veterans who need such services but don’t qualify for nursing home care. But a VA representative testified that the agency would need more time and resources to implement the program. 

In its letter to House and Senate leadership as well as Veternas’s Affairs Committee leaders, the coalition called the proposed pilot program an “economically sound and sensible approach to demonstrate the benefits” of assisted living, and that the bill gives the VA the authority to offer additional options in its long-term care programs.

“It provides VA the critical flexibility to address the needs of a rapidly growing population of aging or disabled veterans who are not able to live at home, and future cost savings will help more veterans receive the assistance they need,” the letter read. “The timing is right for such action given what we know about aging and the increasing demand for supportive services.”

Pointing to statistics from a 2020 VA report, the authors noted that the number of veterans eligible for nursing home care will increase 535% over the next 20 years. The letter also noted that costs to the VA for nursing home care alone are not sustainable and that assisted living offers “significant cost savings” for those who don’t require a high level of medical care.

Additional signers of the letter were the AARP, the Alzheimer’s Association and the Alzheimer’s Impact Movement, DAV, Iraq and Afghanistan Veterans of America, the National Association of State Veterans Homes, the National Rural Health Association and Paralyzed Veterans of America.

Financial support from the federal government and private lenders would be required to lower assisted living rates, National Center for Assisted Living Executive Director LaShuan Bethea told the New York Times and KFF for an article posted Monday on the KFF Health news website.

The piece in which Bethea was quoted, titled “Extra Fees Drive Assisted Living Profits,” is part of a KFF-Times project entitled “Dying Broke.” In part, the article 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.

“Assisted living providers are ready and willing to provide more affordable options, especially for a growing elderly population,” Bethea told the media outlets. “But we need the support of policymakers and other industries.” Offering affordable assisted living, she added, “requires an entirely different business model.”

The article also referenced a 2022 survey by KFF, published Nov. 14, that found that 83% of adults said it would be “impossible” (37%) or “very difficult” (46%) to pay $60,000 a year to live in an assisted living community or get help with ADLs at home (14% said it would be “not very difficult,” and 3% said it would be “not a problem at all”).

The article also cited the growth of rate increases, the for-profit status of most providers, and the operating margins they see. Several provider organizations and real estate investment trusts were named.

“For residents, the median annual price of assisted living has increased 31% faster than inflation, nearly doubling from 2004 to 2021, to $54,000, according to surveys by the insurance firm Genworth,” wrote the article’s authors, who also noted that 80% of the 31,000 assisted living communities nationwide are operated by for-profit organizations.

American Seniors Housing Association President and CEO David Schless told the media outlets that the median operating margin for assisted living communities in 2021 was 23% for communities offering memory care and 20% for communities not offering it.

Providers and shareholders aren’t necessarily just pocketing profits, Bethea said.

Operators can invest returns back into communities’ services, technology and updates to buildings, she pointed out, adding that their doing so contributes to the industry’s “high customer satisfaction rates.”

Beth Burnham Mace, special adviser to the National Investment Center for Seniors Housing & Care, also made the point that a la carte pricing promotes choice and allows residents to pay for what they “actually desire and need.”

Issues beyond provider charges also are in play, the article shared.

The market for long-term care insurance, which individuals could purchase to help them pay to live in assisted living, “has virtually collapsed,” the authors noted, and most assisted living residents pay using private funds. Eighteen percent of residential care facilities do accept Medicaid payments, they said, citing data from the Centers for Disease Control and Prevention’s National Center for Health Statistics, although “a resident must be frail enough to qualify for a nursing home before Medicaid will cover the health care costs in an assisted living facility,” and 37 states have waiting lists.

Read the full article here. Read the survey results here. As part of the project, the media outlets also published a Q&A about assisted living for consumers.

A new overtime rule proposed by the federal government would worsen workforce issues for senior living providers and create unintended consequences for workers and residents, according to industry advocacy groups.

