While 2025 remains a bit uncertain due to the federal staffing mandate and a new White House administration, leaders in the nursing home industry plan to continue working toward improving quality of care, addressing workforce challenges and advocating for fair regulation and reimbursements.

Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), told Skilled Nursing News that amid all of the negative factors at play, there are also some positive trends that will determine the sector’s path in 2025, but there is no mistaking the rising demand for long-term care services.

“Americans continue to age, continue to need skilled nursing care, and continue to look to our workforce to provide this care. Simultaneously, long-term care is ever-changing: we continue to innovate, to find new approaches to quality care, to assess our regulatory environment and seek ways to improve it,” he said. “It’s this duality that stands out for 2025: the opportunity for both challenges and opportunities within our sector. More than ever, our services are in demand.”

One of the greatest challenges aside from workforce shortages, is Medicare Advantage, and Porter said AHCA intends to continue to push reform to mitigate MA’s pressures.

Not surprisingly, for LeadingAge, the nation’s largest association of nonprofit providers, Medicare Advantage and staffing both remain prime areas of concern. To that end, LeadingAge is planning to lobby Congress to make meaningful changes, the organization’s president and CEO Katie Smith Sloan told SNN. Moreover, patching up the survey and certification process is another pressing issue, she said.

Meanwhile, operators also shared how managed care continues to “tighten the screws” on the industry. Ignite Medical Resorts CEO Tim Fields told SNN that a sizable reimbursement gap remains between Medicare Advantage and traditional Medicare, and administrative burdens are still a massive pain point.

“We also have been victims of the rubber stamp contract with new acquisitions, and we are hoping some new, higher level strategic relationships can help us continue to push innovative contracting that is a win-win,” Fields said.

Some nursing home organizations are certainly looking to evolve through partnerships to account for low reimbursement and are hoping to avail value-based care options in 2025. American Senior Communities, which launched its operator-led institutional special needs plan (I-SNP) on Jan. 1, is one such organization taking this step.

“We are focused on ensuring our residents have the ability to appropriately age in place through a coordinated care model,” ASC CEO Steve Van Camp told SNN.

Skilled Nursing News connected with various sector leaders, from association heads to C-suite executives, to get insights into what’s in store for the nursing home industry in 2025. This article is the first installment in a two-part series, highlighting their thoughts in their own words.

Editor’s Note: As nursing home execs look ahead to 2025, our CLINICAL Executive Conference promises to be an excellent opportunity to glean the latest insights into care practices and network with leaders who are driving innovations. Tickets are available here. If you’re a leader with a nursing home provider company and interested in speaking at the event, email [email protected].

Clif Porter, President and CEO, American Health Care Association/National Center for Assisted Living (AHCA/NCAL):

One of the aspects that is most interesting about long-term care, especially when standing at the brink of a new year, is its duality.

The long-term care sector is consistent: Americans continue to age, continue to need skilled nursing care, and continue to look to our workforce to provide this care. Simultaneously, long-term care is ever-changing: we continue to innovate, to find new approaches to quality care, to assess our regulatory environment and seek ways to improve it.

It’s this duality that stands out for 2025: the opportunity for both challenges and opportunities within our sector. More than ever, our services are in demand. Assisted living continues to grow at a steady pace, demonstrating its value and satisfaction among seniors. Skilled nursing care continues to be a critical component of the nation’s health care continuum.

And yet, despite these signs of growth in our sector, workforce challenges remain a top challenge, impacting nearly every skilled nursing facility across the country. We have yet to return to our pre-pandemic workforce levels by a deficit of more than 100,000 workers. This is not about a lack of trying to hire more caregivers: nearly every nursing home in the nation is doing everything they can to fill open positions and recruit more workers.

The reality is that there simply aren’t enough nurses and nurse aides to meet the demand, and we desperately need meaningful workforce solutions in order to grow our pipeline of qualified caregivers. We remain resolved to offer those solutions on Capitol Hill and to defeat impractical ones, like the federal staffing mandate, which I’m optimistic we can achieve next year.

Similarly, we see opportunities to look at reimbursement from equally important perspectives.

Medicare Advantage continues to attract more than half of all Medicare eligible beneficiaries, and yet the insurers are increasingly denying essential post-acute care for seniors when they need it most. We will continue to advocate that these plans provide the benefits that seniors have earned and be held accountable for unfair practices.

