Growth of ALFs

Assisted living facilities are quickly becoming a more common option for long-term care.

“The growth [in assisted living] reflects both the expansion of assisted living communities nationwide and a known preference for more community-based services,” said Paul Lingamfelter, an AARP Public Policy Institute policy adviser for long-term care, said in a statement.

As the number of assisted living residents increases, so does the share of those who have complex health concerns.

For the first time, a larger share of residents living with Alzheimer’s disease or related dementias now call an assisted living community home (44%) rather than a nursing home (41%), according to AARP.

Furthermore, approximately half of assisted living residents were aged 85 and older, a 28% increase from 2020.

“Individuals with dementia who remain physically capable are staying in these settings longer, delaying a move to nursing home care until it’s medically necessary,” Lingamfelter said.

The rise of assisted living residents with dementia and chronic illnesses raises questions about the quality of care provided in the sector.

One area of concern is dementia special care units, as only 21% of assisted living and other residential care communities have these.

Inconsistent state rules and wide variations in reporting practices and staffing and training standards also present problems for the industry.

“Assisted living is an important and growing option, but it’s also a very underregulated industry,” Lingamfelter said. “That creates challenges for families trying to understand what level of care they can expect, especially when residents have more complex needs like dementia.”

Because of these concerns, AARP is calling for enhanced regulation on the industry.

“[T]he absence of national oversight, standards and definitions results in a patchwork of inconsistent state policies forming the national landscape of assisted living,” the organization’s report concluded. “Until federal action makes assisted living more reliable, transparent and accessible, states need to fill the role as regulators or face the reality of substandard care for older adults.”

Affordability is another significant challenge facing families paying for a stay in an assisted living facility.

“Assisted living communities are expensive, and like many LTSS settings, the cost of assisted living exceeds the median household income of an older adult,” AARP’s report read.

Using recently released Genworth/CareScout cost of care data, the report highlighted that the cost of a year of assisted living ($70,800, on average) exceeded the typical income of an aged 65-and-older-led household, where the median income was $59,648 and the average annual Social Security income for retired workers was $23,700 in 2024.

Addressing these causes for concern want be easy, as providers are quick to paint a rosy picture of their supposed “industry-leading” and “high-quality” facilities.

Many families with a loved one in an assisted living home know the real story though.