Everywhere you turn these days, there’s talk of senior living occupancy returning to pre-pandemic levels. And the general view among the industry’s closest observers is that this is going to be a good year to raise rents, as that rare combination of higher consumer demand and a paucity of new startups works its price-point magic.

Then there’s this: A tough financing environment marked by higher interest demands and more restrictive capital access is starting to get better and could improve dramatically in the second half of the year.

The source for this latest prediction is none other than the world’s largest healthcare symposium, which concluded last week in San Francisco. Compared with a year ago, the mood was decidedly more upbeat at the J.P. Morgan Healthcare Conference, which brings together investors, bankers, scientists and various other high-level movers and shakers.

Their general consensus was that capital access will steadily improve. That will no doubt be good news for senior living operators looking to tackle overdue repairs, indulge in renovations or upgrade services. Not to mention possible mergers or acquisitions. (Which are expected to see a notable uptick this year, according to the most technologically advanced Ouija board operators.) No doubt, available funding at reasonable rates could be a game changer for many operators, maybe even the larger senior living field.

Let’s not forget there’s that little matter of whether the Federal Reserve will cut interest rates as a way to spur things on. Last month, Fed Chairman Jerome Powell indicated that as many as three rate cuts could happen this year. Of course, that markdown assumes inflation holds steady. Or better yet, declines.

So, all things considered, it’s easy to feel pretty good about where things stand for senior living operators right now, and where they might be heading. Or as Buffet might remind us, this is probably a good time to start stressing out.

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.

Tuesday’s release of a final rule on worker classification standards surely will trigger many a call to HR for a policy rewrite. And perhaps to legal counsel for advice on how to react.

According to federal regulators, the updated standards promise to bring clarity to the often murky distinction between independent contractors and employees.

Clearly, regulators feel that too many senior living operators — and employers in general, for that matter — are using the “independent” label to identify workers who should rightfully be considered employees.

Specifically, the new rule adjusts the method of analysis and adds criteria for determining which bucket a worker should be placed into.

The Labor Department asserts that the new rule will take a more “holistic” approach that encompasses additional factors and weighs them more evenly in the decision-making process.

But as so often is the case, operators are pushing back against an official narrative that seems to promise help while ignoring burdens.

“We are concerned that the rule, coupled with other proposed federal regulations, will only serve to exacerbate the workforce shortage and wipe out some of the recent modest gains communities have made in recruiting individuals to help care for our seniors,” Argentum Senior Vice President of Public Policy Maggie Elehwany told McKnight’s Senior Living.

Additionally, the changes may place greater legal and financial burdens on senior living operators, suggested Gerald Maatman Jr., partner and chair of the class action practice group at legal firm Duane Morris.

Maatman suggests that implementation of the rule may well prompt more wage and hour misclassification class action litigation in the sector.

Remember that famous line: “I’m from the government and I’m here to help you”?

I guess you could say it took on a whole new meaning this week. Or that at the very least, the old meaning was freshened up.

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.

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.

Howard added that “a lot of these assisted living facilities have been bought by Wall Street crowd types, private equity outfits that are just trying to squeeze as much money out of desperate families as they can.”

“There are perfectly wonderful, good people and facilities in this industry,” he noted. “And then there’s the dirt.”

That caveat emptor reminder was practically a wet kiss when compared with two earlier developments. One is a series of articles appearing Sunday in the Washington Post that link “dangerously understaffed” assisted living communities to thousands of elopements and nearly a hundred deaths.

“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 paper reported.

Not exactly a glowing review, is it?

Prior to that report, KFF and the New York Times published a “Dying Broke” series. The headline probably tells you all you need to know about where the series went. While the reporting generally focused on the general nature of the nation’s long-term care crisis, senior living operators were painted with a less-than-flattering brush.

Those critiques are troubling for many reasons, but two stand out.

