Assisted Living Use Varies Widely by City, NIC Study Finds
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New NIC research shows that assisted living use isn’t determined solely by age or income, but by market awareness, workforce, and policy, with real implications for planning and access.
Assisted living occupancy rates vary dramatically across U.S. markets, and the reasons go far beyond local demographics or household income, according to research from the National Investment Center for Seniors Housing & Care (NIC). The findings have direct implications for families planning long-term care, whether looking ahead for aging parents or considering their own future needs.
The study, conducted by NIC researchers and shared publicly in market research commentary earlier in 2024, examined occupied penetration — the share of households age 75 and older living in assisted living properties — across nearly 100 metropolitan areas.
Markets such as Minneapolis and Portland had relatively high assisted living penetration, while Miami and Las Vegas had some of the lowest, even though the underlying care needs of older adults in these areas were similar.
What “Penetration Rate” Means for You
Assisted living penetration rate, also called capture rate, measures the proportion of older adults in a region living in assisted living communities relative to the total older adult population. It reflects both market supply (options available) and consumer choice (awareness and willingness to move in before a care crisis).
We found that penetration is influenced not just by personal finances or functional care needs, but by how well a market supports awareness, confidence, planning, and workforce stability early enough for families to choose assisted living proactively. — Omar Zahraoui, NIC’s senior principal.
Markets with higher penetration rates do not always have older, poorer, or frailer populations. Instead, researchers found that multiple conditions must align for higher adoption of assisted living:
- Economic capacity isn’t enough: Wealthy markets often have higher usage, but there are high-income regions with low assisted living uptake.
- Need doesn’t always drive demand: In some cities, assisted living moves happen before intensive care needs develop, suggesting proactive planning.
- Awareness and culture matter: Familiarity with assisted living and positive perceptions influence whether families consider it early.
- Affordability barriers persist: Options may be financially viable for middle-income older adults, but a lack of knowledge and delayed planning keep many from moving in.
- Workforce challenges limit access: Markets with stable and available caregiving workforces tend to expand capacity faster, while shortages hamper growth and access.
- Public policy shapes markets: State rules on licensing, Medicaid waiver programs, and land use can either enable or constrain assisted living availability and affordability.
According to NIC’s head of research, a market’s penetration rate is a measure of how well older adults and families plan, prepare, and choose assisted living, not just whether they “need” it.
A market’s penetration rate measures how effectively the entire senior housing ecosystem reaches and supports older adults. Understanding how these forces interact can help operators, investors, and policymakers expand access and choice, especially as the population ages. — Lisa McCracken, NIC’s head of research and analytics.
What This Means for Families Planning Care
Families facing long-term care decisions should take away four key lessons from this research:
1. Assisted living is often a proactive choice, not a crisis solution.
Older adults who plan ahead and explore assisted living options early — before functional care needs escalate — have more choices and less stress. With greater longevity, the number of people who need help with daily living activities or suffer from some type of dementia is increasing rapidly.
Because health insurance and Medicare only cover short-term skilled care, American families will pay out of pocket for assisted living, in-home care, or nursing homes, unless they have Long-Term Care Insurance.
An LTC policy is typically purchased between the ages of 47 and 67, and several top-rated insurance companies offer long-term care options.
2. Awareness and planning matter more than you think.
Too many families wait until after a fall, hospitalization, or caregiver burnout — moments that limit options and increase costs. Early planning can expand choices and reduce emotional strain.
See the LTC News Caregiver Directory to find local resources for support and education for a loved one who needs extended care now.
3. Costs vary by market.
Many older adults must rely on income and savings to pay for assisted living and related services. In some states, Medicaid may pay for assisted living for those with limited financial resources. LTC Insurance will pay for assisted living, but you must have a policy in place before you need extended care.
For a snapshot of local assisted-living costs, run your zip code in the LTC News Cost of Care Calculator.
4. Workforce shortages and policy impact access.
Even if you prepare financially, limited caregiving staff in a region can delay move-ins and reduce the number of available units. State policies on Medicaid eligibility and assisted living licensing also shape access.
Those who desire access to their choice of quality care should review planning options before a family crisis occurs.
A Broader Context: Aging Population & Outpaced Supply
This market variation also reflects broader national trends. Senior housing occupancy rates — including assisted living — have crept higher in recent years, even as construction of new units remains subdued, creating tight supply conditions in many areas. This scarcity can push older adults to secure housing before it’s needed or put pressure on families to find alternatives.
Additionally, according to recent research tracked by LTC News, 63 million Americans now provide unpaid care for a loved one — a 45% increase since 2015 — underscoring the scale of family caregiving and the importance of proactive planning.
The number of those needing long-term care is increasing. According to federal research, your long-term care risk is that more than half of Americans age 65 and older will need long-term services and supports at some point in later life.
Bottom Line for Families
Assisted living availability is more than a zip code issue — it reflects cultural familiarity, planning support, workforce strength, and public policy.
Researchers say that ultimately, the assisted living penetration rate reflects both market capacity and consumer confidence in the product.
If your manage an assisted living facility you can claim your free listing on the LTC News Caregiver Directory and/or upgrade the listing to enhance visibility and highlight your staff and services through the LTC News Directory Business Portal.
For families and future retirees, understanding these forces can lead to earlier planning, more choice, and less crisis-driven decision-making.