Meanwhile, Medicaid holds the potential to enhance quality care and the financial stability of providers across the country, but it is continuously and chronically underfunded. Protecting Medicaid funding through advocacy efforts will be critical for the sector.

Next year, in 2026, the oldest baby boomers will turn 80. We’re facing a new administration, a new Congress, and a new balance of power in Washington. There’s a lot of opportunity to make meaningful changes to improve the lives of those we serve and prepare for the future. This moment allows for AHCA/NCAL to put forth an ambitious agenda and encourage policymakers to embrace bold solutions to confront the challenges ahead. We are a profession that continues to evolve and welcome change. One thing that hasn’t changed — and never will — is our commitment to quality for our residents. By leading with quality, the skilled nursing profession will be poised for success.

Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, including skilled nursing:

Heading into 2025, our focus on developing solutions to workforce challenges and ensuring members’ financial and operational sustainability will continue. Our policy priorities will focus on fostering a regulatory environment that is not overly burdensome, addressing not just quality, but also emergency preparedness and cybersecurity.

Workforce is an ongoing priority. Without staff, there is no care, so recruiting and retaining skilled staff is essential. Though the nursing home staffing mandate may be repealed under the incoming Trump administration, whether that happens or not, staffing shortages will continue to impact the sector. We’re laser-focused on finding solutions to grow the domestic and international aging services workforce pipeline in various ways: enhancing nursing education programs, promoting career progression pathways, and supporting policies that address retention and recruitment issues, including expanding legal immigration pathways.

Financial stability remains a critical concern for long-term care providers. Findings of a recent Department of Health and Human Services research (conducted by a research team including the LeadingAge LTSS Center @UMass Boston) show that on average, Medicaid payment rates covered only 82% of the costs associated with providing care to Medicaid residents, and nonprofit nursing homes experienced a lower Medicaid payment-to-cost ratio (0.76) compared to for-profit (0.83) and government-owned facilities (0.80).

Additionally, we must recognize the impact of Medicare Advantage (MA) plans’ market dominance. Over half of Medicare eligible older adults are MA plan beneficiaries and the number and size of plans is growing. Providers, as a result, must manage considerable, often burdensome, and administrative tasks (which adds to costs). Plans’ low reimbursement payment rates and frequent denials of needed care jeopardize providers’ ability to serve older adults, which impacts the entire health care system. LeadingAge will continue to urge policymakers to address the details of how MA plans contract with providers, pay for care, and determine quality.

Another area where LeadingAge will focus its efforts in 2025 is the regulatory environment.

The survey and certification process for nursing homes has been broken for years—and has now become a workforce issue. The stress of the intensely negative survey experience, and often demoralizing relations with surveyors, drive quality staff away from nursing homes. There exists a real struggle to attract workers to a sector where the focus is on regulatory compliance, rather than on care provision and quality improvement.

LeadingAge will advocate for more meaningful, efficient surveys that recognize the hard work providers are doing and reduce unnecessary administrative burdens. We will also continue to press for regulatory relief, including addressing backlogs and the implementation of risk-based surveys. At the same time, we anticipate new regulations related to emergency preparedness, infection control, and cybersecurity. Given the increasing cybersecurity threats to healthcare organizations, we are committed to helping our members stay ahead of these challenges by ensuring they have the resources and guidance needed to protect their data and operations.

Our priority, and that of our nonprofit, mission-driven provider members, will always be to deliver high-quality care, remain financially viable, and meet the demands of an aging population in a rapidly changing healthcare environment.

Tim Fields, CEO and Co-Founder, Ignite Medical Resorts:

In 2024, Ignite grew in Texas, Indiana and Kansas – we are excited to work closer with our new facilities and new Ignite team members. Proudly, 13 of our 22 skilled nursing facilities made the best of the best list from U.S. News and World Report for short-term rehabilitation, a testament to our team’s hard work to uphold our standards and push our unique culture and mission each and every day.

This year will bring a new national political agenda for skilled nursing facilities, and all of us have hope for optimism. One of the first big items is the looming staffing mandate. I anticipate that it will most likely either get shot down entirely or pushed down to the state level.

We as an industry have been under siege with overburdening regulation and a punitive and vindictive survey environment for the last couple of years post Covid. The last couple years have been brutal in most states regulatory wise, and the publicly reported data shows a sharp increase in total citations and harm level citations.

