The Rise of Assisted Living, Its Aging Population, and What It Means for Facilities and Oversight

Serving as a middle option between independent living and institutional care, assisted living is playing an increasingly important role in long-term services and supports (LTSS), with more older adults than ever living in assisted living communities. That growth has meant changing demographics, emerging challenges, and a greater focus on evolving oversight needs. Today, residents in assisted living communities are older and are more likely to have dementia, amplifying the need for appropriate direct-care staffing. 

Many of assisted living’s challenges, such as affordability, mirror those of all LTSS settings. Others are more specific to assisted living, including limited federal government oversight and inconsistent state policy. This Spotlight report examines who lives in assisted living communities, how these communities operate, and key operational and policy issues that stakeholders should understand. Read the full report. 

Key Takeaways 

• Now serving nearly 1 million people, assisted living is a critically important form of long-term services and supports, bridging the service gap between independent living and institutional care. 
• The population of assisted living residents has changed over time. Almost half (44 percent) of assisted living residents are diagnosed with Alzheimer’s or dementia, surpassing the rate (41 percent) among nursing home residents. 
• Today, more people ages 85 and older live in assisted living than in nursing homes. 
• Limited Medicaid coverage and high out-of-pocket costs for assisted living services make affordability an issue for most Americans. 
• Lack of federal oversight has meant a nationwide patchwork of regulations, quality standards, and enforcement.