1
Table of Contents Part 2.
Topic Page
Introduction 2
Trends: Product Definition 3
Trends: Active Adult Housing 9
Trends: Seniors Apartments 22
Trends: CCRCs 25
Trends: Independent Living 30
Trends: Assisted Living 35
Trends: Nursing Care 38
Trends: Industry Growth 44
Conclusions 50
Part 2. Trends: Product Definition
2
Part 2. Assessment of Senior Housing Development
Trends and Best Practices
Overview of Senior Housing
The Senior Housing market has grown and changed dramatically in the past few years. One of
the primary changes is that all forms of age-qualified housing products are oriented less toward
services and caring for “seniors” and have moved more toward an emphasis on the lifestyle of adults
at all ages and levels of ability. While terminology is difficult to change, many concur that the term
senior housing is out of date with consumer preferences.
The most significant and sweeping change in the industry, at all levels of service, is the change
from communities that are defined by the age of the inhabitants to communities that are defined by
the lives and lifestyle of the inhabitants. The product may be reserved for persons who are 55 years
of age or older, yet in today’s market the emphasis is not on age, but rather on the quality of the
living experience.
This change is seen in all levels of service including active adult, independent living, assisted
living, programs for persons with Alzheimer’s disease, and nursing care properties.
Part 2. Trends: Product Definition
3
The Choices of Age-Qualified Housing Products in the
United States - 2005
There is a comprehensive continuum of housing targeted at consumers 55 years of age and older in the
United States that ranges from few, if any, services to comprehensive health care services. The services,
amenities, and forms of housing are changing every day. The differences between the various age-qualified
housing products become more blurred each day.
The types of housing products can be categorized in a number of ways. One category, shown in the top
line of the chart below, separates age-qualified housing into products where the resident makes the choice of
moving to the community and where the family makes the choice for the resident. A second category,
represented by the line that reads Active Adult to Service Enriched, divides properties by whether or not the
individual receives specific services such as meals, transportation, emergency response, etc. Active adult
properties typically do not provide services to individuals as part of their Home Owners Association (HOA)
fees, with the exception of community maintenance and lawn and landscaping services. Service-enriched
properties provide increasing levels of services beginning with transportation, dining and housekeeping for
independent living and encompassing personal care services such as bathing, dressing, managing medications
for assisted living, and health care services in nursing care.
FAMILY CHOICESINDIVIDUAL CHOICES
Nursing
Care
Nursing
Care
55-75
55-75
80-90
80-90
Entry
Ages
µ=Approx 60 µ=Approx 65 µ=Approx 78 µ=Approx 82 µ=Approx 84 µ=Approx 85
Age-Targeted
Community
55 100
Age-Targeted
Community
Age-Qualified
Community
Age-Qualified
Community
CCRC
CCRC
Independent
“Congregate”
Living
Independent
“Congregate”
Living
55-75
55-75
70-90
70-90
70-85
70-85
Assisted Living
or
Alzheimer’s Care
Assisted Living
or
Alzheimer’s Care
80-90
80-90
Age
Active Adult Service Enriched
Part 2. Trends: Product Definition
4
Classification of Age-Qualified Housing Properties
Age-Targeted or Age-Qualified
Age-targeted communities are designed and positioned to attract mature households, but they are not
marketed as 55+ communities, nor do they comply with the Fair Housing Amendments Act (Sec. 800. [42 U.S.C.
3601] Fair Housing Act). Housing for older persons under the Fair Housing Act of 1988 is the only acceptable
form of legal discrimination.
From the Fair Housing Act of 1988…
(2) As used in this section "housing for older persons" means housing --
(A) provided under any State or Federal program that the Secretary determines is specifically designed and
operated to assist elderly persons (as defined in the state or federal program); or
(B) intended for, and solely occupied by, persons 62 years of age or older; or
(C) intended and operated for occupancy by persons 55 years of age or older, and–
(i) at least 80 percent of the occupied units are occupied by at least one person who is 55
years of age or older;
(ii) the housing facility or community publishes and adheres to policies and procedures
that demonstrate the intent required under this subparagraph; and
(iii) the housing facility or community complies with rules issued by the Secretary for
verification of occupancy, which shall–
(I) provide for verification by reliable surveys and affidavits; and
(II) include examples of the types of policies and procedures relevant to a termination of
compliance with the requirement of clause (ii). Such surveys and affidavits shall be admissible in
administrative and judicial proceedings for the purposes of such verification.
Part 2. Trends: Product Definition
5
Age-Qualified Compared to Age-Targeted
Age-Qualified
At least one person in each household is
55+;
Protected by Fair Housing Act;
Can refuse occupancy to those younger
than 55 years of age (in some
communities the minimum age is set at
62 years of age); and,
Actively advertise that they provide
housing for persons either 55 years of age
and older or 62 years of age and older.
