NaCCRA Forum: Assisted Living & Skilled Nursing

Our CCRC has significantly expanded (almost doubled) its independent living capacity without a corresponding increase in assisted living spaces and, at least for now, no clear plan. Is anyone aware of national standards or perhaps actuarial-based formulas for determining ideal proportions?

You haven’t mentioned whether your CCRC is a for profit or non-profit. Are there LifeCare contracts? What’s the occupancy rate after expansion? I would think all of these factors would play a role in determining the “ideal” proportion. And “ideal” from whose perspective?

A very large percentage of IL residents who can afford it seem willing to pay aides for assistance rather than downsize and move to AL. That, too, is a factor. Many of those folks stay in IL until they are sick enough to require skilled nursing, bypassing AL entirely.

There are no national standards regarding number of assisted living beds. I don't know enough about actuarial standards to address the second part. Here is a link to the Actuarial Standards Board.

https://www.actuarialstandardsboard.org/asops/continuing-care-retirement-communities/#211-levels-of-care

Excellent questions ... and excellent ideas for NaCCRA to lead on setting up an established program of data gathering, monitoring, and reporting... perhaps via encouraging the actuarial industry, or CARF, or LeadingAge or the Senate Special Committee on Aging ....

Any ideas on likely next steps?

I don't have any ideas, but in the meantime I'm going to modify my original post and, perhaps, get some replies that provide initial data on the issue within this forum.

So, I am asking others to share what the proportions for independent, assisted, skilled nursing, and memory care are in their nonprofit CCRCs.

To reiterate, the population here has almost doubled recently with the addition of 62 new independent living apartments and 20 new cottages without a corresponding increase in assisted living units. Overall, independent living is 94% occupied and both skilled nursing and memory care units continue to be around 50% occupied, but assisted living is at 100%.

Ask your management to show you the data in a monthly report. The numbers of beds by assisted living, skilled care, memory care. The number of available beds by each (unoccupied). The number of beds on hold (for residents who will need a bed in a short amount of time). The number of private pay resident beds (revenue is a benefit). Your management should have in place a process to evaluate appropriately. This planning will help ensure you have a bed when you need it.

Linda Kilcrease

Resident of a CCRC

At Seabury Retirement Community in Bloomfield CT, a non-profit, there is 1 assisted living unit for every 4.2 independent units (58/244=23.7%), which management considers a few more than needed. There is one skilled unit for every 3.38 independents (72/144=29.5%), and one memory care unit for every 4.5 independents (54/244=22.1%). Occupancy is 90% in assisted living, 92% in skilled nursing and 88.5% in memory care.

At Greenspring in Springfield VA, we have 1,361 IL units, 168 AL units, 59 Memory Care and 62 SN. IL and Memory Care are over 95%, while A/L and SN are in the low80% range

First, thank all of you who took the time to respond to my post re. assisted living proportions. I hope more forum members will also respond to increase the sample size. In the meantime, on the basis of an extremely small sample size (three), I am surprised to learn how small the proportion of assisted living spaces to total units is in this sample. The range is from a low of 7% here at Country House in Wilmington, DE (which, as I had mentioned in my original post, has just gone through significant expansion of new independent living units) to a high of 14% at Seabury.

As noted in Geoffrey Hughes’ post, residents often opt for private care in their independent living unit skilled nursing becomes essential. Perhaps the impact of this choice is greater than I anticipated. I do know that another factor is that many couples opt to care for each other as long as possible until to skilled nursing or memory care becomes essential while the majority of residents moving first to assisted living are single. 

I’ve started a spreadsheet for independent living, assisted living, skilled nursing, and memory care proportions that I will be happy to share once/if a larger sample size is obtained. 

Channing House in Palo Alto, California has 175 independent living units, 38 assisted living, 26 skilled nursing, no memory care.

As of 2/28/24 (annual report to the state), occupancy was 99% independent living and 67% assisted living and skilled nursing together.

I would suggest rather than reinventing the wheel, use the Leading Age Ziegler 200 Report. it is published every year. It does have a listing of over 200nonprofit senior living organizations with the number of independent living, assisted-living, and nursing care beds.

https://leadingage.org/wp-content/uploads/2023/09/LeadingAge_Ziegler_200_2023_FNL.pdf

Ann MacKay

This kind of suggestion and help is exactly what makes NaCCRA forum so valuable. Thank you!

