Senior Living Operators Report Length of Stay Improvement But Recovery Still Choppy

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Senior living operators are improving care coordination and life enrichment offering for residents in a bid to improve length of stay (LoS) — while also being patient as the market appears to be normalizing from disruptions related to Covid-19.

Many providers have reported that acuity among residents is rising, with people moving into communities with more chronic health conditions than in past years. That’s in part due to the pandemic, which in some instances caused people to delay moving into senior living until their health conditions worsened. As a result, the LoS for many communities dropped, and LoS remains below pre-pandemic levels for some operators.

But some operators are building back LoS, and are reporting that while the figures aren’t where they used to be, they are improving. And there appears to be light at the end of the tunnel, as some operators have reported anecdotally to SHN that acuity levels are normalizing.

“I think the stigma of Covid is over and people are more comfortable moving in, which is a huge help,” said Chelsea Senior Living President and COO Roger Bernier. “People are back to business as usual.”

In addition to these market dynamics helping, some providers are rolling out new, enhanced care models or relying more on data to help improve LoS.

On the lower acuity end of the spectrum, operators are pivoting to boost active adult and independent living (IL) options as a way to get residents into a provider’s orbit sooner.

Some operators have improved to pre-pandemic LoS data. At Legend, LoS is back to 2019 levels, according to Legend Senior Living COO Chris Mahen. At the same time, acuity has increased 5% across Legend’s portfolio since 2019. 

“As occupancy trends continue up, the move ins from that additional growth will add back to length of stay as the customer lives out their full residency in buildings,” Mahen said. “The future of length of stay can be influenced by delivering great care and services, potentially motivating a prospect not ready to move out of their home to make the decision to move to senior living.”

LoS improving but still muted

In 2023, LoS for Fort Wayne, Indiana-based Priority Life Care, excluding memory care, is “slightly better,” according to CEO Sevy Petras. The organization operates over 50 communities across 15 states.

In terms of AL, Priority reported LoS data of 18 months in 2023 compared to 16 months in 2019. Lower-acuity LoS is also improving, Petras noted, with IL moving from 24 months in 2019 to 29 months this year.

Memory care’s peak LoS came in 2020, Petras said, when communities reported that memory care residents stayed with PLC for an average of 709 days, or nearly two years. Now, memory care ranges between 15 and 17 months for Priority Life Care, Petras noted.

Many operators told SHN during last week’s NIC Fall 2023 Conference that memory care LoS is hovering between 12 to 20 months, at best.

Petras said she feels that residents are slowly warming back up to senior living on the lower acuity IL side, while AL and memory care move-ins are largely needs-based and driven by medical incidence.

“We are back or better than we were pre-pandemic for assisted living and independent living from 2019 to 2023 year-to-date,” Petras told SHN. “We’ve adopted, post-Covid, so many new technologies that I think are giving us a lot more abilities to act instead of being reactive. We’re being a lot more proactive.”

That means participating in value-based care initiatives or installing new systems aimed at identifying medical needs of residents sooner, or more closely aligning care coordination and daily community operations to improve reaction time among communities, Petras said.

Presenting that value is paramount for operators who want to increase care services and lifestyle offerings to show families the benefits of congregate living as it relates to health outcomes.

“We are identifying and finding that if we get people in at the right time, we’re going to be very much impacted and we’re going to be able to help better coordinate that care,” Petras added, noting that the goal is not only to help people live longer, but live healthier, happier lives during those additional years.

Tucson, Arizona-based Watermark Retirement Communities has turned to building out engagement and programming offerings to boost LoS through life enrichment, according to CEO David Barnes.

“Getting people thriving again impacts length of stay,” Barnes said. “I think what we’re seeing right now is that the lowered length of stay is temporary.”

From focusing on life saving measures implemented at the height of the pandemic, Barnes said Watermark and other operators have shifted to focus more on life enrichment and engagement with residents. With its program “360 Well,” Watermark is able to track “dimensions of wellbeing,” Barnes noted, to help residents thrive.

“We just had to get every one of our programs that’s looking at engaging residents back up and running,” he said.

While Barnes noted that Watermark communities did not necessarily have a “problem with acuity,” he cautioned that accepting higher acuity residents is a “double-edged sword” that can cause operational headaches down the road as care needs coalesce.

“We’ve always tried to make sure that we are very innovative and creative in doing everything we can to keep the resident at the lowest possible setting as long as we’re doing that safely,” Barnes said.

Watermark reported an IL LoS average of 38 months, according to data provided by Barnes earlier this month. Higher acuity care levels had lower length of stay — and LoS is top of mind as a factor when considering future growth.

“We go through with our equity partners to show how we are doing and it’s being brought more to the forefront of that conversation,” Barnes said.

Length of stay, care inherently linked

Like Petras, leaders with Chelsea Senior Living emphasized the role that care coordination can play in length of stay. Chelsea’s Bernier reported LoS figures are “certainly increasing,” after declining during the pandemic. Chelsea operates more than 26 communities across the northeast.

“Length of stay shrunk a little bit, but now we’re seeing more of our typical assisted living residents move into our communities with typical length of stays,” Bernier told SHN. “I think more people are coming in less sick or less acute.”

But where real improvements can be made on LoS can be done through empowering care staff and creating more distinct care coordination, while boosting services such as physical therapy, Bernier said.

“It’s really the care team,” Bernier said on what impacts LoS. “There’s more eyes on the residents, and I think that’s really helped, and obviously telemedicine has done a lot for residents.”

Of course, identifying which residents could benefit most from enhanced and coordinated care — and billing them appropriately — is paramount importance to increasing length of stay and also driving revenue. Some senior living providers have made wholesale changes to how they bill for care. Take Distinctive Living, for example. The fast-growing operator expanded its care structure from three levels of care to 10 levels of defined care in 2023, in an effort to improve LoS but to also capture lost revenue over time, CEO Joe Jedlowski told SHN during the NIC conference.

“We’re seeing people come in older and sicker,” Jedlowski said. “The reality is, unfortunately, length of stay compresses.”

On average, Jedlowski said LoS across Distinctive Living’s portfolio ranged between 12 and 20 months, with higher acuity being on the lower end of that range, and vice-versa.

And finally, there’s the role that marketing and consumer outreach play. Even for memory care, which generally is a needs-based level of care, it’s possible to reach prospective residents earlier. This can improve length of stay, if people move in sooner and spend more time in a memory care community than they otherwise might.

Anthem Memory Care CEO Isaac Scott told SHN during the 2023 NIC Fall Conference that the Lake Oswego, Oregon-based operator is in the process of improving the company’s move-in model to make it easier for families to transition residents into higher acuity settings.

Anthem is reporting LoS among its properties of 18 months on average, with a bump to 20 months a “significant improvement,” Scott said.

“We’re really looking hard at trying to figure out how we can improve our model so that we are getting longer lengths of stay by making it easier for them,” Scott said. “We’re trying to relate that from a perception standpoint; we’re really trying to educate the market.”