As of writing this, I have no idea of Dr. Mehmet Oz’s plans, who is set to be the new Centers for Medicare & Medicaid Services (CMS) director. From all accounts there should be optimism for winds of change. I am also hoping in 2025 that AHCA and LeadingAge continue to push for regulatory change. This horrible regulatory environment is pulling our hardworking staff away from caring for residents and making them spend their time jumping through bureaucratic hoops with surveyors. We are more regulated than nuclear power plants. Something needs to change.

Managed care continues to tighten the screws. We have a lot of strategic initiatives in 2025 to continue to demonstrate value to the managed care organizations by showing them, with data, we can reduce their inpatient rehabilitation facility (IRF)/acute rehab and long-term acute care (LTAC) spend and better manage their total cost of care.

We also have been victims of the rubber stamp contract with new acquisitions and we are hoping some new higher level strategic relationships can help us continue to push innovative contracting that is a win win. Managed Care is 50% of our revenue, which is very unlike most skilled nursing facilities. We need to continue to fight to stand out as an innovative model that can help them. It’s also very encouraging to see national news around the disparity of Medicare Advantage payment to Medicare payments and the denying or cutting of services. These necessary guardrails will help us work together to do what’s best for the patient, not just the shareholder value of these publicly traded entities.

In 2025, we are analyzing a couple of exciting acquisitions that fit our model, with some possible entries into new states. We are ecstatic to open two brand new facilities at the end of the summer of 2025, one in greater St. Louis and one in greater Chicago.

We’d love to see more incentives from the states, the counties and even CMS to build new products for our incoming demand. You can’t have a supply issue with decreasing bed counts year after year and a demand issue with people turning 80 and 85 years old at a rapid pace and have balance – something needs to change.

This past year brought more growth in our internal data analytics and Power BI Dashboard but we are not where we need to be. A priority in 2025 for us will be to build “a fully functional death star.” With our growth and the complexity of the business it is paramount we put data and trends at the fingertips of our teams to make decisions daily in every facet of the company. This business continues to get harder and we need to become more sophisticated.

There is so much amazing technology that we’ve launched in our therapy departments with robotics and virtual reality, and we look forward to more technology to help our teams in 2025. We are starting to roll out new risk management AI that can help predict regulatory and litigious risks as well as a lot of technology centered on falls and wounds. We are continuing to roll out AI for change of condition and enhancing remote patient monitoring, to prompt our providers and clinicians to intervene quicker and avoid unnecessary hospitalizations. We are also expanding our falls prevention AI technology that helped us reduce fall rates by over 25%.

Lastly, 2025 will continue to enhance our focus on our frontline caregivers. Ignite University, our internal training and education program, has been growing. We now have internal certified nurse aide (CNA) schools set up to grow our own CNAs. We have partnerships in over half our markets with outside nursing schools to take our CNAs and grow them into licensed practical nurses (LPNs) and licensed vocational nurses (LVNs). Our Lion in Training program and Chief Nursing Officer (CNO) in Training program have trained, educated and launched our new administration and nursing leaders. And, we look forward to our next class in 2025 so we can continue to grow our own leaders. The most fun part of my job is being out in the field celebrating our teams who are winning, and I look forward to a lot of that in 2025.

Steve Van Camp, CEO, American Senior Communities:

First, we will continue being a leader in clinical excellence as evidenced by 40 facilities (26 Bronze and 14 Silver) achieving the coveted AHCA/NCAL quality award winners in 2024. In 2025, we hope to build on 2024’s efforts as 50 of our facilities have submitted an intent to apply. Also, we will continue to focus on our star ratings, particularly in light of the regulatory changes that go into effect in February.

Second, we will continue to focus on our employee base with an emphasis on increasing retention rates through continuous improvement of the employee experience.

We will take a hard look at the data and create process improvements that target specific areas where we have some opportunities. An example would be to enhance our onboarding process so that we reduce our turnover in the first 90 days.

Third, we are going to live with our operator-led institutional special needs plan (I-SNP) beginning Jan. 1. The plan allows the company to take on risk and manage our resident populations more effectively, with the goal of reducing hospital readmissions, emergency room visits, and enhancing the overall resident experience. We are focused on ensuring our residents have the ability to appropriately age in place through a coordinated care model.

Finally, American Senior Communities is a family-owned organization, which will be celebrating its 25th year anniversary in 2025. ASC provides an expansive network of post-acute health care and senior services including skilled nursing, memory care, senior living, home health, hospice and palliative care, all within the state of Indiana.