As artificial intelligence becomes increasingly integrated into tools used by senior care and living providers, its uses can be broadly placed into two categories: data analysis and automating routine work.

Some of the best new AI tools that LTC providers should be aware of include the newly expanded Microsoft 365 Copilot and the website scena.ai, according to a new brief guide on AI from LeadingAge. 

The latter was used to generate the opening video at LeadingAge’s conference. 

“At its core, generative AI is a subset of AI that focuses on creating content, whether its text images, music or entire virtual worlds,” a digital avatar told the crowd. “With the right application, generative AI can assist in aging services.” 

While many of these AI tools, and their applications, have been widely available for months, organizations like LeadingAge have been working to advance adoption of these tools, because the LTC industry often lags behind other sectors in onboarding new tech, many healthcare experts have noted. 

Coming into this year, staffing shortages remain an ongoing issue for LTC providers, so the more administrative tasks an organization can devote to AI, the more existing staff and caregivers can focus on resident care.

As for data analysis, AI’s predictive power, which can help predict and prevent falls, was seen as one of the most promising tech innovations in LTC, according to a recent podcast panel for McKnight’s Market Leaders including AHCA President Mark Parkinson.

Seniors themselves may be more open to AI being used in their healthcare systems, or at least accept its presence, a recent report found.

In addition to listing some AI tools and providing a broad overview, the recent LeadingAge post also listed several AI guides for organizations to review, including a report from NetHope and a recent research study published in JMIR Aging.

Long-term and post-acute care organizations have not received the same support as other care settings for creating interoperable patient data tools, putting home health and hospice providers at a disadvantage, according to new research by the Department of Health and Human Services.

Electronic health records (EHRs) are used by the vast majority of long-term and post-acute care (LTPAC) providers. Within the home health and hospice industries, roughly 78% of providers have adopted an EHR, according to the study. And while their functionality is largely the same as those used in other care settings, EHRs used by home care and hospice providers fall short when it comes to their interoperability capabilities. 

A key reason for this, HHS found, is that LTPAC organizations have not been incentivized to use interoperable technology in the same way as other healthcare providers.

“Due to thin operating margins, lack of adequate financial incentives has made it difficult to fund and implement interoperable HIT systems,” HHS said in its December report. “Organizations need a system or market reason to exchange data. Without the proper financial and policy incentives, it will be difficult to make organic progress toward interoperability.”

Meanwhile, other care settings have been able to benefit from government programs that encourage use of interoperable health data tools. Hospitals, for example, were selected to participate in Promoting Interoperability Programs, which offered financial incentives for implementing interoperable HIT.

And since hospitals and other acute care settings received this head start, many LTPAC providers have not been able to lay the groundwork to create interoperable HIT systems.

“Providers and vendors do not have a clear understanding of what data reporting and interoperability requirements will be in the future,” the report noted. “LTPAC organizations and vendors are left to do what they think is best, with limited guidance resulting in the lack of standardized and codified data to support interoperability,” the report said. 

LTPAC organizations have long petitioned lawmakers for help with creating interoperable patient data tools. And while hospitals were successful in earning this support, home health and hospice providers have not been able to do the same, HHS said in its report.

Still, the “next big step” in nationwide health data interoperability may be yet to come. The Trusted Exchange Framework and Common Agreement (TEFCA) has been slated for launch in the first quarter of 2024, and will create interoperable functionality among five EHR systems. LTPAC stakeholders have expressed hopes that TEFCA might benefit, rather than overlook, home health and hospice providers.

Telehealth expansion has been supported by many healthcare and government leaders in the post-pandemic world, including President Biden, as a way to ensure everyone has access to coverage and essential health services.

However, adding broadband access to rural or underserved communities may not be a silver bullet that enables telehealth use in those areas, a new study shows.

This means that long-term care providers, particularly those in rural areas, need to make sure that digital literacy training and cultural factors are in place for telehealth use.