Age-Targeted
Designed and marketed to mature
consumers, but do not mention that age
is a qualifying factor for residency;
Product and covenants usually appeal to
retirees and empty nesters and not to
young families;
Have no legal protections for
discriminating against households who
have younger occupants;
Cannot deny a sale to a family; and,
Cannot refuse occupancy to anyone.
Many builders prefer to build age-targeted active adult housing because they believe they
have an opportunity to capture a greater market share if they do not label the community as
“active adult” or for persons who are a certain age or older. These communities are often
identified by the way they market their homes because they often use language including: care-
free living, maintenance-free living, ranch-style homes, and single-story living.
Some developers build sections within their master-planned communities that have single-
story homes and ultimately sell most of the homes to mature households, but they do not market
these sections as age-qualified communities.
Part 2. Trends: Product Definition
6
Active Adult or Service-Enriched
Active Adult and Service-Enriched Communities
Housing targeted to mature consumers is often categorized by the number and type of services
that are provided. Properties that do not provide services or that provide services solely related to the
upkeep and maintenance of the communities’ buildings and grounds are generally referred to as active
adult. Communities that provide services to the individual such as dining, housekeeping, social
programs, transportation, and possibly personal care assistance, are referred to as service-enriched
communities.
Trends. The differences between active adult and service-enriched communities continue to
lessen. Many service-enriched communities are beginning to provide services a la carte and/or add
sections where services are not required as part of the monthly fee. Thus, these service-enriched
properties offer products that are essentially “active adult.” The households who move to an “active
adult” area on a service-enriched campus, however, are usually older than the households who move to
an active adult community. Many consumers are opposed to about moving to communities that are age-
qualified because they fear it will make them appear older.
Typical Labels for Active Adult and Service-Enriched Communities
Active Adult Service-Enriched
Age-Targeted Community (single-family homes,
condominiums, manufactured homes)
Age-Qualified Community (single-family homes,
condominiums, manufactured homes)
Seniors Apartments (multi-family housing)
Independent Living Community (usually multi-family, but
single-family dwellings and condominiums are becoming
more common)
Assisted Living Community (multi-family)
Nursing Care Residence (Nursing Home)
Continuing Care Retirement Community (CCRC) - A
combination of multiple service levels on a single campus.
Part 2. Trends: Product Definition
7
Product Types and Average Age at Move-In
The bottom line of the chart on page 3 shows the average age of most residents when moving
to each of the product types. These categories are averages, and the actual ages of individuals
moving to the communities vary significantly. An 85-year-old may purchase a home in an active
adult community, and there are many people younger than 60 years of age in assisted living
residences. It is usually the health and abilities of an individual that determine the type of
community to which he or she move.
Usually the positioning and age of a community affect the age of the people who move to the
community. Communities that present a lively and opportunity-filled lifestyle, avoid ageist language,
and market their product as an active lifestyle generally attract younger households. Communities
with smaller residences that focus marketing on the provision of care and services attract older
households.
The longer a community has been open, the older the residents. When a community first
opens, the majority of residents are near the average age at entry for the product, but as a
community ages the average age of the existing residents increases. Incoming residents usually
reflect the same age as existing residents in communities. Or, in other words, when the prospective
residents visit older communities and see that the existing residents are older, they usually look for
other communities where residents are more like themselves. Hence, new communities have
younger residents and older communities have older residents.
Part 2. Trends: Product Definition
8
Description of Age-Qualified Housing Products
The active adult and service-enriched housing products will be defined and described in this
section. The Classification for the Seniors Housing Property Types will be from the classifications
endorsed by the primary organizations who represent the seniors housing industry. These
organizations include:
American Association of Homes & Services for the Aging (AAHSA)
American Health Care Association (AHCA)
American Seniors Housing Association (ASHA)
Assisted Living Federation of America (ALFA)
National Center for Assisted Living (NCAL)
National Investment Center for the Seniors Housing & Care Industries, Inc. (NIC)
Part 2. Trends: Product Definition
9
Active Adult Community (endorsed definition)
Active Adult Communities
Definition. For sale single-family homes, town homes, cluster homes, mobile homes, and
condominiums with no specialized services, restricted to adults at least 55 years of age or older.
Rental housing is not included in this category. Residents generally lead independent lifestyles;
projects are not equipped to provide increased care as the individual ages. May include amenities
such as a clubhouse, golf course and recreational spaces. Outdoor maintenance is normally
included in the monthly homeowner's association or condominium fees.
Active adult communities are designed to attract the mature consumer who prefers to live
in a neighborhood with others of the same age. Active adult communities may be age-targeted or
age-qualified (age-restricted).