One is that the concerns they collectively raised are valid. The second is that such revelations hardly support  the industry’s long-held position that there’s no real need for federal oversight.

Who knows? If people keep reading about problems of and by senior living, they might start wondering whether senior living is well enough to be left alone.

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.

But that’s just part of the story. Looking ahead, operators may have even more cause celebration. Especially those with the inclination and resources to improve the reality of senior living.

Let’s begin with the aforementioned sore spot: staffing. To be sure, this is a perennial challenge. But look around. Increasingly, operators are embracing new ways to attract and keep the best possible talent. And not just by increasing pay, although that is no small matter. Options such as generous training programs, career advancement opportunities and flexible scheduling were considered unusual in the recent past. Increasingly, they are becoming a price of admission. The result? Lower turnover, more motivated staff members and, ahem, happier customers.

Speaking of change, it wasn’t too long ago we were talking about tech tools as a futuristic, someday, novelty item. Now, technology is ubiquitous, touching almost every area of operations and services. From state-of-the-art health monitoring systems to interactive communication platforms, those innovations don’t just make the job of community leaders easier. They also help create a more engaging and connected environment for residents.

One of the most promising emerging trends is a focus on personalized care plans. This was, until recently, often viewed as a concern limited to skilled care. These days, senior living communities increasingly are tailoring services to meet the unique needs and preferences of each resident. This is not only ensuring a better quality of life for residents; it’s also helping operators set themselves apart.

We’re also starting to see unprecedented levels of community integration. As never before, operators are creating senior living spaces that seamlessly blend into the fabric of surrounding neighborhoods. This connection isn’t just fostering a sense of belonging for residents; it’s also opening up new opportunities for collaboration with local businesses and services.

In addition, many communities are beginning to recognize the need for holistic programs that promote not just physical health but also mental and emotional well-being. Initiatives such as art therapy, mindfulness programs and intergenerational activities are gaining traction, contributing to a more vibrant and fulfilling experience for residents while also creating a positive work environment for employees.

There’s no doubt we are witnessing both evolution and revolution in senior living. The payoff of this unique marriage will be better options for consumers and a better future for operators willing to join the dance.

And perhaps as never before, operators will have good reason to kick up their heels.

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.

Item: Report: Alternative approaches to senior living, LTSS needed for growing older adult population

The gist: A recent story highlighted a report from the Harvard Joint Center for Housing Studies, revealing that only 13% of adults aged 75 or more years, living alone across 97 metro areas, can afford to move into an assisted living community without depleting their assets.

Why this matters: We’re hearing a lot these days about the need to serve the so-called middle market. (I say “so-called” because industry views on the meaning of that range can vary considerably.) What this report makes clear is that the senior living sector more than has its work cut out here. Success is not just going to be a matter of paring options and operating costs to the bone — although that, too, likely will need to be a part of the equation. Essentially, those findings suggest operators will need to re-imagine how to reach this market. And that, my friends, is going to be a very heavy lift.

Item: CCRCs continue to report higher occupancy than other senior living segments

The gist: Continuing care retirement / life plan communities continued to outpace non-CCRCs in senior living occupancy in the third quarter, according to a data analysis from specialty investment bank Ziegler.

Why this matters: At first glance, the implication is obvious: These are good times to be running CCRC / life plan communities. Part of the advantage is that CCRCs often can charge higher entry fees and monthly rates. So everyone should want to become a CCRC, right? Not so fast. Many of these campuses have a 60-acre or larger footprint, which can be a substantial barrier to entry. Moreover, the full-service aspect of CCRCs can backfire, especially if one component of the portfolio — such as skilled care — hits hard times. Then what? It’s worth noting that the things that make CCRCs formidable also can hamper them when times are tough.

In case you didn’t notice, there is no single silver bullet when it comes to ensuring success in senior living.

Probably best to focus on finding many good bullets instead.

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.

In the spirit of helping, I’d like to suggest five books that are chock full of valuable insights and strategies that can help you better navigate these — and other — awake-at-night issues.

