The assisted living industry shrinks as the need for it grows

Does rising cost parallel consumer distaste for long-term care? Perhaps this caught your eye – the NY Times article on escalating long-term care costs noted that the assisted living industry, according to its trade association, ALFA, now has a national resident population of 730,000, that the move-in age is now 87, and that the average time of residence is 2 years. As has been noted several times on this blog, if the move in age is rising, the industry must be continuously marketing its capacity. Tours with those not yet in need must be painful -- the assisted living resident increasingly resembles the nursing home resident of yore -- and at the same time dementia care costs have risen to their current daunting average level. Furthermore, dementia care is the most profitable service -- and fastest growing offering -- in today's assisted living industry.

As lives lengthen, oddly, the industry shrinks. But despite lengthening life expectancy for those who can afford assisted living, the looming need for dementia care, it was just two years ago at the peak of the recession that there were more than 900,000 residents in assisted living. If that decline in resident population is correct, can it be that the prospective consumer – the family – simply does not want to buy the product? How can that be in a time when the 85+ population is growing, the numbers of seniors with dementia is growing, and managing home care workers is, as the Times article indicates, such a challenge?

Perhaps a retail customer service mission is required.  A nurse friend of mine told me how on a recent Sunday she visited an aging friend living in an assisted living memory unit. She found the aging resident wheezing, sitting without shoes and eyeglasses. My friend worried that there were too few aides present and that the staff was confused about the resident’s current ailment and related medication. After finding shoes and eyeglasses, she asked to check the prescribed medications, it turned out that the resident was now on a cough medication that she had been taking for many days. My friend knew that the family (temporarily out of state) had not been told about it. Was this a good retail experience? Would my friend or the resident's family provide word-of-mouth referral? For that matter, is excellent customer service and an outstanding retail experience the marketing message to consumers of an assisted living memory services? Or is word-of-mouth spreading the message about the industry's warehousing of frail seniors, about residents left with too few low-paid aides and about nurses who are too pre-occupied with busywork to be aware of the residents or oversee the work of aides? And if not the nurse, then who?

Caring for seniors means providing excellent service that is priced right. There are numerous theories, from inside and outside observers, about the self-inflicted reasons for the shrinking assisted living industry. The battered housing market and shrinking value of retirement assets are often bemoaned as barriers to residents moving in at a younger age. Some note the need for better marketing, better food, improved staff training, more engaging activities, social network smarts, and of course, providing ever-more-attractive property. But is great care marketed? Do we know what it is? For example, is this new report about dementia and care quality communicated across the assisted living industry so that the industry can rationalize its pricing to customers? This is an industry that publicly asserts an aversion to federal regulation. Perhaps by following best practices for quality care that focus on the customer’s experience, perhaps counting a visitor's observation as a proxy for quality of service for memory-impaired clients, then maybe the assisted living industry will reverse its frog-in-cold-water trend of slowly shrinking. Perhaps it could then lower the move-in age and be known as an industry with a reputation for excellent care and easily observable quality of life that visitors will recommend and refer.