Study authors were most concerned with policymakers and whether they were viewing telehealth issues too narrowly.

While the study, which looked at 170,000 Wisconsin Medicaid beneficiaries, supported the idea that telehealth helped remove geographical barriers to important healthcare services, the researchers concluded that actual telehealth use is separated by what they termed the “digital divide.” This includes a mix of factors including age, ethnicity and tech literacy.

“Although telehealth expansion has been touted as a low threshold policy intervention to expand access to care,” the study authors wrote, “leveraging telehealth to improve access for underserved populations will require more nuanced attention to the specific mechanisms linking telehealth and health care utilization to avoid inadvertently deepening disparities for select populations.”

After the pandemic, those who adopted telehealth skewed older, urban and female, the study found. While the researchers held back on making a definitive conclusion for why this cohort would be more amenable to telehealth use, they speculated that it was broadly due to better knowledge and trust in the healthcare system. The study showed greater telehealth use for lower-income and education individuals — but only for audio-only interventions, which are only a small fraction of telehealth care.

While seniors are often slower to adopt new technology, it is not the older adults themselves who are hesitant to use telehealth, but rather clinicians who worry that telehealth visits are insufficient to address more complex medical needs, McKnight’s reported last year.

The assisted living sector touts itself as the most cost-effective option to provide quality-of-life care and services for the nation’s older adults. But that value comes at a cost, according to a new report.

Seniorly set out to determine how much assisted living communities actually cost and how those costs stack up against other options, including in-home care, by analyzing the average cost to consumers in all 50 states.

The price of assisted living, as with most business offerings, is increasing. Between 2021 and 2023, 30 states saw average costs for assisted living rise — with Wyoming (a 53% increase), West Virginia (46%) and New Hampshire (46%) seeing the biggest average increases, according to the report. The 2023 national average monthly cost of $4,401 is an 8% increase over 2021.

Costs charged to consumers actually fell in 15 states — Washington saw the biggest decline, at 16% — and remained relatively flat in six states, according to the report. 

The average monthly rent for assisted living communities ranged from $2,946 in Louisiana to $8,248 in New Hampshire, where it was almost double the national average. Average monthly costs were more than $5,000 in 10 states, most of them concentrated in New England and the Mid-Atlantic, whereas the most affordable states included Indiana ($3,695), Iowa ($3,420) and South Dakota ($3,378).

Middle market highlighted

The cost of senior living is shining a spotlight on options for the “forgotten middle,” those whose incomes are too low for them to be able to afford current private-pay senior living options but too high for them to qualify for federal assistance.

A recent Milken Institute report, released in partnership with the National Investment Center for Seniors Housing & Care and CVS Health, projected that almost three-fourths of the estimated 16 million middle-income older adults who will be aged 75 or more years will be financially unprepared to afford housing to meet their needs in 2033. Even with home equity, the Milken researchers found, only 39% of those middle-income older adults will be able to afford assisted living.

Another recent study from the Harvard Joint Center for Housing Studies, released last month, found that only 13% of adults aged 75 or more years who are living alone across 97 US metro areas can afford to move into an assisted living community without starting to cash in their assets.

A NIC-funded 2019 study by NORC at the University of Chicago found that 54% of middle-income older adults will lack the financial resources to pay for senior housing and care in 2029, calling for a combination of public and private efforts to address the looming crisis.

The Seniorly study in part used data from the US Census Bureau’s 2022 median annual household income for states and savings rates from the Bureau of Economic Analysis. In doing so, Seniorly estimated that it would take the average American 17.2 years to save for one year of assisted living. 

Using those data to look at the affordability of assisted living, Seniorly found that New Hampshire residents would need to save for 26.8 years to cover a single year of assisted living, with West Virginia (26.1 years), Mississippi (24.8 years), Wyoming (24.6 years) and Delaware (21.7 years) rounding out the top five states as far as timing. 