Most salaried workers earning less than $1,059 per week, or about $55,000 per year, would be eligible for overtime pay under the proposed rule. The Department of Labor estimates that 3.6 million more salaried workers would be newly eligible for overtime under the changed thresholds, and approximately 600,000 of them work in healthcare.

The rule would increase the standard salary level for eligibility to the 35th percentile of weekly earnings of full-time salaried workers in the lowest-wage census region (which was the South at the time of the rule’s proposal). Currently, employees earning up to $684 per week, or $35,568 per year, are eligible for overtime pay. The rule would

The Labor Department also is proposing to automatically update all of the earnings thresholds beginning three years after the overtime rule’s effective date and every three years thereafter, to reflect current earnings data. The proposed salary threshold represents an increase of almost 55% since 2019.

The rule also would restore overtime protections in US territories, where the overtime threshold applied from 2004 until 2019.

33,000+ comments received

The DOL’s Wage and Hour Division said it received more than 33,000 comments and as of Wednesday had posted almost 24,000 of them online. The deadline for commenting was Tuesday.

In a joint comment letter, Argentum President and CEO James Balda and American Seniors Housing Association President and CEO David Schless called the proposed rule “flawed” and urged the agency to withdraw it.

“The proposed rule constitutes bad policy at a time when employers and employees are adapting new and innovative approaches in staffing to meet these needs,” they wrote.

Specifically, their comments focused on the “unnecessary and harmful” layering of complexity on a workforce and workplace that already has imposed new demands on employers to offer new flexibility, higher wages and other accommodations. Balda and Schless also addressed what they described as the “flawed” methodology for determining the standard salary level for eligibility, urged removal of bonus caps to meet exempt status and include safe harbors of unintentional errors, and called for keeping the current salary threshold for “highly compensated” employees and for the withdraw the automatic indexing of the salary level test every three years.

“If enacted, these proposed rules would exacerbate the workforce crisis in senior living, increase costs and likely reduce access to assisted living at the same time that the population is aging at the fastest rate in more than a century,” Argentum Senior Vice President of Public Affairs Maggie Elehwany and ASHA Vice President of Government Affairs Jeanne McGlynn Delgado said in a joint statement. “We urge the Department of Labor to withdraw this proposed rule and work with stakeholders to develop solutions for overtime pay that more closely reflect current economic conditions, while also ensuring that senior living providers can continue to provide high-quality care to their residents.”

Argentum and ASHA said that during the pandemic, senior living operators faced substantial operating losses and increased care expenses exceeding $30 billion with minimal government relief. Providers also increased wages “significantly” for nonexempt employees and hired thousands of additional employees to meet residents’ needs, Balda and Schless said.

“The proposed rules would have a disproportionate and potentially devastating impact on the long-term care industry, which will need to attract more than 20 million workers by 2040 to keep pace with our rapidly aging population,” they said. Argentum previously calculated that of those 20 million workers, 3 million would be needed for senior living.

LeadingAge also submitted comments about the proposed rule, calling it “challenging to absorb” for providers.

“We are concerned that the impact of the Department of Labor’s proposed rule, if enacted unchanged, will add to the financial burdens of providers who are already navigating a lot of operational challenges, from inadequate reimbursements to cover the cost of care; a highly competitive labor market that drives up wages; and inflation-fueled rising prices for necessary goods,” LeadingAge Vice President of Legal Affairs Jon Lips told McKnight’s Senior Living. 

In submitted comments, Lips told the federal government that the proposed increases would  have significant effects on long-term care operators, especially those that heavily depend on reimbursements from public healthcare programs, which he said are insufficient. 

“Providers that are not able to absorb the full increased labor costs of the proposed rule will be required to make challenging decisions,” Lips wrote. “In some cases, a provider may have to reduce non-essential services and programming in some form, affecting the quality of life for those they serve, or, alternatively, choose to serve fewer individuals.”

