‘significantly More Difficult’: Assisted Living Operators Grapple With Changing Resident Acuity

It’s a common refrain in senior living that today’s assisted living communities are closer to yesterday’s skilled nursing facilities. In 2025, operators are indeed contending with residents’ increasing acuity needs.

Multiple factors have pushed assisted living care delivery into higher acuity. Operators have said older adults are waiting longer to seek out senior living services, meaning they are farther along in their aging journeys when they move into a community. At the same time, older adults are bringing with them preferences for wellness and expect those kinds of amenities and services, even in assisted living.

“The business is significantly more difficult now than it was five years ago,” Ascent Living Communities Co-Founder Susie Finley recently told Senior Housing News. “We’ve seen some organizations back down from assisted living, but we’ve chosen to lean into the care side of the world while embracing a path forward that puts living a fulfilling life at the center of what we do,”

Staffing, technology adoption and value-based care models have helped operators including American House Senior Living, Juniper Communities, Arrow Senior Living and Ascent Living Communities reevaluate how they provide and charge for care and make better margins. 

Value-based care models fill care gap

Over half of senior living residents manage two to three chronic health conditions, according to a 2024 analysis from the Centers for Disease Control and Prevention (CDC). That number climbs higher to over a dozen chronic health conditions when combining assisted living residents of senior living communities and nursing homes, according to NORC at the University of Chicago.

Southfield, Michigan-based American House Senior Living, which operates 60 communities nationwide, and the company recently partnered with Curana Health to bring in-residence health care services to residents to older adults living at 11 of its communities in Tennessee.

“We’re seeing more complicated acuity in our residents that our teams are having to manage on a daily basis,” American House COO Alex Germain-Robin told SHN. “It’s hard for families to navigate through the health care system and they look at us as an expert but we wanted to make sure we had the right partners to help us do that.”

The partnership also includes American House participating in Curana Health’s Medicare Shared Savings Program (MSSP) and Accountable Care Organization (ACO) to improve care coordination, shared savings benefits with an aim of improving resident health outcomes.

With the Tennessee market as a “launching point,” Germain-Robin sees opportunity in potentially expanding the partnership in other states and American House communities. The effort launched in the Volunteer State is directly pointed at improving health outcomes for residents, while improving high acuity care delivery through care coordination.

In the future, Germain-Robin said “nothing’s off the table” with Curana going forward regarding the rollout at future communities in other markets.

“Things are just more complex now and costs are going up and we need to deliver care property and there’s a big push on value-based care because there’s proof that it works,” Germain-Robin said. “Our goal is improving length of stay, quality of life and resident satisfaction and this will be a partnership in tandem going forward.”

Prior to the partnership with Curana, Germain-Robin said nurses on care teams at American House communities often faced a delay in communicating with physicians’ offices regarding questions of care for residents who recently visited their primary care physician. Through the new partnership, it “shortens the access point” care staff face in connecting with health care staff in providing resident care.

“We’re talking about how do we improve a resident’s health to where a negative episode doesn’t happen in the first place and we’ve seen residents that have waited so long that they’re coming to us in even more complicated health situations and now we have a strong partner,” Germain-Robin said.

Bloomfield, New Jersey-based Juniper Communities, a longtime adopter of the value-based care effort in senior living, has expanded its Perennial Consortium model as assisted living “continues to evolve,” according to CEO Lynne Katzmann.

Katzmann said there were multiple ways operators can shift operations to better accommodate higher-acuity residents, including: Improved resident monitoring, real-time and updated health assessments and the ability to “intervene appropriately” in order to prevent hospitalizations.

“Assisted living providers without data are going to have a harder time as acuity continues to evolve and I believe for people who don’t need 24-hour nursing, or can’t afford it, you’re going to see assisted living change,” Katzmann said.

As these challenges in rising acuity mount, Katzmann said she envisions a kind of “assisted living plus,” blending services typically seen in memory care and hospice into assisted living overall.

“The way [operators] deal with higher acuity requires some differences in the way we have been doing things,” Katzmann added.

Katzmann urged operators to put their efforts into improving staffing, stabilizing employee turnover and evaluating technology platforms to ensure data can be accessed by care teams easily and is updated regularly.

“We’re going to see that people will continue to come to us older than in the past and that’s going to happen because there are more options for people who want to stay home until they’re unable,” Katzmann said. “The people part of it and the cost part of it are difficult to solve, and that’s why people come to assisted living.”

Evolving care needs force ‘better practices’

As assisted living care needs continue to become more complex, senior living operators must drive changes to their operating playbooks if they want to remain competitive and build brand recognition in their local markets.

Saint Louis, Missouri-based Arrow Senior Living is in the midst of expanding its tech platform, known as Archer, through an app that allows residents to view lifestyle and programming information. While not care-related, the effort shows the operator’s commitment to deepening services, and shows that operators can’t rely on care delivery alone to meet resident needs, according to CEO Stephanie Harris.

Evolving care needs in assisted living have been a “progression,” but create an opportunity to bring new ideas forward in solving challenges in assisted living, Harris said.

“We have an opportunity to mitigate acuity with better practices,” Harris said, noting that the company has committed to seeking Joint Commission accreditation to improve the company’s care coordination effort.

That effort follows Arrow placing emphasis on moving new residents into communities “more proactively” while engaging in a “long-term cultivation process” of prospect leads in sales and marketing.

“If we could start to look at ways to extend or meet people a little sooner in the process, that will add value to the bottom line and improve outcomes,” Harris said.

St. Charles, Missouri-based Arrow Senior Living operates 44 communities.

Building out a technology platform in a way that provides care teams real-time information and is easy to navigate can be a differentiator in improving resident care and combat rising acuity, according to Ascent Living Communities Co-Founder Tom Finley. The Centennial, Colorado-based senior living provider crafted a data platform capable of providing health data to care staff that is, in some cases, less than 24 hours old.

This allows the company the ability to shift resources and direct caregivers as to which residents to focus more closely on as acuity rises in assisted living.

“We know that we’re staffing exactly to the hours of what the residents need at each community and we know we’re able to meet those needs,” Tom Finley said.

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