​Every day 10,000 baby boomers turn 65, according to U.S. Census data. The baby boomer generation began turning 65 in 2011 and will continue to add 10,000 each day through 2030.

The number of older adults will more than double over the next several decades to top 88 million people and represent over 20 percent of the population by 2050, according to a 2019 report from AARP. This silver tsunami of aging individuals will have a ripple effect through U.S. society, impacting industries across the nation. One of the most affected sectors will be the long term care profession.  

This rapid increase in older adults will create challenges and opportunities for the long term care profession over the next few decades. In addition to having more older individuals, people are living longer—between 2022 and 2040, the number of people who are 85 or older will more than double, according to the “Aging in the United States” report to Congress in May 2024. 

Demand for Senior Care Facilities

The long term care profession has been aware of this coming demographic shift for years and will need to provide solutions in several main areas. First and foremost is availability. Demand strongly outpaces supply and will continue to widen as the baby boomers age.

This demand is a business opportunity for those operating senior living, assisted living, and skilled nursing facilities. In addition to expanding and modernizing facilities, new locations will need to be built and staffed. This has led to innovation in construction methods to meet the rising need for space.

Tino Popescu, vice president of clinical services at Maplewood Senior Living, said some states, such as Texas, California, and Florida, may each need more than 250 new nursing homes by 2030 to maintain current population-to-nursing-home ratios.

“However, staffing shortages, rising labor costs, and high construction expenses constrain growth,” Popescu said. “New development remains slow, and acquisitions are focused on smaller, distressed assets. Federal policy shifts—particularly in Medicaid reimbursement—will be critical in shaping investment strategies.”

“The industry has been trying to solve this by creating less expensive construction,” Zach Bowyer, MAI, MRICS, executive managing director, Cushman & Wakefield, said. “For example, hotel conversions can reduce real estate costs.”

Developers sense the need to move quickly and efficiently in building structures to serve this population, according to BKV Group’s Senior Housing Practice Leader, Grant Warner.

“Some are shifting toward prototype construction that saves time and money,” said Warner. “Some are also focusing on much-deserved areas such as suburbs, exurbs, rural communities, and urban areas.” Others are developing pre-fabricated housing solutions to save time and money.

Despite increased demand, growth in new senior housing options is at one of the lowest levels in recent history, according to Anne Hill, senior vice president of Bayview, PACE, which provides financing for senior living and long-term care facilities.

Like other commercial real estate segments, construction starts have slowed significantly nationwide due to the more expensive financing environment and elevated construction and labor costs.

Doug King, vice president emeritus, health care at Project Management Advisors, Inc., said he is confident that existing assisted living communities will be able to scale up, as renovating existing housing stock doesn’t require significant adaptation to become an effective assisted living community.

“The need for skilled nursing facilities is another, more complex matter,” King said. “These licensed rooms have technology and other health care features such as telemetry, medical gases, nurse calls, patient lifts, and provisions for patient safety, such as handrails, that are not found in the typical multifamily residential structure.”

Affordability Remains a Primary Challenge

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, according to Bowyer. “When you look at housing affordability in the middle markets, half the population can’t afford it,” he said.

“We need more solutions on the horizon for the middle market, which is made up of folks who will have a fixed income that doesn't align with some of the more luxurious options, such as teachers, firefighters, skilled trade workers,” according to Shannon Arnold, president, Kara Casa.

The number of unpaid caregivers (such as family and/or friends) will on average decrease over the next five years, resulting in the increased need for paid caregiving in an appropriate long term care setting such as assisted living, according to a 2024 article from the National Council on Aging (NCOA).

Over 15 million (or roughly one in three) older adults aged 65 and older are economically insecure, with incomes below 200 percent of the Federal Poverty Level said NCOA. Unfortunately, many seniors must spend down their assets in order to qualify for Medicaid to have their long term care covered. (Medicare does not cover long term care.) To qualify for Medicaid, most states require that you demonstrate that you require skilled nursing level care. Not everyone who needs long term care necessarily needs 24/7 support and may have their needs better met in a setting like assisted living.

One option is to make assisted living a more affordable option to meet the changing needs of a growing elderly population. Assisted living communities that are 100 percent Medicaid are often built in areas specifically to serve low-income residents. To offer affordable assisted living exclusively requires an entirely different business model and vigorously looking for loans and programs to stay viable. This includes HUD loans, low-income tax credits, and USDA multifamily housing direct loans. Public-private partnerships are needed to identify opportunities and facilitate grant programs or other financing options.

Research shows that some seniors will need more affordable assisted living options, as fewer resources and fewer family caregivers will impact the need for and ability to access assisted living care. But the path to getting there faces obstacles.

“There are many challenges that need to be addressed in order for assisted living providers to be able to deliver more affordable care options,” said National Center for Assisted Living Executive Director LaShuan Bethea. “How long term care is currently financed, Medicaid underfunding, and essential public-private partnerships—these all need to be considered as we face an increasing senior population that will depend on the high-quality care offered in assisted living sooner than we realize.”  

Managing Multiple Conditions

One result of a longer lifespan is that those in the 80+ demographic are also experiencing more health issues. Popescu said it is estimated that 90 percent of adults over age 65 experience one or more chronic conditions requiring specific treatments and medical care.

This need to manage multiple conditions has led to an increase in innovations in technology. Technology use has exploded in the long term care profession in the past few decades and will be a critical part of caring for the silver tsunami. Innovations in monitoring and care practices have allowed skilled nursing residents to avoid hospital visits and continue to be managed in the facility.

Electronic health records, interoperability, telehealth, and cybersecurity developments have helped move paper records into the electronic age, allowing for greater collaboration and communication, particularly in moving between care locations and physicians.

Artificial intelligence is one of the most exciting areas of technology in long term care right now. Whether AI is helping to optimize the use of staff time, monitoring residents to reduce falls, providing companions or enrichment activities, AI is finding its way into the industry in a myriad of ways.

“We not only have a rapidly growing number of elders in this demographic group, but many are not aging in healthy ways,” Banta said. “There is tremendous growth in dementia and co-morbidities that will require a vast expansion of acute care resources and housing in this country.”

Greater research and development in treatment methods for conditions such as dementia are experiencing greater uptake as well. An estimated 6.9 million Americans age 65 and older are living with Alzheimer’s dementia as of 2024, according to Popescu. This number could potentially grow to 13.8 million by 2060 without medical breakthroughs. Alzheimer’s remains the fifth-leading cause of death among Americans age 65 and older.

As a sector, “We have a good history of caring for residents with advanced dementia,” said David Gifford, chief medical officer at AHCA/NCAL. New, neurology-forward approaches to care have shown great promise in helping those with dementia manage these conditions better.

While the silver tsunami brings challenges with higher numbers of seniors living longer and with more conditions, long term care as a profession is poised to tackle those challenges. New thinking, compassion, and technology—combined with investment, regulatory support, and a focus on workforce—will see the long term care segment growing well into the future.

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