Senior living operators are not facing a short-term labor shortage, they are facing a “long-term realignment” as rising demand puts pressure on their ability to staff communities.
That’s according to National Investment Center for Seniors Housing and Care (NIC) Senior Principal Omar Zahraoui, who said Tuesday during a webinar on workforce trends that senior housing and care companies “will need to capture a larger share of a tight labor market, especially for care aides and nursing assistants, roles that now make up the majority of new job growth.”
“The future won’t be built on higher pay alone, it will be built upon better work,” he said during the webinar.
By 2033, the U.S. population is projected to grow by 4% while the 75 and older population will grow by 49% in that time. That growth is no doubt good from an occupancy perspective, but operators may struggle to meet demand as it rises in the years ahead.
At the same time, trends show incoming older adults are arriving at operators’ doorsteps with complex medical conditions that require care.
Assisted living and home health industries have now surpassed continuing care retirement communities (CCRCs) and skilled nursing in total workforce participation, with over half of the workforce in senior housing and skilled nursing coming from specific, care-based roles.
The industry will need to add over 660,000 workers by 2033 to keep up with projected demand in that time as the population ages, NIC data shows.
According to NIC data, CCRC employment is down 5% while assisted living employment rates have increased 11% since 2020. Between 2023 and 2033, the number of care aides is projected to grow by 21% or 820,000 jobs while resident nurses are projected to grow just 6% in that time, followed by nursing assistants by 4% as licensed practical nurses (LPN) could see a 3% increase.
New scale needed to thwart these demographic-driven changes in the industry will require a “net new workforce growth at scale,” Zahraoui said.
In search of senior living workforce’s ‘next chapter’
To take steps to improve the senior living industry’s ability to court new workers and retain existing staff, Zahraoui noted that the industry must not rely on wage growth alone to attract new workers. Instead, operators must create purpose, support and demonstrate “long-term value” to existing employees and jobseekers to build careers in the sector.
The true nature of the senior living talent crunch is not a compensation problem tied to wages, but providers must refocus employment efforts around schedule flexibility, culture and career growth for improving retention, Zahraoui noted.
“The opportunity ahead is not just to compete for talent, but to redefine what it means to build and belong to a care workforce in senior housing and care,” Zahraoui said.
The senior living industry could improve labor shortages within health care positions by advertising caregiving careers to men. Although ASHA data shows men hold about half of all the management positions in senior living, NIC data shows there are far fewer in frontline caregiving roles. At present, nearly 90% of caregiving and support roles are currently held by women in the industry, NIC data shows.
Indeed, operators have an opportunity to attract more men to the senior housing and care workforce, but only if they create “intentional roles and pathways” for men in caregiving roles seeking “purpose, stability and growth,” Zahraoui said
The projected total number of senior living residents is also set to increase from 2.9 million today to 4.3 million in 2033.
“We’re not just talking about more people here. We’re talking about more people who are older, more medically complex, and more likely to need care support,” Zahraoui said. “The aging population is accelerating much faster than the general population, as this slide shows, and employment in the senior housing and care industry needs to rise proportionally to meet that shift.”
Nursing assistants had an average staffing ratio of 22 workers per 100 residents, while care aides on average have a ratio of about 11 per 100 residents. For LPNs and LVNs, that ratio was just eight per 100 residents; and for registered nurses, six per 100 residents.
“Based on projected demand and staffing ratios … senior housing and skilled nursing will require 484,000 care aides, up 159,000 from 2023 levels; 245,000 registered nurses, up 80,000 from 2023 levels; 958,000 nursing assistants, up 328,000; LPNs and LVNs, up 108,000,” Zahraoui said. “Combined, that’s more than 660,000 additional workers across just four occupations over the next decade.”
Wage growth in CCRCs increased 2.9% in 2024, at the same time that rent growth has remained at 4%. While wages have peaked, they are still returning to pre-pandemic levels, Zahraoui added.
Wages in assisted living increased by 7.4% last year while rents have lagged at 3.7% increase compared to last year, a gap that has persisted for years, Zahraoui said.
In assisted living, wage growth peaked last year reaching 13% in 2024 and is “now leveling off” as both senior living and skilled nursing workforces account for 60% of total expenses, NIC data shows.
That puts “direct pressure” on net operating income and reinvestment capacity, Zahraoui said.
While care aides, nursing assistants, LPNs and other nursing positions in senior housing remain “broadly competitive” with adjacent health care sectors, Zahroui said wage pressure is “not the only issue” facing the industry’s workforce challenges. Traction and retention challenges will remain as it will require more than just wage growth to improve staffing challenges in senior living, he added.
‘Dependent on an immigrant workforce’
Senior living operators have long viewed immigrants to the U.S. as a crucial source of new workers. But the administration of U.S. President Donald Trump is taking a hard line on new immigration, and is actively deporting immigrants seeking residency, along with raiding construction sites and other businesses.
Last month, the Supreme Court ruled that the Trump administration can revoke the temporary legal status of more than 500,000 migrants from Cuba, Haiti, Nicaragua and Venezuela.
About a quarter of employees of residential assisted living communities are immigrant workers, according to Lisa McCracken, head of research and analytics at NIC.
“Our sector is definitely dependent on an immigrant workforce,” she said during the webinar Tuesday. “The immigrant workforce is something that has been a key part of helping us fulfill those positions and meet the demand.”
She pointed to programs helping nurses from the Philippines immigrate to the U.S. and work in health care as “a strategy – but not the [only] strategy” that operators can use to fill open positions.
Although deportations and the lack of new immigration isn’t imperiling the current construction workforce, according to McCracken, she said that current actions could lead to a chilling effect on the future pipeline of immigrant construction workers, representing a potential complication for new projects in the future.