Other unintended outcomes of the proposed rule, he said, could include increased costs for residents and added work burdens on exempt employees as employers reclassify some workers to hourly status.

In its comments, the American Health Care Association / National Center for Assisted Living asked that a final rule consider the challenges that providers face and to allow flexibilities.

AHCA/NCAL Associate Vice President of Constituency Services and Workforce Dana Ritchie raised concerns about the effects on operations at a time when long-term care is “being squeezed by inflation, wage increases rising interest rates” and, for skilled nursing facilities, the Centers for Medicare & Medicaid Services’ minimum staffing proposal. 

“While providers certainly understand what DOL is trying to accomplish here — and fully support appropriate overtime pay — there is concern on how many additional requirements the long-term care industry will be able to bear,” Ritchie wrote, adding that keeping up with the every-three-year update of the salary threshold would present additional challenges.

All of the association commenters said that if a final rule is adopted, there should be a transition period to enable employers to conduct analyses and make operational adjustments.

Cost? $664 million+ over 10 years

The Fair Labor Standards Act requires covered employers to pay minimum wage, and for employees who work more than 40 hours a week, overtime pay of at least 1.5 times the regular rate. Certain executive, administrative and professional employees are exempt, however.

Annualized direct employer costs over the first 10 years of the rule would total $664 million, according to a Labor Department estimate. But the proposed rule also gives employees higher earnings in the form of transfers of income from employers to employees, and the department estimates that those annualized transfers would total $1.3 billion.

In total, the Labor Department estimates that 3.4 million people earning $55,068 or less annually, and 248,999 “highly compensated” employees, would be eligible for overtime pay under the changes in the first year after implementation.

The new joint-employer standard released Thursday by the National Labor Relations Board will present greater risk for employers that contract with services providers, “creating greater liability for the actions of others,” according to senior living experts.

The NLRB said its new joint-employer standard reflects a “legally correct” return to common-law principles and a “practical approach” to ensuring employers respect their bargaining obligations. But senior living industry advocates said that the issue is complex and that the rule represents a “significant departure” from current law.

“This rule moves from a 2020 rule that set out a simplified determination of ‘joint employer’ status to one that significantly expands the standard, making it easier to establish an entity’s status as a joint employer,” Jeanne McGlynn Delgado, American Seniors Housing Association vice president of government affairs, told McKnight’s Senior Living. “This will present greater risk for any employer who contracts with services providers — such as staffing agencies or subcontractors — in terms of creating greater liability for the actions of others.”

Of particular concern, Delgado said, is the rule’s requirement that joint employers both must bargain with the union representing the joint employees and may be liable for unfair labor practices committed by the other employer. She added the rule also could serve to incentivize more union-organizing efforts.

Many long-term care providers routinely enter into contracts to provide services to residents, including temporary staffing contracts, therapy, food service and maintenance agreements, LeadingAge said, adding that providers also often share service agreements with hospitals or other providers sharing their campus. 

LeadingAge called the new standard “much broader and more vague” than the existing rule in its previous comments.

“Our concern with the new rule is that aging services organizations will face challenges in determining how to align existing business models and arrangements to this new standard, such as contracts with services providers, or to structure new arrangements, in a way that can reasonably be expected not to result in a joint-employer determination,” LeadingAge Vice President of Legal Affairs Jon Lips told McKnight’s Senior Living. 

“If actual control, reserved control — whether exercised or not — direct control and indirect control of one or more essential terms and conditions of employment may all be sufficient to establish status as a joint employer, it creates additional uncertainty compared to the existing rule, and with it the risk of expanded collective bargaining obligations and of liability for unfair labor practices committed by an organization’s business partners, with respect to that partner business’ own employees,” he added.

Senior living advocates had voiced their opposition to the proposed standard during the comment period.

Argentum signed on to comments from the Coalition for a Democratic Workplace, which recommended that the NLRB “start over or leave the current standard in place.” The coalition argued that the rule was “arbitrary and capricious, diverges from the common law, ignores federal law, congressional intent, and court precedent, and would undermine collective bargaining and destabilize labor relations.”

