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The future of assisted living hinges on technology adoption and rising resident acuity, and operators must continue to get creative to shape the sector’s landscape.
Driving the sector’s change is the fact that residents are arriving older and with more chronic health conditions. At the same time, the next generation is bringing new preferences for aging in place and lifestyle-oriented amenities and services that they enjoyed in their everyday life.
Both Trilogy Health Services and Cogir Senior Living report a growing number of residents arriving with more advanced care needs for many reasons, and the companies are catering to those residents by shifting their services to improve their care quality and extend resident length of stay.
“You’re going to see more remote patient monitoring, more technology being utilized,” said Trilogy Health Services Senior Vice President and Chief Nursing Officer Rhonda Dempsey. “What assisted living looks like today is going to look different 10 years from now.”
All the while, senior living operators are exploring artificial intelligence to make staff more efficient and analyze trends in resident conditions sooner than they previously were able.
Another driving trend continues to emerge in the form of lifestyle- and hospitality-driven programming and amenities combining the clinical expertise common in assisted living with vibrant options that help residents live fulfilling lives in retirement.
Shifting model for rising acuity, new preferences
Rising acuity among residents is both a challenge for operators to grapple with, but also an opportunity to differentiate themselves with new clinical services and technology.
Scottsdale, Arizona-based Cogir Senior Living COO Gottfried Ernst said residents arrive at the operator’s communities at a later stage than they did prior to the Covid-19 pandemic. Often they are bypassing independent living and moving directly into assisted living or memory care.
“Our care teams increasingly support more complex health needs and that challenges us to think outside the box,” Ernst said. Cogir sees an average length of stay in assisted living between 18 and 22 months.
Louisville, Kentucky-based Trilogy Health Services previously saw an assisted living length of stay over two-and-a-half years before the pandemic. That average now sits at around 18 months, according to Dempsey.
Senior living operators such as Trilogy and Cogir have catered to that shift through programming and care services that are both more specialized and also more lifestyle-oriented than in previous years.
Technology is a piece of the puzzle for both companies. Dempsey envisions a future in which senior living providers increasingly rely on remote patient monitoring and AI-supported technology to improve patient care and staff support.
Trilogy uses a tool AI On to predict resident falls and detect changes in condition. Residents wear a device about the size of a half-dollar coin, which tracks their temperature and other data, according to Dempsey.
“It’s an early indication of illness and it changes before your heart rate, blood pressure, those signs that lead to falls, hospitalizations and unplanned ED visits,” Dempsey said. “We’ve been able to catch unplanned avoidable hospitalizations, infections, and pneumonia. We’re able to catch this because of technology.”
The system integrates data into Trilogy’s electronic health record and care teams receive alerts when a resident’s temperature rises to 100.4 degrees.
Trilogy’s nursing teams can use the data to make faster adjustments. Residents who opt in to the voluntary program either pay for it directly or receive reimbursement.
Cogir also implements fall detection technology from SafelyYou in assisted living and memory care. Since partnering with the company last year and implementing its tech, Cogir communities have significantly reduced hospitalizations among assisted living residents, Ernst said.
With added flexibility and new insights from tech-enabled systems assisted living providers now revamp care models to better support aging in place.
“There’s going to be an increased demand for flexible care models that support aging in place” Ernst said.
In the not-too-distant past, assisted living was a gateway to higher-acuity care, and residents moving into the setting were not always able to keep their friends or enjoy the same amenities as before their move. But that has changed in recent years as operators have prepared for the looming boomer generation.
Trilogy’s communities span the senior living continuum from independent living to skilled nursing, and the company’s units are licensed so that residents don’t have to move to get a higher level of care. The company also designs its campuses such that residents share public spaces and spark interactions. The idea is to enable residents to access needed health services without disrupting routines, social networks or quality of life.
“When you’re on the same campus you’re not leaving your friends,” Dempsey said. “You’re just getting more supportive services… and able to age in place.”
Blending clinical excellence with lifestyle offerings helps keep assisted living residents balanced, Ernst said. The company offers weekly and monthly gatherings, spa treatments and chef-driven menus with resident input.
“It’s really helped us insert that hospitality flare into our assisted living,” Ernst said. “We’ve seen much more demand for a hospitality-focused program than ever before.”
The incoming group of residents aren’t just bringing with them different preferences, they also are arriving with new financial needs than their predecessors. By 2033, 15.9 million seniors will not be able to afford assisted living services as they are priced today, while also not qualifying for Medicaid, according to the latest projections.
No doubt, affordability is a huge challenge for residents. But for operators, it can be an opportunity if they can bring their monthly rates down to middle-market levels.
To address affordability, Ernst urged senior living providers to lean into technology adoption. That also means reducing costs or coming up with a “hybrid” senior living program that could address aging-related needs outside of the traditional senior living environment. Cogir has had success in decentralizing its concierge function, automating medication dispensing to residents and reimagining its dining program with technology while also adding fall detection systems to better care for residents.
With Trilogy’s robust campus model, the company is able to support high acuity care needed for older adults as they age, with Trilogy able to allow residents unable to pay or who have outlived their financial resources to a bed supplemented by a Medicaid waiver, Dempsey said.
Evolving staffing for the future of assisted living
In 2025, senior living demand is surging. But operators must have the staff to actually meet that demand or they risk leaving money on the table. To that end, Trilogy and Cogir have also rethought their models for staffing in assisted living.
Residents are not the only ones who desire more flexibility, workers also desire it in scheduling. Many senior living organizations now have flexible schedules for employees as a result, and Ernst said Cogir’s scheduling aligns with employee life needs instead of purely business goals.
“Flexible scheduling models are tailored to the person’s life not tailored to our business needs,” Ernst said.
Both Cogir and Trilogy have strengthened internal pipelines by creating tuition reimbursement and career pathways to recruit and retain staff.
“We pay for our CNAs to become LPNs or LPNs to become RNs,” Dempsey said. “Employees want to know there’s a place to grow in the organization.”
Pay increases and career advancement help providers respond to very competitive recruiting environments Ernst said. He added that operators must get creative to solve retention and turnover challenges noting that Cogir communities monitor employee burnout and offer additional time off when needed.
In the future, Ernst said operators must continue to leverage technology and attempt to serve more customers in the middle market to reach a wider customer base of older adults.
In assisted living, Dempsey sees an opportunity to turn the sector into a space that can meet the wide ranging needs of services for older adults today.
“I would want the future of assisted living to be like a miniature Blue Zone taking care of the mind, body and spirit,” Dempsey said.
