​Long term care services are in greater demand than ever. Given that the oldest Baby Boomers will turn 80 next year, the industry has responded by improving operations, leveraging technology, monitoring legislation, and focusing on wellness. These efforts will show in 2025 as the industry addresses needs, capitalizes on growing trends, and continues to deliver the best care to those in need and their families.

“Long term care is ever-changing: we continue to innovate, find new approaches to quality care, assess our regulatory environment, and seek ways to improve it,” Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said. “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.”

Porter said assisted living continues to grow steadily, demonstrating its value and satisfaction among seniors. Skilled nursing care continues to be critical to the nation’s health care continuum. He also noted that despite these signs of growth, workforce challenges remain a top challenge, impacting nearly every skilled nursing facility nationwide.

“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 possible to fill open positions and recruit more workers,” said Porter. “The reality is that there simply aren’t enough nurses and nurse aides to meet the demand, and we desperately need meaningful workforce solutions 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.”

Growing Needs in Assisted Living

A foreseeable challenge facing assisted living will be managing the growing needs of a population that is entering assisted living with more chronic conditions, said LaShuan Bethea, executive director of NCAL.

“Assisted living communities must adapt to help residents manage these chronic conditions. As seniors age, they increasingly focus on health and wellness to maintain independence. Population health management will be essential in helping seniors stay healthy and enabling providers to offer more personalized and preventative care for seniors requiring assisted living services,” she said.

Integrating technology, such as wearables, can play an important role in helping providers monitor chronic conditions while helping residents remain independent and minimize the likelihood of health decline, she said.

Additionally, Bethea said, a critical challenge will be maintaining regulation at the state level.

“State regulations allow for a more tailored approach that reflects the unique needs of each community,” she said. “Preserving this at the state level will ensure that regulations remain flexible and responsive to the realities of providing care in diverse settings.”

Addressing Staffing Shortages

Leaders must be prepared to invest in competitive wages to recruit and retain while balancing these demands with inflationary pressures on expenses, according to Brian G. Lawrence, LNHA, CPA, MBA, president and CEO, FellowshipLIFE.

“We are exploring opportunities to recruit talent from abroad,” he said. “This decision has been assessed through a careful financial lens because of the time it may take for foreign recruitment to take shape. It’s crucial to involve financial experts in human resources and operational planning to ensure the organization can invest in quality staffing.”

Additionally, leaders cannot rely solely on compensation to retain high-quality employees. 

“Today’s workforce expects an environment with a strong workplace culture that prioritizes their personal and professional development,” Lawrence said. “To retain skilled workers, leaders must be able to articulate the benefits of employment outside of compensation. They must also be willing to build longer onboarding periods, mentorship programs, and more personal skill development opportunities to demonstrate the organization’s investment in each employee.”

Mentorships and Apprenticeships Support Staffing

More programs involving various nursing homes with mentorship support are planned for 2025, according to James Chang, workforce development manager at New York-based organization, 1199SEIU Training and Employment Funds (TEF), which provides CNA mentorship training through its long term care, community-based organization, and pharmacy division for certified nursing assistants working with CNA apprentices.

“As a result of the implementation of the projects, the overall post-graduation retention rate of these CNA apprentices with their existing employers has been approximately 90 percent,” Chang said. “The mentorship training teaches the mentors about empathy and compassion, which helps them to build trust with their apprentices. They learn to coach the apprentices on how to practice active/reflective listening skills and learn to respect others in the workplace.”

Pay and Benefits a Top Factor for Employees

As for employee preferences, the JLL 2024 Employee Perspective on Healthcare Real Estate reports that pay and benefits are the top factors in choosing an employer. However, flexibility, specific roles, and location are important in employee attraction and retention.

Additionally, generational preferences vary for these workplace factors. Baby boomers prioritize flexibility, with 15 percent ranking it as their top factor, while Gen Z values workplace culture.

The greatest impact of a facility's location on employee experience is its safety, convenience, and proximity to affordable housing. Employee spaces like break rooms and offices received lower ratings than patient care areas for newness, maintenance, and sound privacy, affecting employee experience.

Credentialing Changes

Credentials will continue to play an important role in training and hiring. Doug Helman, COO, The Kendal Corporation, foresees a resetting of nursing and caregiver professional credentialing and a continued increase in physician extenders and telemedicine.

“The health  care workforce shortage has become very real,” he said. “Many health care and medical professionals elected to leave the field or away from direct patient care following the pandemic. While the Baby Boomer demographic is encouraging from a consumer perspective, it has conversely further contributed to the health care workforce shortage. This will translate to resetting credentialing requirements for all licensed health care workers.”According to Helman, “Many state nursing and medical boards will reevaluate their credentialing requirements to address the shortage. This will result in more certified medication aides to support the nursing shortage and more nurse practitioners or physician assistants to support the family medicine and geriatrician shortage.”