Wake Robin in Shelburne, Vermont has 408 total residents of which 328 are independent living, 38 are in residential care (state licensing term corresponds to assisted living); 30 are in skilled nursing and 18 in memory care (licensed as skilled nursing). 96% occupancy

Carol Long in Southbury, Connecticut. Watermark East Hill has 130 Independent Living Units; 51 Assisted Living Units; 34 Skilled Nursing Beds and 14 Memory Care Spaces.

I live at CCRC Medford Leas in Medford, New Jersey. Our current management does not publish the numbers but I agree that many people pay for private care in their indepent living (IL) apartments to get better care. Our AL care, nursing care, and memory care are substandard because workers are paid much less. We used to be known for great care. Now we are known for high prices but not great care. My name is Kay Roberts at 609/947-4887.

I agree with Leslie. I never heard of the Ziegler 200 report.

The Ziegler reporting

See update above. I cannot delete this.

Linda Kilcrease

Resident of a CCRC

This is updated:

The Ziegler reporting is very respected. Here is the most recent report. You can read through it, or scroll down to see the list of the 200 CCRCs.

This is a repeat of what Ann posted before.

You will see the numbers you want in this report.

Note that the numbers do not separate skilled nursing and memory care. Also, if as I posted below, if you want more info on how the available beds are used, ask your community for: The number of available beds by each (unoccupied). The number of beds on hold (for residents who will need a bed in a short amount of time). The number of private pay resident beds (revenue is a benefit). Your management should have in place a process to evaluate appropriately. This planning will help ensure you have a bed when you need it.

LeadingAge_Ziegler_200_2023_FNL.pdf

Linda Kilcrease

Resident of a CCRC

Thank you. Like others, I was not aware of the Ziegler Report. It certainly will avoid reinventing the wheel.

A new LeadingAge/Ziegler 200 report with 2023 data will probably be published this month--since the previous report came out in Sept. 2023.

Reply to Philippa Strahm. I doubt there will be a second release of the report. I don't think that makes sense; this does not say "draft". The link below is to the list of reports by year. They all seem to be published one time in September or October.

LeadingAge Ziegler 200

Linda Kilcrease

Resident of a CCRC

Linda, the link you posted says "developed annually", which supports the idea that a new edition will be out this month.

To clarify further: Right after the picture at the top of the report which you and Ann have provided, it says "Report issued September 2023." The data in that report is for 2022.

Philippa,

The most recent link saying LeadingAge Ziegler 200 has the list of reports by year. That does not yet have the 2023.

The link I posted prior to that which adds to the title 2023 FN pdf is the 2023 report itself just released. The first page has on the cover 2023, and it was released in September 2023.

Linda Kilcrease

Resident of a CCRC

I'll add that the 2023 report says, "The 2023 LeadingAge Ziegler 200 lists the largest not-for-profit systems providing aging services through senior living in the United States, in order of total owned market-rate units, as of December 31, 2022."

Each annual report has this same format. In the 2023 report, the data is from the end of 2022 and published a few months later in Sept 2023. I see nothing that says a second edition will be published a month later in October.

Linda Kilcrease

Resident of a CCRC

Also note that, in addition to the multi-site communities starting on page 22, there is a break-down of IL, AL, & SN for single-site communities beginning on page 242.

Concerning Samuel's July 31 question "Is anyone aware of . . . actuarial-based formulas for determining ideal proportions?":

A. V. Powell is an actuarial firm that specializes in CCRCs. They are retained by some CCRCs periodically to examine the individual CCRC's finances and other characteristics, to produce a report to help in decision making about setting fees and the capacities of various levels of care. 

The reports include a vast array of data, including such as 10-year projection of IL turnover, 10-year projection of health center usage by contract-holders, number of health center contract-holders per 100 IL residents, average occupancy by level of care, etc.

https://www.avpowell.com

Very helpful to have the A.V. Powell information. I do have a further question. In reviewing the Powell benchmarks and the LeadingAge/Ziegler data it is no breakdown for memory care units. So, does anyone know whether memory care is included under assisted living or skilled nursing categories in the Powell or LA/Ziegler reports?

Is the referenced A.V. Powell report the one at https://www.avpowell.com/knowledge-base/ ??

yes