Rising Resident Acuity Prompts Senior Living Operators to ‘Get Real’ About Independent Living 

It’s no secret that independent living means something different than it did just one or two decades ago — but in 2023, the product type faces an existential question: Does IL still exist?

Of course, plenty of senior living operators still offer something in their communities called “independent living.” And by that measure, the product type still has a clear place in senior living now and in the future. But as independent living is squeezed on one side by active adult and by assisted living on the other, its role in the care continuum is being re-evaluated.

And a big challenge for operators going forward is that the senior living resident profile “hasn’t shifted back” to pre-pandemic trends — and likely won’t anytime soon, if ever, according to outgoing American House COO Brianne Zitko.


“We need to get real about the situation here,” Zitko told Senior Housing News. “We have to provide the right health care services.”

Zitko’s tenure as American House’s COO is ending this summer when she will begin her venture as a senior living consultant where she will be “on the other side, providing solutions to operators because it’s such a different landscape in the last couple of years compared to the previous 20,” she told SHN.

Getting real about IL

Where independent living was once a setting for residents who needed little to no assistance, the acuity profile of those residents has steadily risen in recent years.


That was especially true during the first couple of years of the pandemic, when many residents delayed moves into senior living communities and arrived with more care needs than they otherwise would have and sometimes unrealistic expectations for the kind of care they might need.

Now, operators of independent living residents are searching for ways to both pitch prospective residents to enter communities earlier and to offer necessary services to those residents who are already in the communities with needs surpassing typical independent living.

Independent living does indeed exist as it did previously, but that is changing, according to Pacifica Senior Living Senior VP of Operations Carl Knepler.

“There are still seniors that move into independent living to enjoy the services of dining, housekeeping and a maintenance-free lifestyle,” Knepler told SHN. “However, more and more residents move into IL requiring assistance with at least one or more ADLs.”

He estimates the average age of IL residents at San Diego-based Pacifica’s 90 communities is 84 while the average of its AL residents is 87. Most IL residents move in at between the ages of 75 and 84, he told SHN.

Arrow Senior Living CEO Stephanie Harris estimated that the shift in independent living has on average shortened the length of stay by approximately two months.

“Even residents that are choice-driven, their move-ins are coming with potentially greater needs,” Harris said.

And that has tempered the post-covid recovery and slowed growth for St. Louis-based Arrow.

“While our gross deposits are at record levels and our inquiries are at record levels, the net growth has been delayed by a record number of move-outs,” Harris said.

Dr. Chirag Patel, chief medical officer at Hansa Medical Group, said he first noticed that the IL acuity paradigm was shifting about ten years ago. Hansa employs approximately 35 health care professionals in about 130 communities. The company mostly provides primary care services, but also pain management, neurology, cardiology and others that are often needed in senior living.

Today, he sees IL residents moving into senior living in their mid-70s with “comorbid conditions, multiple medications, falls, emergency department visits and hospitalizations.”

He believes that today’s skilled nursing resembles hospital patients of yesterday, that today’s assisted living resembles what skilled nursing used to be, and so on.

“Does independent living exist? Well, in theory, yes,” Patel said. “Everything has shifted.”

He added: “Independent living in the true sense is probably what is referred to as 50-and-over active communities based on what it was 10-15 years ago,” Patel said.

Years-long delays in move-ins are common in the product type, and residents are often wary of losing their independence or paying a high cost for senior living services. But sooner or later, those residents will need care, prompting a move-in — even if they still think they want independent living.

“Do they deserve assisted living? Absolutely – they probably shouldn’t be independent living,” Patel told SHN. “But you can’t force someone. It’s one of those things where you have to try to convince them.”

‘New IL emerging’

It’s clear senior living prospects still desire something called independent living, even if they might need a higher level of care.

For the senior living industry, getting “real” about the product type means acknowledging that clinical care does have a growing role to play in independent living communities, even if senior living operators are reluctant to provide it. And that is the modus operandi of Patel and Hansa.

By providing certain primary care and clinical services, “we can give a patient a little bit of extra time in independent living because we’re taking care of their higher-acuity needs,” Patel said.

Independent living operators have woken up to the idea that independent living means something new in 2023, and there is a sense that they need to provide the right services and offerings to serve a new generation of residents.

“There is a new IL emerging that is all about giving seniors more options and adjusting services to fit changing needs,” Knepler said.

Pacifica has accordingly shifted its IL focus to include enhanced dining programs with things like regionally-focused menus and high-speed internet, for example.

In addition to the bells and whistles of dining and internet speed, operators like Pacifica are adding ways for independent living residents to access health care right there in their community.

“We’ve partnered with home health groups to offer services to our IL residents and with therapy groups like EmpowerMe to offer therapies,” Knepler said.

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