The new standard

Under the new standard — scheduled to be published in the Federal Register today — a joint employer is defined as an entity that shares one or more of an employee’s essential terms and conditions of employment related to compensation, work hours and schedules, duty assignment and supervision, work rules and discipline, employment tenure and working conditions.

The new rule rescinds the 2020 final rule, which the NLRB said made it easier for joint employers to avoid that status because it set a higher threshold for possessing or exercising substantial direct control over conditions of employment. The agency said the new rule provides extensive guidance on rights and responsibilities in situations where joint-employer status has been established.

“The board’s new joint-employer standard reflects both a legally correct return to common-law principles and a practical approach to ensuring that the entities effectively exercising control over workers’ critical terms of employment respect their bargaining obligations under the NLRA,” or National Labor Relations Act, Chairman Lauren McFerran said in a statement. 

The NLRB received more than 13,000 comments after publishing a notice of proposed rulemaking in the Federal Register on Sept. 6, 2022. The new rule goes into effect Dec. 26. 

Legal reaction 

Law firm Fisher Phillips said the “controversial” rule will result in increased union organizing and collecting bargaining efforts. 

In a blog post, firm attorneys said that instead of requiring actual direct control over essential terms of and conditions of employment, even potential retained (but unexercised) indirect control over working conditions could be deemed sufficient to label a business a joint employer for labor relations purposes.

Fisher Phillips recommends that employers review written service agreements and underling practices; review franchisor-franchisee arrangements; work with an attorney to evaluate service contacts and related documents for language reserve the right of control over workers; assess vulnerability to union-organizing efforts; train managers in best practices in dealing with third-party staff, franchisees and contractors; and create clear policies on the role of third-party vendors. 

Emily Harbison, a partner at law firm Reed Smith, told McKnight’s Senior Living that the new rule makes it much easier for a senior living provider to be deemed a joint employer of someone from a third-party staffing agency. 

That fact means senior living providers may have to bargain with a staffing agency-related union with respect to “any” terms and conditions of employment that it possesses the authority to control or exercise the power to control. Providers also potentially could be liable for unfair labor practices committed by the other employer and may be subject to union picketing or boycotts during labor disputes.

“While the new rule will likely be challenged, senior living providers who use staffing agencies or temp agencies — or otherwise obtain services from individuals who are not their direct employees — should consider their policies and practices around the exhaustive list of the seven key terms and conditions of employment that the new rule considers to determine the risk they may be deemed a joint employer,” Harbison said.

Broken promises about service and care levels, attributed to “grossly understaffed” at senior living communities and skilled nursing facilities, are the driving force behind a surge in class-action lawsuits against such providers, according to two legal experts.

The Long Term Care Community Coalition hosted a webinar Tuesday that included AARP Foundation Litigation, a charitable nonprofit arm of the AARP that focuses on civil rights cases, abuse and neglect in senior living communities and skilled nursing facilities. The group advocates for systemic change in federal and state courts to “change the circumstances that give rise to poor care,” AARP Foundation Litigation Vice President Kelly Bagby said.

Benjamin Davis, AARP Foundation Litigation senior attorney, said an issue arises when operators promise to provide a sufficient level of staffing but residents and their families mistakenly believe that that promise means that their loved ones will receive individualized care. The dynamics of senior living communities and skilled nursing facilities, he said, mean that staff members are devoted to all residents, not individuals.

The result, Davis said, is that providers make promises to attract residents but then don’t meet resident needs or effectively reassess residents to determine their changing needs.

Davis highlighted a current case against Chancellor Senior Management, a Columbus, OH-based organization that manages four assisted living communities in the state. The lawsuit alleges that Chancellor used a formula to determine the hours of care that each resident needed based on their individual conditions but only applied that formula for billing purposes, not to determine staffing levels. The lawsuit further alleges that staffing decisions are made at the corporate headquarters rather than at the community level.

