Kate Miller
Katherine Miller, PhD

Produced in conjunction with the Population Aging Research Center at the University of Pennsylvania.

By 2029, more than half of middle-income senior Americans will struggle to afford the cost of health care, including fees for residential care. To meet their needs, the country needs to ensure an adequate supply of affordable home-based and community-based long-term care services.

Liisa Laine, PhD, MSc

But that’s not happening, according to a study by LDI Associate Fellows Katherine Miller and Liisa Laine, and Senior Fellow Norma Coe that explored the changing landscape of private pay senior housing communities—the independent living, assisted living, and continuing care retirement communities that are increasingly popular for adults not requiring nursing home-level care. They found that between 2015 and 2019, the number of these senior housing facilities increased, but the number of available beds and skilled nursing beds decreased. There was also a shift in ownership, as the proportions of facilities owned by for-profit companies and operating as chains increased as well. The findings were consistent across regions.

What do these nationwide changes mean for seniors and their families? The declining availability of senior housing beds could make access to care more difficult and more costly, while the declining availability of skilled nursing beds in areas of decreasing senior housing beds may compound the problem. As care becomes less available and less affordable, seniors may need to rely more heavily on support from family caregivers. However, by 2034, older U.S. adults are expected to outnumber children, increasing overall demand on family caregivers.

Next Steps

Norma Coe
Norma Coe, PhD

We are at a pivotal time where the need to ensure access to affordable senior housing has become critical. To prevent significant disparities in access to senior care housing, policies must be developed that promote accessibility and affordability. What steps are needed to address issues surrounding affordability and access? The collection of better data and increased research on senior housing communities.

  1. Supply Data: Due to existing regulations, licensing, and certification processes which vary by state, limited data exist to identify and describe the national market of senior housing communities. National, systematic data are needed to identify facilities, operators of facilities, where they operate, the type of care provided, and the health outcomes of seniors receiving care.
  2. Quality and Price Indicators: More information is needed on key quality and affordability indicators, including prices, patient health outcomes, and staff turnover. With a growing proportion of senior housing communities operating as for-profit businesses (which is associated with worse patient outcomes in the nursing home setting), identifying senior housing providers and monitoring patient outcomes systematically across facilities should be considered.

Improved data can allow for research to be conducted to inform policies surrounding the supply and delivery of long-term care for seniors in the United States.

The study, “Growth of Private Pay Senior Housing Communities in Metropolitan Statistical Areas in the United States: 2015–2019,”  was published in the July 5, 2022, issue of Medical Care Research and Review. Authors include Katherine Miller, Jiayi Zhao, Liisa T Laine, and Norma Coe.


Kaday Kamara

Kaday Kamara

Health Policy Coordinator, Penn LDI

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