Wellness as Part of Person-Centered Care

Alice Bonner, director of the Moving Forward national coalition, said nursing homes “aren’t just sites of care. They are people’s homes. Residents need to not only direct their care but have a say in the function and communal life of the nursing home,” Bonner said. “Empowering resident councils is vital to ensuring residents have that voice.”

Erin Caswell, COO, Revel Communities, said her company prioritizes listening to the voices of its independent living residents. Their feedback aligns with 2025 industry trends, highlighting the importance of autonomy and easy access to comprehensive health and wellness services.

Revel partners with personal trainers, physical and occupational therapists, concierge health care providers, primary care physicians, and mental health specialists to deliver multidimensional care directly to residents in the comfort of their homes and communities.

Wellness Accentuated Through Interior Design

A facility’s design can lead to healthier living environments, according to Johnny Dagher, director of senior living design, Baker Barrios Architects.

“Wellness has long been a central focus in the design of senior living facilities,” Dagher said. “Designers and owners have consistently prioritized elements like natural lighting, outdoor spaces, fitness areas, indoor air quality, and accessible design features. While many of these aspects are guided by building codes and shaped by lessons from the pandemic, the current emphasis has shifted toward leveraging wellness as a key selling point.”

Dagher also anticipates seeing design models that better accommodate individuals who fall between different care levels, such as those transitioning from assisted living to memory care or from independent living to assisted living.

“There’s a clear need for middle-ground services that offer more support than typical assisted living without requiring memory care,” Dagher said. “Similarly, there will be a demand for options that allow residents more independence while still having access to all the services provided in traditional assisted living.”

Technology and AI Help Communities Optimize Efforts

Companies are examining the requirements for value-based care models, which may require specific health information technology (HIT) capabilities (e.g., health information exchange) to enhance and improve care delivery by 2030. Technology is a key component for optimizing communities’ efforts to stay ahead.

However, Gregory L. Alexander, PhD, RN, FAAN, FACMI, FIAHSI, Helen Young CUPHSONAA Professor and Informaticist, Columbia University School of Nursing, said there are significant structural technology disparities among US nursing homes may lead to greater disparities in value-based care, such as poorer patient outcomes and lower quality of care with greater costs. Many of these problems may be exacerbated by a facility's rurality or size, he said.

“Document-sharing systems for nursing homes are receiving more attention as leaders realize that technology is here to stay and may provide important benefits, like more timely access to critical resident information when a resident’s condition changes,” Alexander said.

Experts identified AI, robotics, and virtual reality as important emerging capabilities that integrate technological components into care delivery and should provide new opportunities to address the challenges of caring for older adults in new ways. 

“Corporate long term care companies with IT departments may be the first to take advantage of these capabilities because they have the departments and infrastructure to support them,” said Alexander. “There’s much promise in these emerging technologies, but leaders must approach their use cautiously.”

One example of increased adoption of AI is at Maplewood Senior Living, with communities across the Northeast. Resident-focused innovations include AI-enabled life story platforms that allow residents and families to upload cherished memories, providing easy access to life highlights; wearable, predictive health monitoring systems for early detection of health issues and real-time updates; and machine vision AI safety systems for fall detection and prevention.

Maplewood also employs operational AI enhancements such as automated financial processing tools and AI-driven planning systems for sustainable and accurate operations and streamlined resident transition platforms to enhance the move-in experience.

These advancements will continue to provide tangible benefits, offering peace of mind, enhanced safety, and personalized care for residents while reducing burnout and improving job satisfaction among frontline staff, according to Brian Geyser, vice president of enterprise intelligence at Maplewood.

“Looking to 2025 and the years ahead, AI is positioned to revolutionize how we deliver resident care,” he said. “Our goal is to ensure that innovation enhances—rather than replaces—the personal connections that are the foundation of exceptional senior care.”

Doug King, vice president emeritus of health care at PMA, said new technology has made it easier for seniors to live independent lives.

“From the wide adaptation of telehealth to the increasing use of wearables that can track health indicators, monitor for red flags and even alert the proper authorities in the event of a fall or accident,” King said. “In 2025, we will see even broader adoption of these tools and services in the world of senior living. For example, many health care providers are developing digital twins of patient bodies, which can be used to predict and optimize health outcomes through advanced analysis and modeling.”

Affordability Still a Challenge

Affordability remains broadly unsolved, though new design trends are emerging, according to Zach Bowyer, executive managing director, Cushman & Wakefield.

“With middle-income seniors projected to double by 2029, over half of this segment will not have adequate finances to afford conventional senior living and care,” he said.

Paul Bergeron is a freelance writer based in Herndon, VA.