Age-targeted refers to a community that targets its product offering and marketing to persons
55-years-of-age and older, but does not choose to comply with the requirements of, nor enjoy the
protections of, the Fair Housing Act of 1988 (see page 4).
Part 2. Trends: Product Definition
10
Example of an Active Adult Community in Prince George’s County
Victoria Falls, a Central Parke 55+ Resort Community by Slenker
Land Corporation
Part 2. Trends: Active Adult
11
Variations in Traditional Active Adult Communities
Active adult communities have as many variations as there are communities. The attributes
that vary among these communities include the size or number of homes in the community, type of
homes, price level of homes, amenities, and services.
Size: Active adult communities range in size from 20 to more than 20,000 homes.
Type of homes: Types of homes in active adult communities include single-family detached,
single-family attached (duplex, triplex and quadplex are common), manufactured (mobile) homes,
condominiums (multistory and town home style).
Part 2. Trends: Active Adult
12
Variations in Active Adult Communities (continued)
Amenities. Amenities often seen in active adult communities include a club house, swimming
pool, fitness center, tennis courts, and golf course. Large communities such as those
developed by the Del Webb Division of Pulte Homes, Lennar Corporation, K. Hovnanian
Companies, U.S. Homes, Robson Communities, and others often have golf courses, restaurants
and a variety of other facilities where residents may meet with and/or entertain others.
Services. Active adult communities usually provide basic home owner association services
related to maintaining the streets and central buildings. Some active adult communities
provide lawn and landscaping services and maintenance of the exterior of the homes.
Gated, Guard-Gated Communities. The level of perimeter security varies widely among
active adult communities and often depends on their location. The majority of communities
have an entrance gate that remains open and is there predominantly to provide a landmark
and signage for the community. Some communities, particularly those in high-traffic areas,
may have an electronic gate to restrict traffic flow to residents and their guests. A small
proportion of communities employ security guards who operate the gates to the community.
These communities tend to be located in more populated areas and may include higher priced
homes.
Part 2. Trends: Active Adult
13
The Market for Active Adult Communities
1. Active adult communities appear to be gaining in popularity, particularly because more
communities are being built. Active adult communities are appearing in virtually every metropolitan
area in the U.S., and thus are an option for people where the option was not available in most
markets even just a few years ago.
2. Residents range from 55 to 80+ years of age. The amenities of the community, size and
design of the homes, and positioning of the community influence the age and nature of the resident.
Communities with amenities such as golf courses and other recreational amenities with larger,
single-family homes are more likely to attract younger households compared to communities with
small attached homes that focus on low-maintenance and community services.
Part 2. Trends: Active Adult
14
Profile of Residents in Active Adult Communities
Characteristics of Households in Active Adult Housing in the United States
Average age: 73.7 years
Gender: 44 percent male, 56 percent female
Marital status: 61 percent married, 23 percent widowed, 15 percent single or divorced
Work for pay (part-time or full-time)
Residents younger than 65 years of age: 47 percent are working
Residents 65 years of age and older: 20 percent are working
Source: Understanding Seniors Housing: Demand, Choices and Behavior, 2003, National Investment Center for the
Seniors Housing & Care Industries.
The profile of residents in each active adult community depends on a variety of factors
including:
1. The age of the community: the age of residents in new communities is typically younger
than the age of residents in older communities, because these residents will have lived there since
the community opened. They may have had an average age of 63 years when they moved in, but
after they have been there for 10 years their average age is 73 years.
2. The price of homes in communities: higher priced homes attract a more affluent market,
that typically has a higher proportion of married couples.
3. The style of homes: small, single-story attached homes have a tendency to attract a
slightly older age group, and more single-person households than communities with large detached
homes.
Part 2. Trends: Active Adult
15
Race/Ethnicity: 98 percent Caucasian (with the exception of properties in the Prince George’s
County market where it appears that the proportion of African-American households may more
closely reflect the racial balance in the market area).
There are few active adult communities in the United States that are located in markets that
have high proportions of people of color. Across the United States, the proportion of home
owners or residents in any form of age-qualified communities that are a race or ethnicity other
than Caucasian is less than 3 percent.
Evidence from Prince George’s County, however, suggests that African-American households
will purchase the active adult housing product. Although only two properties would provide
any information to us about the proportion of sales made to African-American households,
these two properties reveal that the majority of their buyers are African-American. The Village
at Collington estimated that between 90 and 100 percent of the households in their three
neighborhoods are African-American. The sales representatives at Victoria Falls estimated that
60 percent of their homeowners are African-American (the marketing agency handling the
Victoria Falls account refused to verify the estimate of the sales staff).
