Assisted Living Facilities

Industry Profile Report

Dive Deep into the industry with a 25+ page industry report (pdf format) including the following chapters

Industry Overview Industry Structure, How Firms Opertate, Industry Trends, Credit Underwriting & Risks, and Industry Forecast.

Call Preparation Quarterly Insight, Call Prep Questions, Industry Terms, and Weblinks.

Financial Insights Working Capital, Capital Financing, Business Valuation, and Financial Benchmarks.

Industry Profile Excerpts

Industry Overview

The 14,000 assisted living centers in the US serve adults who need help with everyday tasks, but don’t require full-time care. Continuing care retirement communities (CCRC) provide independent living, assisted living, and nursing home facilities, allowing residents to stay on the same campus as their needs change.

Resident Turnover

Because the average stay at an assisted living facility is less than two years, firms may struggle to maintain occupancy while managing constant turnover.

Employee Turnover

Employee turnover in the senior living industry is high at about 50%.

Industry size & Structure

The average assisted living facility employs about 35 workers and generates about $2 million annually.

    • The assisted living industry consists of about 14,000 firms that employ almost 500,000 workers and generate over $30 billion annually.
    • The industry is concentrated at the top and fragmented at the bottom; the top 50 companies account for about 40% of industry revenue.
    • The assisted living industry includes chains, independent operators, and non-profit organizations. More than 55% of establishments are chain-affiliated; more than 40% are independently owned, according to the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).
    • About 90% of firms are for-profit entities, while about 10% are non-profit tax-exempt organizations.
    • Large companies include Brookdale Senior Living (726 communities), Life Care Services (LCS – 135 communities, 95 campuses), and Holiday Retirement.
    • There are approximately 28,900 assisted living communities with almost 1 million beds in the US.
    • More than 800,000 Americans reside in assisted living; 71% are women and 29% are men. More than half of residents are aged 85+.
                            Industry Forecast
                            Assisted Living Facilities Industry Growth
                            Source: Vertical IQ and Inforum

                            Coronavirus Update

                            Jun 14, 2022 - Staffing Shortages Continue
                            • About 87% of facilities are facing moderate to high staffing shortages, 99% rely on staff working overtime or taking extra shifts to keep running, and 70% are hiring temporary staff, according to an American Health Care Association survey. Burnout and fatigue cause many people to leave the industry for other careers.
                            • The Centers for Medicare and Medicaid Services (CMS) issued guidance in early April that terminates numerous blanket waivers applicable to skilled nursing facilities (SNFs), inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities. CMS expressed concern “about how residents’ health and safety has been impacted by the regulations that have been waived, and the length of time for which they have been waived.” CMS said that it is removing some operational flexibilities not directly related to infection control. A CMS modification of requirements related to development, implementation, evaluation, and maintenance of an effective, comprehensive, data-driven QAPI program by long-term care facilities is among those cancelled. This waiver gave providers the ability to focus on adverse events and infection control, and those aspects of care delivery most closely associated with COVID-19 during the federal Public Health Emergency.
                            • About two-thirds of the senior housing units relinquished during the four quarters following the onset of the coronavirus pandemic were refilled in the second half of 2021, according to real estate services firm Marcus & Millichap (M&M). The pace of move-ins during the second half of 2021 increased in some cases to pre-pandemic levels, whereas the pace of move-outs remained stable. “The recovery last year was driven by a pent-up need for the care services that seniors housing communities provide, as well as a higher level of confidence among prospective residents once more of the population became vaccinated,” M&M analysts said.
                            • Long-term care providers surveyed by insurer Genworth Financial said that elevated costs associated with personal protective equipment and other COVID-19 protocols such as testing, vaccination status tracking, and quarantining are likely to subside if COVID-19 case numbers continue decreasing.
                            • The US Supreme Court allowed a federal vaccine mandate to stand for medical facilities that take Medicare or Medicaid payments. "We agree with the Government that the [Health and Human Services] Secretary's rule falls within the authorities that Congress has conferred upon him," said the majority, writing that the rule "fits neatly within the language of the statute. After all, ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm."
                            • Some industry experts say that the vaccine mandate helps vulnerable facility residents but may cause more caregivers to resign from facilities that are already suffering from staffing shortages.
                            • COVID-19 deaths in LTCFs make up at least 23% of all COVID-19 deaths in the US. This share has decreased since the start of the pandemic, when LTCF deaths were nearly half of all deaths nationally. The share has dropped over time for a number of reasons, including high rates of vaccination among residents, rising vaccination rates among staff, an increased emphasis on infection control procedures, declining facility occupancy, and the lack of data on deaths in assisted living and LTCFs other than nursing homes in recent months.
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