The Next 50 Years of Senior Living: Perspectives from a CCRC CEO

It is an accepted truth that senior living is a starkly different business today than it was 50 years ago, especially as shifts in health care, the aging population and consumers’ expectations have forced it to evolve since that time.

But while half a century is a long time, the next 50 years of senior living looks increasingly promising for organizations, says Ed Thomas, CEO of Asbury Communities, a not-for-profit organization well into its 86th year of operation.

In September, Asbury Communities, which manages five continuing care retirement communities (CCRCs) in Maryland, Pennsylvania and Oklahoma, celebrated the 50th anniversary for one of its properties in Mechanicsburg, Penn., Asbury at Bethany Village.


SHN sat down with Thomas to learn what the future holds for the next 50 years of senior living, expectations for 2015, the need for reinvention and what keeps a non-profit CCRC chief executive awake at night.

Big picture, what’s the biggest difference you see between the last 50 years and the next 50 years in senior living?

If we look at the past 50 years, care was for older people considered ill or handicapped, and ‘good’ care was thought to be putting them in bed, fluffing up their pillow and sitting in a rocking chair all day.


Today, senior living is about wellness and engagement and providing programs that fit residents’ emotional, physical, spiritual, intellectual or vocational needs. Senior living is a platform for individuals to continue their interests and expand the interests they had in midlife or retirement.

The whole idea of retirement in senior living has moved from the idea of rocking chairs and playing golf, to one that’s more engaged with friends, family and the community than it used to be. The next 50 years is going to extend that.

The term “senior” is also going to change from its old chronological dial. Because people are living much longer and healthier, that age dial will move upward chronologically.

How do you see the business of senior living evolving or remaining the same in 2015?

I look at it positively. For one, there’s a lot of medical research and advances in biotechnology being developed. We’re going to see medical advances that change the future and have an impact on Alzheimer’s and other forms of dementia, which is going to significantly change how aging occurs.

Closer, in the Affordable Care Act, there is a significant game-changer that is going to affect senior living and all of health care. I think we’re going to see more care and services delivered at home, and see what had previously been skilled nursing facilities become almost rehabilitation or hospital replacement beds.

In the near term, there’s going to be a reinvention—a new range of choices and options for seniors in the future.

What new products and services will emerge to meet the needs of the growing demographic of aging Americans?

We’re hopefully heading for an era when all of us will live longer and healthier lives, making health decline and death a shorter part of life than it is currently. In that sense, I think a lot of the newer products and developments will be those focused on bio-tech and cell regeneration.

With the notion that at some point we can regenerate an organ that is failing, the future could be wonderful for advances in fighting diseases like cancer and dementia.

What are the greatest uncertainties in the business of senior living?

One uncertainty is the Federal Reserve and repressed interest rate, because rates have been forced to near-zero for already a very long time. How much longer will the government persist in repressing returns for those who have saved? It’s almost like if you’re a saver, you are penalized today. Most retired people throughout their ages have saved, invested those savings and have lived off of the earnings.

Another uncertainty relates to risk management. In recent history, [the U.S.] has had terror attacks, unprecedented economic occurrences, even high degrees of damage from storm and other weathers. We’re in an era where anyone who’s in charge of an enterprise wonders about risk management and how do we be prepared and protect for the future.

As the CEO of one of the largest CCRC providers in the nation, what keeps you up at night?

A major issue is government regulations and expectations. On one hand, the government is sending strong signals with healthcare reform to change, innovate and do things differently. On the other hand, existing legacy regulations—Certificates of Need and some of the anti-competition Medicare rules—stifle being creative and innovative.

There’s a conflict from the government that you must change, but you’re restricted in how much you can change or the way you can change. A lot of us who are leaders in healthcare are wrestling with: how do we operate with the government’s regulations while they’re essentially telling us to do opposites at the same time?

What we need to be about in operating CCRCs is creating a new continuum for the 21st century, one that delivers the healthcare part of our continuum in a different way. However, barriers to create that way puts you in a conundrum of how can you get from where you are to where you need to be.

We are already working to get there, but working with legacy regulations and limitations as we try to better the continuum for our residents restricts our getting there.

What are the characteristics of this new continuum?

It will simply be the continuum we already have, but will have home care, home health and hospice added to it. All of the components would be connected with care navigators, where a resident can then come to us asking for help and we can assist them in navigating areas such as the insurance company or navigating from hospital-to-rehab or hospital-to-home care, for example.

Think of it as home- and community-based services, home care, home health, hospice all tied together with care navigation.

Do you anticipate any increased competition arriving from the for-profit side of senior living in 2015 or beyond?

What I think will happen for consumers is that there will be more innovation, more options and more competition from both new providers and existing ones, but this will create a wealth of choices for them.

Thus far, more than about 80% of CCRCs are non-profits. I don’t see that changing. I do think not-for-profits will continue to be involved in affordable housing and market rate housing. The real differentiator will be quality and consumers’ choices around quality that will be tracked further with actual real data and outcomes.

For for-profits in the CCRC industry, consumers will still look for and value organizations that, within their organizational DNA, have that spirit for caring and have that spirituality and faith around how we deliver services and care for individuals. That will continue to be valuable moving forward.

Written by Jason Oliva