Skilled Nursing Presence in CCRCs Remains Steady, But Drop Coming

The median number of skilled nursing units in continuing care retirement communities (CCRCs) has remained steady over the last five years, but a decline is coming as developers continue cut SNFs out of the equation.

Among the nearly 2,000 CCRCs across the United States, there are a median of 72 skilled nursing units per site, according to the most recent data from Chicago-based specialty investment bank Ziegler.

That number was largely unchanged from the last time Ziegler looked at the data in 2013, director of senior living research and development Lisa McCracken told Skilled Nursing News. Still, she says a nationwide trend away from skilled nursing offerings at CCRCs — also known as life plan communities, or LPCs — will soon show itself in hard data.


“The more evident pattern is the number of providers building independent living and assisted living, but not skilled care,” McCracken said. “We have also seen some providers who are historically life plan communities, but they have elected to drop the skilled nursing. That is a very clear trend in the western part of the U.S.”

McCracken also pointed to a Ziegler survey from last summer, when the vast majority of chief financial officers in senior living organizations said they were either planning to keep the same number of skilled nursing beds or reduce their ranks. A similar survey conducted earlier this year found that skilled nursing and post-acute pressures were the third most common worry among non-profit senior living CFOs.

“Licensed care is our biggest area, increasing requirements with pressure on reimbursement and workforce issues — perfect storm,” one anonymous CFO told Ziegler in that analysis.


The trend away from skilled care has taken hold in some new developments. For instance, the Avamere Family of Companies earlier this year announced a so-called “micro CCRC” in St. George, Utah, which would have 300 units of independent living, assisted living, and memory care — but no SNFs.

That raised questions over whether a senior living complex without a SNF qualified as a CCRC; after all, the entire concept revolves around a senior receiving all possible levels of care at the same facility. But Avamere vice president of growth and development told SNN that CCRCs come in all shapes and sizes, with the model changing over time.

“We’re entering into a paradigm shift [where] this static concept of a CCRC will be looked at very differently,” Haller said. “We sat down in a boardroom and said: We like this CCRC concept, but how do we change it for the next generation coming through?”

Some CCRC operators that have dumped skilled beds from their offerings have instead turned to partnerships with nearby providers, though others have revamped their assisted living care strategy to accommodate higher-acuity residents, McCracken said.

“I just think it will take a little yet to start to see that national median number go down,” she said. “I am guessing [that] within two years, we may start to see that median figure dip.”

Written by Alex Spanko

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