The Supreme Court of Appeals of West Virginia opened the door for the case to move to a class action lawsuit, Davis said. The court also further declared that the provider’s arbitration agreements in resident admission contracts were unenforceable because they were part of a larger contract rather than a stand-alone agreement. The American Health Law Association requirements incorporated into those agreements call for them to be stand-alone agreements. 

Bagby referenced a federal class action case against Brookdale Senior Living filed in 2020. The lawsuit accuses the country’s largest senior living company, based in Brentwood, TN, of “chronically insufficient staffing” at its communities, allegedly to meet financial benchmarks. The lawsuit also accuses Brookdale of misleading residents and families and of failing to provide care and services.

“Our cases are about how to force companies to change their practices around adequate staffing,” Bagby said, adding that attorneys are focusing on violations of the consumer protection statutes that allow residents to recover damages for injuries when companies do not deliver on their promises. “In every assisted living and nursing facility, the residency agreement lays out those promises to residents,” she said.

Bagby said that it is critical for providers to be transparent about their practices and to not lie about their staffing levels. 

Class action staffing lawsuits not unprecedented

Class action lawsuits against senior living providers related to staffing levels are not a recent phenomenon.

In 2021, for example, Aegis Living of Bellevue, WA, settled two class action lawsuits for a combined $16.25 million. The lawsuits alleged that Aegis based staffing levels on predetermined staffing budgets rather than on resident care needs and in doing so violated elder abuse and consumer protection laws.

Similar legal action against other senior living companies also resulted in settlements.

For instance, the former Emeritus Corp., which merged with Brookdale in 2014, settled a class action lawsuit in 2016 for $13.5 million. The suit alleged that Emeritus misled assisted living residents about the use of a computerized system to evaluate residents and determine sufficient staffing and care levels. 

Atria Senior Living settled a similar lawsuit for $6.4 million that same year, and Oakmont Senior Living settled a class action lawsuit for $9 million earlier this year. A similar lawsuit against Sunrise Senior Living is pending.

Last fall, Argentum, the American Seniors Housing Association and the California Assisted Living Association filed an amicus brief in the Sunrise case, arguing that class actions are “unnecessary and counterproductive” because assisted living communities are highly motivated to provide quality care to residents. The brief also argued that the expense and disruption of defending class action suits diverts resources from care provision.

Brookdale Senior Living reported 23 consecutive months of year-over-year weighted average occupancy growth in an update released Monday.

According to the Brentwood, TN, senior living operator, the company’s September weighted average occupancy of 78.2% represented a 60 basis point increase sequentially over August’s occupancy of 77.6%. The September 2023 occupancy represents a 130 basis point increase over the September 2022 level.

Weighted average occupancy increased sequentially each month within the third quarter, according to Brookdale. Third quarter weighted average occupancy of 77.6% represented 110 basis points of sequential growth compared with the second quarter.

The news comes after Brookdale previously announced it had seen the highest number of move-ins in the past five years in August, reaching more than 2,200 move-ins across its communities.

During a second-quarter earnings call in August, Brookdale President and CEO Lucinda “Cindy” Baier said that the company had increased occupancy each month in the second quarter, returning to an occupancy level greater than that at the end of 2022.

Baier said at the time that she was confident that the company would remain on the path of occupancy growth into the future, “capturing an organic growth opportunity that has more potential for positive emomentum than at any other point in the past decade.”

Bookdale operated and managed 672 communities in 41 states as of Sept. 30, with the ability to serve more than 60,000 residents. It is the largest operator and third-largest owner of senior living communities, according to the 2023 ASHA 50 list from the American Seniors Housing Association. Brookdale also topped Argenum’s 2023 list of largest providers, with 55,430 total units.

The company had 265 communities recognized in the US News & World Report Best Senior Living program for 2023.

Read more news about Brookdale Senior Living here.