1. “Leaders Eat Last” by Simon Sinek

Sinek explores the dynamics of effective leadership by examining the correlation between a leader’s behavior and team performance. For senior living professionals struggling with employee retention, “Leaders Eat Last” provides valuable lessons on building a culture of trust and loyalty within your community.

2. “The Lean Startup” by Eric Ries

As senior living professionals face the challenge of increasing occupancy levels and navigating market competition, “The Lean Startup” offers a fresh perspective on entrepreneurship and business strategy. Ries introduces the concept of the lean startup methodology, emphasizing the importance of rapid experimentation and validated learning. Applying these principles can help senior living professionals refine their marketing strategies, enhance customer satisfaction, and adapt quickly to changing market dynamics.

3. “From Good to Great” by Jim Collins

This classic work smartly examines factors that differentiate successful companies from their counterparts. It also delivers timeless principles for achieving sustainable growth. By studying companies that made the leap from average to outstanding, senior living leaders can glean valuable insights into effective management practices while also fostering a culture of innovation and strategic planning.

4. “Nonprofit Management 101: A Complete and Practical Guide for Leaders and Professionals” by Darian Rodriguez Heyman

Don’t let the title fool you. For-profits sizing up funding sources and exploring potential portfolio expansions can learn a lot here as well. The book covers various aspects of organizational management, fundraising and strategic planning.

5. “The Innovator’s Dilemma” by Clayton M. Christensen

This ground-breaking work is a must-read for senior living professionals seeking to adapt and thrive in a rapidly changing industry. Christensen examines how successful companies can fail by sticking too closely to their existing products and processes. He argues that disruptive innovations, often initially inferior or niche, can upend established industries, challenging companies to adapt or risk obsolescence.

As the saying goes, readers are leaders. These five books offer valuable insights and strategies that can help you lead your organization through times both good and bad.

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.

In a bid to improve ownership transparency in the skilled care sector, the feds posted a final rule calling for more disclosures.

This move follows years of criticism against opaque ownership structures among skilled care operators. One major beef: It can be challenging if not nearly impossible to determine who actually owns facilities. Another suspicion is that many facilities have essentially become a destination point for other goods and services controlled by the same operators. Both of these practices have had a deleterious effect on care quality, critics claim.

I’m not going to attest to the legitimacy of such concerns. But it’s undeniable that they exist.

This latest government scrutiny extends to ownership involvement across several dimensions, including financial control, property leasing, stake percentages and the provision of various services.

This week’s final rule, according to Centers for Medicare & Medicaid Services officials, responds to growing concerns about the quality of care in nursing homes, particularly those owned by private equity companies and investment firms.

CMS Administrator Chiquita Brooks-LaSure emphasized the move is underpinned by a desire to furnish stakeholders, including residents, their families, researchers and regulators, with transparent information for informed decision-making.

“Taking steps to help consumers to learn more about the owners of a nursing home will allow them to make the choice that best meets their needs,” added HHS Secretary Xavier Becerra in a statement.

This final rule is happening as more senior living operators expand their portfolios and business interests. Or to put it more bluntly, it’s happening at a time when more senior living organizations are establishing the kind of unclear ownership structures that landed nursing homes in hot water.

To believe the feds will never be interested in taking a closer look under your hood is not merely wishful thinking. It’s dangerous thinking.

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.

So imagine the anticipation that crackled in the air as industry operators converged for a LeadingAge session on Tuesday, where the esteemed speaker was none other than Evan Shulman. He just happens to direct the nursing homes division at the Centers for Medicare & Medicaid Services.

Shulman, widely acknowledged as a sharp and amiable figure, did address many existing and pending regulatory issues facing operators today. But there wasn’t much he was able to share about when CMS will be taking its relationship with staffing mandates to the next level. 