Maryland came out at the other end of the spectrum, with residents needing to save an average of 11.7 years to cover one year of assisted living costs, followed by Utah (12.3 years), Minnesota (12.3 years), Georgia (13.3 years) and Washington (13.4 years). 

In comparing assisted living with home care costs, Seniorly pointed to a report from Genworth Financial that put the monthly cost of a home health aide at $5,462, although wide variation exists between states. Minnesotans will pay the most for home care, with a median monthly cost of $7,333, compared with $3,472 for assisted living. West Virginia was the least expensive state for home health aides at $3,793 per month, compared with $4,846 average monthly rent for assisted living.

Some question value

The assisted living industry’s pricing structure and providers’ for-profit status were two topics examined in a New York Times and KFF article package in November. Costs also were discussed in a December Washington Post article package looking at the deaths of residents who had eloped from communities. 

Those and other lay media investigations into the assisted living industry led the US Senate Special Committee on Aging to launch a review of the industry, including questions to three large providers, and to schedule a Jan. 25 hearing based on “significant concerns” about costs, staffing levels and resident safety.

It’s no secret that the largest population of older adults is about to come knocking on senior living’s door. What worries dementia care expert Teepa Snow is how unprepared operators may be to handle the incoming “dementia shockwave.”

In a recent webinar on the state of dementia care hosted by workforce education provider Relias, Snow, an occupational therapist and CEO of Positive Approach to Care, said that there are 120-plus types, causes and forms of brain change under the dementia umbrella. 

In 2020, approximately 7 million people aged 65 or more years were living with dementia. That number is anticipated to increase to 9 million by 2030, and 12 million by 2040. And Snow said that 60% to 70% of people moving into long-term care have cognitive changes consistent with the early signs of various forms of dementia. According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, 42% of assisted living residents have Alzheimer’s disease or another form of dementia.

Communities are unprepared

Senior living communities are missing the signs of the disease because they aren’t preparing staff members to recognize them at the earliest stages, Snow said. 

In most cases, she added, certified nursing assistants are required to have the most dementia training of staff members, but that requirement averages only six hours. Most skilled care providers are not required to have any dementia care training, she said. 

“The challenge is, when we’re talking about somebody whose brain is dramatically shifting and abilities are variable, we are asking people to step forward into this role without preparation,” Snow said, adding that the situation sets up staff members for job dissatisfaction. “If we can’t get people to want to work with us, we can’t serve the population.”

The brains of people with dementia change over time, taking an average of 10 years to change from a neurotypical brain to a brain with Alzheimer’s disease, Snow said. And 80% of cases of individuals experiencing brain changes are not identified in the early stages, when interventions would be most effective, she said.

Providing truly person-centered care involves supporting the right culture and environment, building competence through education and training and practice, and working with families, Snow said. The “state of dementia care” is not where it needs to be, she added, but she said she knows it can get to where it needs to be — with collaboration. 

Adding family to the care team

Senior living communities may be admitting people who have more complex care needs than anticipated, resulting not only in untrained and unprepared staff members but unprepared families, Snow said. 

The baby boomers aging into long-term care, she added, will be moving in at a more advanced age than members of previous generations, will have more chronic conditions and will be at higher risk for dementia.

“Not only are there more of us getting older; there are more of us getting older and having brain changes,” Snow said, opining that society already is poorly equipped to understand what aging typically looks like, let alone understand the brain changes that come with dementia.

Educating residents’ family members about the progression of dementia is just as important as training staff, she said. 

“Somewhere around 75% to 80% of family members have little to no awareness that the diagnosis of dementia is going to lead to somebody’s gradual decline no matter what we do,” Snow said. “It will change their ability to live their life.”

Family members are additional team members and need to be involved and engaged with creating a care plan for their loved ones, she said.

The LCS Foundation has announced a partnership with the Granger Cobb Institute for Senior Living to provide an annual scholarship to add more professionals to the senior living industry.

