Assisted living 2013: On the upswing

From the Great Recession to recovery, long-term care sectors across the continuum have felt the impact of the economic downturn and its slow recovery. Although some assisted living organizations experienced higher vacancies, most managed to maintain their edge in the marketplace through innovation and out-of-the box creativity. It’s been a topsy-turvy time with sales, acquisitions and mergers.

As the economy continues to rebound and as the senior population steadily grows, assisted living is positioned to move forward, according to industry experts Richard P. Grimes, president of the Assisted Living Federation of America (ALFA) and David Kyllo, executive director of the National Center for Assisted Living (NCAL).


Of all the models in long-term care, assisted living felt the least impact, according to Grimes. “Independent living business took the hardest hit because it presents a ‘lifestyle’ choice,” says Grimes. When housing values dropped, people decided to take a wait-and-see attitude and wait for a rebound before making a move predicated on lifestyle choice.

On the other hand, Kyllo and Grimes agree that a move to an assisted living community is a needs-based decision and the demand will continue to grow. The recession’s impact on assisted living was less severe than on LTC sectors because, as Kyllo explains, “An assisted living community is an instrument to improving a person’s quality of life by having caregivers available 24/7 to help maintain choice, independence and autonomy; it is not a lifestyle option.”


Ten to 20 years ago, today’s assisted living resident would have been cared for in the nursing home setting. “People are living longer and are healthier than in the past,” notes Grimes. Assisted living provides those with the need for assistance with activities of daily living the additional care and opportunities to enjoy an active, engaged and fulfilling quality of life.

While it’s only natural that someone prefers to age at home, it’s not always the safest or sanest decision. A recent AARP study revealed that 42 million Americans are serving as family caregivers in their home for a disabled or elderly person, of which 46 percent are providing medical and nursing care for which they have little or no background or training. This is a serious and growing national problem that is getting little or no attention. “Visit any emergency room or urgent care center any time to see some of the consequences,” says Grimes.

Family caregivers, although well-meaning and generous in spirit, are most often not suitably prepared to provide the care necessary to ensure a good quality of life for either the cared-for or the caregivers. Assisted living is a great alternative to many who have difficulty living at home, but don’t need the complex 24/7 care provided by nursing homes.

While the AARP study focused on at-home family caregivers, it did not study other areas of concern where assisted living may be an appropriate option: the elderly person living alone, the elderly caregiver who is trying to care for his/her elderly spouse or the elderly patient released from the hospital after an accident or illness.

“The person living alone or the elderly person caring for an elderly spouse may be at even higher risk than being under the care of another family member,” says Grimes. And going directly home from the hospital is also risky. Consequently, patients are often readmitted too soon after discharge because, for example, they didn’t follow their medication regimen.

“Since the Centers for Medicare & Medicaid Services [CMS] is levying penalties against hospitals with 30-day readmission rates of Medicare beneficiaries, providers are working closely  with assisted living facilities and other settings to ensure that the patient will not be readmitted within the established 30-day time frame,” adds Kyllo.


It’s estimated that 74 million Americans are in the pipeline to require long-term care services in the next 15–20 years. Within that estimate is a large increase in those people who will require Alzheimer’s/dementia care. Assisted living is positioning itself to provide that care. “This is a growth opportunity for many organizations,” says Kyllo.

With lower interest rates and the lending market available to organizations with healthy balance sheets, opportunities for expansion are available. Companies without memory care, may choose to add it, adds Grimes. They might build new residences or opt to renovate existing space to that purpose. Both executives agree that memory care is a growth opportunity.


Every state regulates its assisted living communities. “In any given year, at least one-third of the states add, alter or modify their regulations for assisted living,” says Kyllo. “However, there is plenty of interest at the federal level. In the past five years, agencies such as the Centers for Disease Control and Prevention, have added assisted living to their focus,” he adds.

But Kyllo and Grimes agree that laws and regulation happen much quicker at the state level; legislators are much more flexible and will create innovative approaches to ensuring quality care for their elderly citizens. Facility inspections are a large part of the regulatory landscape. “A nursing home is inspected every 15 months. Everyone gets the same survey. On the assisted living side, however, if your community receives a certain grade on inspection and has a solid history, you go on a staggered inspection cycle, which adds more time between surveys,” Kyllo explains.

AL communities are primarily private-pay businesses that generally do not receive government subsidies or reimbursement. Because they are consumer-driven, they tend to exceed state regulatory requirements. “The performance of assisted living communities is less driven by the need to meet state requirements—they must meet the requirements to maintain their licenses anyway—but more by resident and family satisfaction,” says Grimes.


Having survived the Great Recession relatively intact, assisted living is poised for growth and innovation in its design, service offerings and business expansion. The outlook for this unique setting is strong, its leadership is strong and the next generation will reap the benefits of its innovators’ foresight and creativity.

Topics: Advocacy , Articles , Design , Executive Leadership , Housing , Regulatory Compliance