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.

While still a state legislator in the mid-1990s, Parkinson and his wife, Stacy, founded the first of their 10 eldercare communities in Kansas and Missouri, an assisted living community. 

The lanky lawyer particularly distinguished himself in recent years as the most visible spokesperson for the long-term care sector — the segment of society most devastated by infections and deaths during the COVID-19 pandemic. He has been the president and CEO of the 14,000-member American Health Care Association / National Center for Assisted Living since 2011, the year after he declined to run for another term as governor of Kansas.

“Mark doesn’t just talk the talk. He walks the walk. During his years at the helm of AHCA/NCAL, he has helped guide the industry through some of the most challenging times we’ve ever faced,” said McKnight’s Editorial Director and Associate Publisher John O’Connor in making the announcement of Parkinson as this year’s top Pinnacle honoree. “This he has done with amazing skill, wisdom, grit and grace. He is deserving of this honor, and we are truly fortunate to have him among us.”

When not touring the country to visit members and affiliates, Parkinson spends most of his time lobbying on senior living and care operators’ behalf from his home in Washington, DC. 

He and his wife started their chain of facilities in 1996 while still working in their private law practice.

A Republican state legislator dating back to 1991, he switched parties in 2006 to become Kathleen Sebelius’ running mate when she ran for governor of Kansas. They won, and in 2009, he became governor after Sebelius became secretary of Health and Human Services in the Obama administration. He declined to seek another term and instead accepted the top AHCA/NCAL post before he left office in January 2011.

In 2020, McKnight’s named him one of long-term care’s most notable figures of the past 40 years.

Before becoming especially prominent as an industry point person during the pandemic, one of his biggest accomplishments was stitching back together a fractious AHCA/NCAL constituency, convincing major chains that had set up their own alliance to come back into the fold. The number of AHCA and NCAL state affiliates also has grown under his guidance.

Recognition is not a stranger to Parkinson. He also has been selected as one of the “100 Most Influential People in Healthcare” by Modern Healthcare multiple times and was named a Top CEO in the Washington Post’s 2019 Top Workplace survey in the small-employer category. He was named a Top Association CEO by CEO Update in 2013 and has appeared on The Hill’s list of top lobbyists every year since 2013.

A former No. 1 graduate of the University of Kansas Law School and champion college debater, he leads a list of 31 McKnight’s Pinnacle Awards honorees who will be celebrated at a gala ceremony open to all March 21 at the Ivy Room in Chicago.

A full list of 2024 winners, spanning the senior living, skilled nursing and home care professions, can be found at the McKnight’s Pinnacle Awards website. The program honors industry veterans who are setting standards, driving change and providing guidance to others in their field.

The McKnight’s Pinnacle Awards are a joint effort of McKnight’s Senior Living and sister media brands McKnight’s Long-Term Care News and McKnight’s Home Care.

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.

The list below details some of the most popular columns that were posted and read between Jan. 1 and Dec. 18, according to our analysis. Here’s a chance to revisit those columns or read them for the first time.

• Most-read column by Editorial Director John O’Connor:

A new and needed direction for senior living

“Argentum’s president and CEO wants to do something that runs against conventional wisdom. It also happens to be brilliant,” O’Connor wrote May 11, shortly after Argentum’s annual conference had concluded. There, James Balda had called for better provider relations with Congress.

“Increasingly, the actions of Congress are affecting senior living in ways both subtle and obvious. …That alone is reason to be on good terms with lawmakers in Washington, particularly those with clout,” O’Connor wrote, adding that good relations also could help senior living in its quest to continue to be regulated primarily at the state level. Read more here.

Read additional columns by O’Connor here.

• Most-read column by Editor Lois A. Bowers:

‘The Golden Bachelor’ could be a golden opportunity

Is “The Golden Bachelor” another example of stereotyping and ageism? Or is the show’s outreach and focus on older adults a reason to cheer?

Bowers pondered those questions in her and McKnight’s Senior Living’s most-read blog of the year, in which she also discussed senior living community watch parties, researchers’ musings about the TV “reality show” and more.

“I’m hoping that the airing of ‘The Golden Bachelor,’ faults and all, will lead to thought-provoking, productive discussions about aging and ageism and that senior living residents, and older adults in general, ultimately will be more visible and celebrated,” she wrote Oct. 23. Read more here.

Read additional columns by Bowers here.

• Most-read guest column:

The big shift coming to senior living

“What’s going to happen to senior living when your best consumer segment — those high-income, high-net-worth boomers — don’t need you anymore? This question is especially important because we know they already don’t want what you offer.” That was the question posed and point made by Matt Thornhill, founder and CEO of a middle-market solution called Cozy Home Community, in an Oct. 23 guest column.

