Larry H. Miller Senior Health is entering 2026 from a position of operational momentum having acquired a six-facility portfolio recently. However, COO Andy Frasure remains clear eyed about the growing challenges facing nursing home providers.
The Kissito Healthcare portfolio’s acquisition and successful integration was his company’s biggest milestone in 2025, Frasure told Skilled Nursing News. The portfolio – comprising 532 licensed beds in Virginia across six SNFs – became a CareTrust REIT (NYSE: CTRE) tenant on January 1, 2026, under a long-term triple-net lease in a $142 million deal.
Beyond expanding the Utah-based organization’s footprint, the Kissito deal deepened its clinical offerings with specialty services – including ventilator, tracheostomy, and memory care – to meet the projected growth of higher-acuity residents.
“These additional facilities and further expansion will allow Larry H. Miller Senior Health opportunities to enter additional markets across the county,” Frasure said.
Frasure said the company is reinvesting heavily in its core markets through leadership development and targeted facility upgrades aimed at supporting quality and efficiency. At the same time, the organization is evaluating growth opportunities that align with its culture and long-term strategy, while remaining disciplined about expansion.
The successes aside, like many providers in the sector, Larry H. Miller continues to navigate staffing shortages, rising patient acuity and increasing administrative complexity tied to regulatory requirements and Medicare Advantage (MA) plans. To address these pressures, the company is investing in workforce development, building leadership pipelines through its administrator-in-training (AIT) programs and recruiting internationally through staffing partnerships.
“We see increased administrative burden as there are demands to meet regulatory requirements, complex billing issues and fragmented care systems,” said Frasure. “We are approaching 2026 with clear priorities: improve consistency across operations, scale what works, and strengthen coordination across our continuum so patients experience smoother transitions and better outcomes.”
Frasure sat down with SNN to discuss how the company is reducing costs while maintaining strong clinical outcomes – the organization’s facilities routinely achieve 5-star ratings.
Larry H. Miller Senior Health provides post-acute health care through several different business lines, including Advanced Health Care (AHC), which offers high-quality skilled nursing and transitional rehabilitation services, Advanced Home Health and Hospice, and Aspen Ridge Senior Living in Lehi, Utah.
The following transcript has been edited for length and clarity.
SNN: Can you reflect on Larry H. Miller’s last year operationally and describe one win that the company achieved?
Andy Frasure: 2025 was a strong year of performance with continued growth in our post-acute business lines. A clear win was the successful integration of Kissito Healthcare into our operations. This acquisition in Virginia has added six traditional long-term care facilities and specialty ventilator care units to our existing portfolio. This addition has strengthened our “Continuum of Care” approach and has expanded our ability to serve more people, along with adding a long-term care service line to our group of companies. Most importantly, it has been a successful integration because Kissito already had a culture of high-quality care that aligns with our mission and values.
What are some big operational challenges for your company in 2026?
The skilled nursing operating environment remains demanding, and we anticipate that will only get more demanding as more adults become Medicare eligible. Staffing pressures, rising acuity, and payer complexity continue to be real challenges across the industry. We also see increased administrative burden as there are demands to meet regulatory requirements, complex billing issues, and fragmented care systems. We are approaching 2026 with clear priorities: improve consistency across operations, scale what works, and strengthen coordination across our continuum so patients experience smoother transitions and better outcomes.
Tell us about how you are reinvesting in your core footprint? Are there plans to expand beyond the core footprint?
We are reinvesting in our core footprint by strengthening operations, developing leaders, improving systems and reporting, and making targeted facility upgrades that support quality and efficiency. We continue to evaluate responsible growth opportunities that align with our strategy and culture, but we are disciplined about where and how we expand.
Are you looking to downsize anywhere?
No. Our focus is on performance improvement and strategic growth, not downsizing. We believe the need for high-quality senior care will continue to increase, and we are building to meet that demand.
Tell us a little bit about the model of care at Larry H. Miller?
Our model of care is grounded in our mission of enriching lives. Everything we do is centered on delivering high quality, personalized care that every patient and resident deserves. Through the Larry H. Miller Health Continuum, which includes Skilled Nursing, Transitional Rehab, Home Health, Hospice, and Assisted Living, we can better support individuals at each stage of their journey with coordinated, compassionate care. We feel that this complete continuum provides added value to the people we serve.
We focus on understanding each person’s unique needs, goals, and circumstances, and aligning our clinical teams around those priorities. By combining strong care coordination with a culture that values dignity, respect, and excellence, we create an experience that not only improves outcomes but truly enriches lives.
Is Medicare Advantage as a payer adding burdens for your company? If so, how is the organization responding?
Yes, Medicare Advantage has increased complexity, particularly around authorizations, documentation, and appeals. We are responding by strengthening our processes, standardizing documentation expectations, and investing in the operational support needed to manage those requirements. We also believe our Continuum helps because coordination across settings supports stronger clinical narratives and more consistent outcomes.
Are there any metrics you can share related to how Larry H. Miller has been able to bring down systemic health care costs such as reduced hospitalizations, et cetera?
In terms of metrics on health care costs, using CMS’ publicly reported data, Larry H. Miller Senior Health operations routinely outperform industry results with 5-star ratings and quality metrics. Our proactive clinical management, strong transition coordination, and accountability models have led to lower costs to health systems and payer networks. Advanced Home Health agencies achieve all-cause rehospitalization rates which are 5% lower than the reported national averages. These incredible rehospitalization rates translate into significant systemic cost savings.
Have you added any new services and what was the company’s strategy in adding them?
One of the most meaningful ways we strengthened our service lines was through the acquisition of Kissito Healthcare involving six skilled nursing facilities in Virginia. Kissito has a stellar reputation in long-term care, specialty care including ventilator, tracheostomy services, and memory care. Bringing those capabilities into our organization enhanced both the depth and skill set of our clinical offerings.
As we see patients with growing acuity and complex needs, these specialty units will be in more demand. These additional facilities and further expansion will allow Larry H. Miller Senior Health opportunities to enter additional markets across the county.
How are staffing pressures shaping up for 2026?
Staffing remains competitive across the industry, and we do not expect that to change overnight. What gives us confidence is our focus on culture, leadership, and creating environments where caregivers can do their best work. We are developing leaders in house through our AIT programs, maintaining strategic staffing partnerships through organizations like StaffWrx, which recruits nurses internationally, and leaning into operational systems that help reduce friction for frontline teams and support sustainable staffing models.
What workforce-related initiatives has Larry H. Miller undertaken recently to improve recruitment and retention? Any metrics to share on workforce issues?
We are investing in leadership development and building strong pipelines for key roles, while improving the recruiting and onboarding experience. We are also focused on engagement and consistency in how we support team members across the platform. We track outcomes internally, but the main point is this: we are building a long-term workforce strategy, not a short-term fix.
How have surveys been going for your company?
Surveys remain a major focus across the industry, and we take them seriously. We have worked hard to build strong day-to-day habits, compliance practices, and leadership accountability so that we are always ready, not just ready during survey season. Our approach is to keep quality and safety at the center, and to treat feedback as an opportunity to improve.
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