The institute was announced for Washington State University in 2017 and dedicated in 2019 to focus on building the future senior living workforce through academic programs, industry partnerships and research. It is named for the senior living industry executive who helped build the Washington State University senior living curriculum and taught a course in senior housing administration before he died in 2015. The senior living management program, launched in 2020, offers industry-driven courses, immersive learning, community operations expertise and industry-expert connections before graduation. 

In December, the program celebrated its first graduate, who earned the degree through the institute’s global campus. Six students have completed the senior living minor, which began in fall 2021, and 25 students are in the pipeline working on a senior living major or minor, according to GCISL founding director Nancy Swanger, PhD. Since offering an elective class in senior living management in 2010, almost 800 students have taken the course, with many now working in the industry. 

“Our program is quite unique in that it is housed in a hospitality school within an accredited college of business. The industry loves the business acumen and relationship-building foci in our curriculum,” Swanger told McKnight’s Senior Living. “The program at Washington State University is relatively new, and having such generous support for our students from LCS lends tremendous validity and credibility to what we are trying to build.”

Swanger added that many industry providers have given their “time, talent and treasure to help the program grow,” and that the LCS scholarship is one of three specifically for students studying senior living.

Swanger is on the board of trustees of the Vision Centre, which is supported by several industry associations — including the American Health Care Association / National Center for Assisted Living, the American Seniors Housing Association, Argentum, LeadingAge and the National Investment Center for Seniors Housing & Care — and working to create university and college programs and facilitate internships to prepare future generations of aging services leaders.

Since 2017, the LCS Foundation has awarded more than $450,000 in scholarships and professional development programs. The foundation also has collegiate partnerships with the University of Northern Iowa, Northwood University and the University of Wisconsin-Eau Claire. Those partnerships have placed senior living experts on advisory boards, developed curricula and helped provide students with interactions to advance their learning.

Other senior living-focused academic programs include an assisted living/senior housing administration concentration at George Mason University, a Master of Arts degree in senior living hospitality at the University of Southern California Leonard Davis School of Gerontology, an undergraduate degree in senior living management in University of Central Florida’s Rose College of Hospitality Management, and Boston University’s concentration in senior living in the Masters of Management in Hospitality degree program.

Johnson was addressing investors at a Thursday webinar moderated by Kevin Holloran, senior director and sector leader of the not-for-profit healthcare group in Fitch’s public finance department. 

Earlier this month, Fitch Ratings assigned the CCRC sector a rate of “deteriorating” for the second year in a row, indicating that the company anticipates that credit pressures will worsen this year amid persistent labor and cost pressures.

The sector would have to demonstrate improvement in staffing numbers as well as the efficacy of measures leading to “stable” or “improving” ratings if it is to revise the outlook to “neutral,” according to Fitch, the McKnight’s Business Daily previously reported. 

CCRCs “still face a number of considerable headwinds heading into 2024,” Johnson said. “Cost inflation in terms of supplies and labor, higher interest rates and volatility in the housing sector all contributed to the ‘deteriorating’ or ‘negative’ outlook. But by far, the biggest driver of the ‘deteriorating’ outlook is continued wage pressure.” 

CCRC payrolls are below pre-pandemic levels, whereas wages are at a historic high, Johnsonn said, “meaning it’s taking more and more money to hire workers and even then, [CCRCs] overall remain understaffed.”

This situation is especially true in communities that offer skilled nursing services, she said. 

The good news, Johnson said, is that most of the CCRCs that are a factor in the Fitch outlook have more independent living units than skilled nursing units and are able to take nursing beds offline and adjust staffing levels.

Doing so “allows them to limit the use of more expensive agency nurses and also positions them well to withstand the effects of possible new regulation around minimum staffing ratios that’s been getting some air time at the federal level,” she said, adding, “They also have the ability to pass through rate increases to their independent living residents to offset these high labor and supply costs.”

