Assisted Living Facilities: What Lies Ahead?

Glenn Ebersole//April 25, 2022

Assisted Living Facilities: What Lies Ahead?

Glenn Ebersole//April 25, 2022

Nursing homes received an exceptional amount of attention during the pandemic because of the large number of deaths from COVID-19. However, what seemed to be somewhat ignored and less publicized was the fact that assisted living facilities also were hit hard by the pandemic.  

Assisted living facilities are the other primary form of long-term care in the U.S. These facilities generally are for older adults who require some assistance with their daily living tasks and yet do not require the higher level of care from a nursing home facility.  


The assisted living facilities in the United States do not have national, federally-mandated standards.  In fact, they have less regulation than nursing homes and the rules and regulations vary widely from state to state.  


Assisted living homes have faced enormous challenges during the pandemic. These facilities must define their challenges and then develop and execute plans to prepare for what comes next and determine whether the assisted living model has the capacity and the will for a transformation. 



Deaths: The number of deaths in assisted living facilities in 2020 escalated compared with the normal number during that time period, most likely due to COVID-19 and many COVID patients being moved into assisted living facilities in some states. 


Long-term care facilities overall accounted for more than a third of all coronavirus deaths nationwide, resulting in negative PR for the assisted living industry and leading many would-be clients to seek alternatives like home care. 


Competition: Medicaid dollars cannot be used to pay for assisted living facilities in most states. Low-income people who may be ideal candidates for assisted living are more likely to end up in nursing homes instead, even though they don’t need skilled nursing care the facility provides.  


Confusion: Personal care facilities add another challenge since they are often mistakenly called assisted living facilities. So, what is the difference between a personal care and an assisted living community? The primary difference is that if residents in a personal care community require the services of health care (formerly known as skilled nursing), they have access to a health care center within the organization. An assisted living community does not have a health care center, so additional services are brought to a resident for as long as possible. They will be discharged to a health care center with availability if a healthcare stay is needed.  


Staffing: Staffing challenges existed prior to the pandemic and it reached a crisis point in 2020 that has continued. Memory care emerged as a powerful, profitable marketing tool for assisted living facilities because families typically are more willing to purchase a private pay service. However, this has also proved to be the industry’s greatest risk of litigation, both before and during the pandemic.  


Memory care units emphasize socialization as a tactic to slow cognitive decline. But it can be difficult to help residents with memory impairments understand why they need to physically distance in the face of a new disease or restrict certain types of interactions with others.  



How can the assisted living industry change to meet present-day challenges, as well as the challenges of the future? 


History: Assisted living facilities began as a reaction to the increased regulation around nursing homes. Nursing homes were the sole facility option for older adults who needed help with daily living activities, regardless of their level of independence, at the beginning of the 1970s. 

The federal government began to impose more regulations on nursing homes directed to increase resident safety, especially for more medically frail older adults. Assisted living facilities began to emerge as a less costly and less medicalized option to nursing homes. 


The assisted living industry was born in the 1980s. There were no regulations governing the model. Guidance followed on an ad hoc, state-by-state basis and anyone could own and operate an assisted living facility.  


Transformation: Assisted Living Alternative 

Some industry leaders believe another form of senior living may rise in popularity in the aftermath of the pandemic, labeled as a sort of “assisted living facility-light.”  

This could mean assisted living with only one daily meal or fifteen meals a month. It could also include limited housekeeping, possibly a la carte. The maintenance staff could come in and fix your utilities, help with the Internet, and assistance with other technology stuff that frustrates seniors. Basically, the alternative would have a little more support than a 55-plus community, but be less intensive, heavily-staffed or expensive as an assisted living facility. 



AARP says states across the country could also make existing assisted living facilities more affordable if they allowed Medicaid funding to be used for them (e.g., Oregon). Assisted living facilities could also become more transparent about their capacity to care for someone as that person develops more complex medical needs.  


Clarity of Assisted Living Services 

It is critical for people thinking about and moving into assisted living facilities to clearly know what they are signing up for at the facility. One common area of surprise for people moving into an assisted living facility is that nurses are not present at all of these facilities. People need to clearly understand that they may not be able to stay there for as long as they live. The assisted living brand will be significantly threatened without more consumer protection safeguards put in place.  


Future Regulations  

The debate will continue whether assisted living facilities should have more uniform, nationwide regulation as a consequence of the pandemic. The repercussion of more regulations could mean that these facilities increasingly look like nursing homes. And people are thinking the result will exacerbate the skilled staffing and cost issues that already plague the nursing home industry. 


Looking Ahead 

The future of assisted living facilities requires anticipatory thinking, learning from mistakes made during the pandemic and considering the hard trends and soft trends in the industry to identify the disruptors that may appear. 


Closing Thought 

“I think that we’re moving into a decade of disruption.” Beth Mace, Chief Economist National Investment Center for Seniors Housing & Care. 


Glenn Ebersole is a registered professional engineer and the Director of Business Development at JL Architects,  a nationally licensed commercial architecture firm based in West Chester, PA. He can be contacted at [email protected] or 717-575-8572.