Thornhill encouraged readers to pursue “different, and less expensive” solutions to attract a potentially huge market. Read more here.

Read more guest columns here.

• Most-read marketplace column:

Sliding scale insulin for diabetic residents: Is it helpful or harmful?

Twenty percent of assisted living residents have type 1 or type 2 diabetes, and they are relying on their healthcare professionals to assist in managing their disease, Jered Yalung, PharmD, director of marketing and operations at Options for Senior America, wrote in a May 18 marketplace column.

Yalung suggested actions for senior living operators to take for residents with this chronic condition. Read more here.

Read more marketplace columns here.

Be part of the story

Interested in submitting a guest column or marketplace column in 2024? Find out how here.

And help decide our top columns of 2024.

Subscribe to our free flagship newsletter, the Daily Briefing, and our other free daily e-newsletters, by clicking on “Subscribe” in the upper right corner of our website, wwwmcknightsseniorliving.com, or via the “Have we got news for you!” box in the right column.

Also join us on our social media channels to be a part of the story next year.

McKnight’s Senior Living is on X, formerly known as Twitter, at @_McKnightsSL. Additionally, you can follow editors John O’Connor at @ltcritr, Lois A. Bowers at @Lois_Bowers and Kim Bonvissuto at @KimBonvissuto on X.

To join us on Facebook, visit www.Facebook.com/McKnightsSeniorLiving. Follow the McKnight’s Senior Living company page and join the group on LinkedIn. Find us on Instagram at https://www.instagram.com/_McKnightsSL/.

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.

Long-term care providers have argued that the more than the 2,000% increase would hamper worker recruitment.

“We hope that the USCIS will take into consideration long-term care facilities that rely heavily on immigrants to care for their residents as well as fixed government resources,” the American Health Care Association / National Center for Assisted Living previously told the McKnight’s Business Daily.

The USCIS argues that the agency receives approximately 96% of its funding in the form of filing fee and that the most recent fee adjustment occurred in 2016. A proposed fee increase in 2020 was sidelined by a federal district court ruling.

Pilot project

The State Department also is set to launch a pilot program meant to expedite domestic visa renewal for qualified H-1B nonimmigrant visa applicants under certain conditions. The program will accept applications from Jan. 29 to April 1.

The criteria are set by the Deputy Assistant Secretary for Visa Services. The program is limited to applicants who already have an approved and unexpired H-1B petition and applicants who do not require an in-person interview, for example. 

“Currently, H-1B visa holders must apply at a US consulate or embassy abroad to renew their visa stamps,” Kelli Natrin, an attorney in the Philadelphia office of Cozen O’Connor, told SHRM. “Foreign nationals often have to plan work and travel schedules around their scheduled consular visits.”

According to Natrin, the State Department expects to reduce the wait time for visa renewal appointments from an average of 130 days to 90 days under the pilot program.

Read additional immigration-related news here.

“One is the ‘frenemy’ status with home care. It’s going to be interesting to see to what extent home care and senior living work together versus compete against each other,” he said.

A second big issue for the industry, O’Connor said, is finding a way to serve middle-income individuals, those whose incomes aren’t high enough to afford to live in most existing senior living communities but are too high to qualify for Medicaid. “Solving that is going to remain challenging for economic reasons and some others as well,” he said.

A third big challenge, O’Connor said, is “something I predicted 20 years ago that still hasn’t happened” — the prospect of federal regulation.

“Back then,” he continued, “I said it was inevitable that assisted living was going to become a federally regulated business, and my rationale then as now was, you have a very large customer base of older adults with various health conditions who are trusting an option in the market to help them get through their final years in as much comfort and dignity is possible. To me, it’s mind-blowing that for as many things as our government regulates, it doesn’t regulate that kind of activity.”

“We saw there was a need in the marketplace,” said John O’Connor, editorial director, vice president and associate publisher of all of the McKnight’s brands. “The thing that I really am happy about is that we’re helping our readers — our customers — do their jobs better, understand what’s going on better, make better choices, serve their residents better and, hopefully, at the end of the day, do well as they’re doing good.”

The magazine has been published every other month since February 2004. The brand was expanded in 2015 to include a website, the Daily Briefing e-newsletter and social media. Lois Bowers was brought on board at that time to help lead the digital expansion. That year also saw the brand’s name change to McKnight’s Senior Living.

Today, the brand also offers the annual McKnight’s Senior Living Online Expo as well as numerous e-newsletters, webinars, podcasts, awards, and online and live events, some in collaboration with its sister brands, McKnight’s Long-Term Care News (covering skilled nursing and having celebrated its 40th anniversary in 2020) and McKnight’s Home Care, launched in 2020. 

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.