Demographics also favor the sector, Johnson said.

“I’d say the [CCRC] model of communal living has a distinct competitive advantage over aging at home and other models of senior living. And this is especially in light of a recent Surgeon General advisory about the negative health impacts of loneliness and isolation, especially among seniors,” Johnson said.

She added that the communal living model appeals to baby boomers — those born between 1946 and 1964 — which is on the brink of forming the largest cohort of demand for senior living and care over the next decade.

Against the backdrop of the strong demographics, Johnson said, it is possible for the sector to change its outlook to “improving” or “stable” over time.

“But until we get to a situation where we have a significant stabilization of labor availability, wages and housing prices, so that [CCRCs] can move away from double-digit rate increases and back to their historical norms of 2% to 5% rate increases per year, I think the best we can probably hope for for the sector is ‘stable,’” Johnson said.

The research included 3 million Glassdoor reviews of 500 large employers in 25 industries to uncover which sectors have the most frustrated workers as far as wages are concerned.

Only workers in the education field are less satisfied with their pay than are workers in healthcare, according to the findings.

“This is likely one reason why education and health services have a higher-than average vacancy rate of roughly 6%, compared to about 5% across all industries, according to data from the US Bureau of Labor Statistics,” wrote Carissa Rawson, Glen Luke Flannigan and Robin Saks Frankel.

At the other end, workers in the field of pharmaceuticals/biotechnology were least likely to have complaints about the amount in their paycheck, followed by workers in food/soft beverages/alcohol/tobacco and utilities.

Help may be in sight for some healthcare workers, but optimism may be waning in California, where, in the wake of a projected $38 billion deficit, Gov. Gavin Newson (D) is reevaluating an incremental minimum wage increase to $25 an hour for workers in nursing homes, assisted living communities and other settings. He had signed it into law in October.

California has the largest number of skilled nursing facilities and assisted living communities of any state, according to SNF Data and Statista.

Overall, nursing home salaries — including those of executives — continued their upward trajectory with many facilities responding to staffing shortfalls by increasing hourly rates and offering signing bonuses, according to the industry’s largest annual salary survey released in August.

According to the results of another study, from TollFreeForwarding.com, registered nurse salaries are projected to increase over the next decade at a rate that surpasses the rate of increases for some other healthcare professions.

Meanwhile, resident assistants in assisted living communities received a 9.22% hourly rate increase in 2022, according to the 25th annual Assisted Living Salary & Benefits Report, published by Hospital & Healthcare Compensation Service. Resident assistant hourly rates increased by 10.61% in 2021 and by 9.22% in 2022. As a result of continued pay increases, turnover rates for the position began to decrease in 2022. Resident assistant turnover was 68.09% in 2021 but declined in 2022 to 49.08%. Vacancy rates for resident assistants were 19.91% in 2022.

“Despite this earlier age, emerging adults, known as GenNext for being the next generation of workers, heads of households, consumers and investors, haven’t started planning for retirement just yet,” the authors noted.

Simply put, the so-called GenNext has other financial priorities at this stage of life, including planning for a family and taking care of everyday expenses, according to the report. 

At the same time, however, Edward Jones advisers indicated that more than 40% of their younger adult clients are “thriving” (42%) and actually are in a more favorable position regarding their financial stability than people of the same age a decade ago.

“We know from our research with emerging adults ages 18 to 34 that they want to be comfortable or have enough money to have a meaningful life, but they aren’t concerned with financial accumulation or career in the same way,” said Julia Bartak, an Edward Jones financial adviser in the Kansas City area. 

But only 12% of those surveyed said they discuss their finances with a financial adviser, and one reason for the finding may be a simple one, according to Edward Jones. Sixty-eight percent of members of the generation “don’t think they have enough income or savings for professional financial advice, despite being the most educated generation in history, with one in three having some college education and access to information,” the company said.