He quickly made it clear that the controversial staffing rule was off the table. For many in attendance, it was akin to entering a renowned steakhouse only to discover that chicken or fish were the only menu choices.

Now in fairness to Shulman and CMS, the government has a lot to, er, digest. By Monday’s midnight deadline, the feds had received somewhere in the neighborhood of 50,000 replies to its staffing proposal. Every single one of those comments will need to be read. 

That being noted, it’s probably safe to assume most of the correspondence directed regulators to take one of three steps:

1) Implement the proposed mandates,

2) Don’t implement the proposed mandates or

3) Give this a little more thought before doing anything rash.

And as LeadingAge President and CEO Katie Smith Sloan and others have noted, even though the proposed rule applies directly only to nursing homes, there’s no doubt that it would affect senior living providers and others along the long-term care continuum. As Sloan told McKnight’s editors this week, providers all are “fishing from the same pool” of workers.

For what it’s worth, Shulman’s LeadingAge session did address an array of other important regulatory topics.

He highlighted CMS’ renewed emphasis on the survey process, infection control practices in the post-public health emergency era, and the agency’s campaign to make the long-term care field more attractive to potential job candidates. Antipsychotic drug use and more equitable application of civil monetary penalties also received a shout out.

Shulman welcomed questions and engaged with attendees, promising to take their concerns about access to care, especially in rural settings, back to his colleagues.

All those matters matter. But as for the meatiest matter of them all? Let’s just say we probably won’t be seeing steak on the menu any time soon.

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.

Until recently, unions have been largely unsuccessful at convincing senior living workers to join their ranks. But there are some pretty clear signs that the times, they are a changing.

Unions recently captured some eye-popping contract settlements. In August, American Airlines agreed to give its pilots a 46% pay increase over four years. Also in the summer, UPS workers won raises of $7.50 an hour over five years, with drivers’ wages climbing to $49 an hour.

More than 85,000 Kaiser Permanente workers won raises of 21%, with a guaranteed minimum of $25 an hour for company workers in California.

But perhaps the most notable recent victory goes to the United Auto Workers. The UAW launched a six-week, surgical strike against the nation’s largest automakers:  Ford Motor Co., General Motors and Stellantis.

The Big Three quickly caved and agreed to 25% pay increases that will raise top pay to about $42 an hour. With a little overtime, many workers soon could be earning six-figure incomes, putting them solidly in the middle class. The union also gained pension improvements and other concessions. 

The list of union victories goes on, but you probably get the general idea. Unionized employees are killing it these days.

To understand the implications for senior living operators, it’s important to consider the three main drivers of increased union activity: soaring living costs, rising income inequality and the significant pay gap between workers and top executives. Funny enough, all three are in play when it comes to senior living.

Adding to the mix is a low unemployment rate and an abundance of job opportunities.

Moreover, high-profile victories such as the one UAW workers achieved might inspire organizing efforts across various other sectors, potentially leading to future contract talks and strikes.

If there’s any comfort to be had here for management, it’s worth noting that despite the recent surge in labor activism and growing support for unions among the public, union membership rates have been on the decline for decades. 

In fact, only 6% of private-sector workers in the United States currently belong to unions, a fraction of the 35% in 1953.

Additionally, the rise of the gig economy has made it harder for workers to unionize, as some large companies classify employees as “contractors.”

In recent years, labor laws have had a significant impact on the state of unions. Some states have passed “right to work” laws that undermine the financial resources and bargaining power of unions. Furthermore, some states have rolled back union protections, creating a challenging environment for organizers in areas with little history of organized labor.

All things considered, it is essential for long-term care providers to stay informed, understand the evolving labor laws and proactively address employee concerns to maintain a harmonious working environment while navigating the changing dynamics of the labor market.

As never before in recent memory, employees are in a position to  challenge their employers for higher pay, better benefits and clearly defined career paths. If and when they feel employers are not treating them well enough, they are that much more likely to start looking for the union label.

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.