Major differentiators among assisted living facilities

Glenn Ebersole//April 26, 2023


Major differentiators among assisted living facilities

Glenn Ebersole//April 26, 2023

Senior living facilities have been experiencing rapid growth. The over-65 population is projected to grow from 46 million today, to 71 million by 2030. And 33 million of that population will be over age 75 with increasing risk of dementia and chronic conditions. 

The horrific impact from the COVID-19 pandemic was highlighted by the dreadful effect it inflicted upon frail seniors. This impact has accelerated the need for safe and desirable housing options for this rapidly growing demographic. 

About 6% of people over age 65 live in senior living communities, which includes independent living, assisted living, memory care, and skilled nursing, either standalone or part of a life plan community that offers the full continuum of care; the rest live at home.  

All assisted living facilities are not created equal. There are almost 30,000 assisted living facilities in the U.S. that serve the same general population and support the same general goals, but they vary widely in size, location, offered services, transition path to next level of care, affordability, safety and planning for the future. 

Here are some of the important things that differentiate assisted living facilities  

Location of facility 

The importance of location depends on each potential resident and their individual preferences. Many residents prefer to stay in the community where they were living, so they can remain close to friends and familiar surroundings. Other considerations include proximity to a hospital or doctor’s office to provide needed health care and to be prepared for occurrences that will require additional health care services beyond what they have at the assisted living facility. 

Size of facility 

Size does matter in assisted living facilities. The average number of licensed beds in an assisted living facility is 33, according to NCAL (National Association of Assisted Living). Facilities vary widely in size, from very small facilities with 4 to 10 beds to extra-large facilities with more than 100 beds.  

The staff-to-resident ratio is another differentiator. Group homes, including adult family homes or board-and-care homes, are an emerging type of assisted living facility that generally has fewer residents and sometimes as high as 1 staff member per 5 or 6 residents. This favorable ratio allows staff members to really get to know each resident on a personal basis and provide personalized care. These small group homes are typically located in residential neighborhoods.  

Size can also affect the types of services offered. Large facilities, for instance, may be more likely to offer amenities including movie theaters and swimming pools or specialized units for memory care. 

Number and level of offered services 

Assisted living residents often need help with only a few activities of daily living, such as bathing, dressing and walking, and do not require 24/7 skilled nursing care like the residents in nursing homes. 

Assisted living facilities typically offer dining services, housekeeping, exercise and wellness programs and medication management support. In addition, the facility may also provide some tailored services based on specific health needs, such as Alzheimer’s disease, Parkinson’s disease, and intellectual and developmental disabilities. 

Most assisted living facilities provide health care services, such as a pharmacy or pharmacist, dietary support and physical, occupational and speech therapy. About two-thirds of facilities provide hospice and skilled nursing, while slightly more than half provide mental health counseling or social work services, according to NCAL.  

There are also many facilities that invest in programs to enhance quality of life, including art and pet therapy, computer labs, piano lounges and community outings.  

Transition path to next level of care 

Assisted living facilities that are part of a larger community offer a range of facilities including nursing homes and this can facilitate a future transition if and when assisted living is no longer adequate to meet a resident’s person needs. 

Certain assisted living facilities may have enhanced licensing. These Enhanced Assisted Living Residences (EALRs) have additional certification that allows residents to age in place. An EALR can accommodate residents who require physical assistance from another person to walk or climb stairs, for instance, or who are dependent on medical equipment and require frequent assistance.  

If the facility is not licensed to provide a higher level of care, assistance will be provided to families to find the next proper facility, which may be a nursing home or a memory care provider. 


The cost of an assisted living facility and how it is paid for is a major differentiator. The room size or assignment to a private or shared room likely will be affected by the price. 

Facilities can differ in how you pay for them. That may involve an upfront cost, monthly rent, a la carte services or a tiered system. 

Assisted living is primarily paid for through personal resources, while most nursing home residents are covered by Medicare or Medicaid, due to the way those government programs currently cover long-term care. Long-term care insurance may also help cover assisted living, depending upon the policy. 


Proper safety measures are major differentiators. Safety measures of utmost importance in assisted living facilities include:  

  • Safety alert systems 
  • Proper levels of security for the facility and its residents 
  • Vigilance to prevent resident abuse 
  • Preventing antibiotic-resistant infections of residents 
  • Proper administration of medications 
  • Adequate grab bars and handrails in bathrooms 
  • Adequate lighting in living areas 
  • Unobstructed walkways 
  • Well maintained flooring surfaces 
  • Chairs with armrests 

Planning for the future 

Architects, interior designers, landscape architects, civil engineers, MEP engineers, acoustic engineers, and other professional service providers must be included as part of the team that plans and designs assisted living facilities. And the team needs input from the stakeholders that include health care workers, future residents, operations and maintenance staff, and other members of the team that provides the services to the residents. 

Scenario planning with the “what ifs” is required as one of the lessons learned from the pandemic so there is thoughtful and strategic planning for the future. 

Closing Thought 

“Old age is an excellent time for outrage. My goal is to say or do at least one outrageous thing every week.” – Maggie Kuhn, was an American activist known for founding the Gray Panthers movement. 

Side note: Being surrounded by people all the time in assisted living provides a better opportunity to take on outrageous activities. 


 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. He can be contacted by [email protected] or 717-575-8572.