Although all of the active adult communities were contacted, told the reason and for whom we
were soliciting the information all but these two properties adamantly refused to provide the
information. Many said it was illegal for them to collect this information.
Profile of Residents in Active Adult Communities
Part 2. Trends: Active Adult
16
The Benefits of Active Adult Housing
Less Impact on Traffic
Building an active adult
community of 100 single-family
homes can produce $3 million in
local income, $504,000 in taxes and
other local revenue for local
governments and 67 new jobs.
Active adult households generate
fewer trips in their cars than the
average household — especially at
rush hour. They don’t need to go to
work at a specific time and they
conveniently avoid getting
entangled in rush hour traffic.
Less Impact on Water and
Sewer Services
Local governments spend less
on water and sewer services for
residential developments that are
age-qualified or age-targeted than
they do on average households.
7
10
51
62
21
23
75
101
0
20
40
60
80
100
120
Senior Apartments All Apartments Seniors Single
Family
All Single-Family
Average Number of Trips Generated Per 100
Housing Units: Morning Rush Hour
Part 2. Trends: Active Adult
17
The Benefits of Active Adult Housing
Vehicles Per Household by Age of Household Head
Households headed by someone
55 to 64 years of age have slightly
fewer vehicles per household than
those 35 to 54 years of age, but
households headed by someone 75
years of age and older have
approximately 20 percent fewer
vehicles per household.
1.92
1.21
2.19
1.11
2.09
1.01
1.75
0.62
0
0.5
1
1.5
2
2.5
Vehicles
Under 35 35 to 54 55 to 64 75 and older
Age Group
Number of Vehicles per Household by Age of
Head of Household
Single-Family Detached Multifamily
Part 2. Trends: Active Adult
18
The Benefits of Active Adult Housing
Low Crime Rates
Households headed by someone
55 years of age and older are
significantly less likely to be involved in
crime. As age increases, the number of
arrests per 1,000 individuals decreases.
211
166
120
60
27
15
12
0
50
100
150
200
250
Arrests per 1,000
Under 34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Arrests per 1,000 Households by Age
Part 2. Trends: Active Adult
19
The Benefits of Active Adult Housing
Low Use of Community Resources
$435
$486
$486
$454
$407
$372
$360
$0
$100
$200
$300
$400
$500
Monthly Bil
l
Under 35 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 and over
Age Group
Average Water/Sewer Bills by Age of Household
Head
Less Impact on Water and
Sewer Services
Local governments
spend less on water and sewer
services for residential
developments that are age-
qualified or age-targeted than
they do on average
households.
Part 2. Trends: Active Adult
20
Quick Survey of Active Adult Properties in Areas
Where There Are High Proportions of African
American Households
The market areas around the
ten communities of 100,000 or more
population with the highest
percentage of African-Americans and
other areas in the U.S. were explored
to identify active adult communities
and to learn the percentage of
African-American homeowners within
the active adult communities. A total
of 10 communities were identified in
market areas where the African-
American population was 20 percent
or higher. Most of these markets
were in areas around a few of these
10 communities.
There were no active adult
properties within the market areas
around Gary, IN; Detroit, MI;
Birmingham, AL; Jackson, MS;
Memphis, TN; Washington, DC that
had African-American populations
exceeding 20 percent of the total
population.
Part 2. Trends: Active Adult
21
African American Active Adult Homeowners
Among the total number
of ten active adult properties
identified in market areas
where more than ten percent
of the population is African-
American, three refused to
provide us any data, stating it
is illegal to collect the
information. It is evident,
however, among the properties
willing to share information,
that African-American
households accept and
purchase the active adult
product.
Percent of African-American-Households Owning Homes in Active Adult
Communities in Markets with 10+ Percent African-American Households
Percent African
American Households
City
Laurel, MD
Mitchellville, MD
Olympia Fields, IL
Homewood, IL
South Holland, IL
Lansing, IL
Berlin, MD
Property
In City In Property
Central Parke at Victoria Falls 34.5 % 60 %
Signature Club at Collington 78.5 % 90 to 95 %
Traditions at Olympia Fields 52.1 % 90 %
Garden at Homewood Place 17.5 % 85%
Villas of South Holland 50.8% 60%
Villas of America 10.7% 12%
River Run 32% 0%
3 (30%)7 (70%)10
Number (and Percent)
Refused to Provide Data
Number (and Percent)
Provided Data
Number of Properties
Identified
Total Number and Percent of Properties Identified in Areas
with 10+ Percent African-American Households That Provided Data
on the Proportion of Sales to African-American Households
Part 2. Trends: Active Adult
22
Senior Apartments Market Rate
(endorsed definition)
Age-Targeted Community/Senior Apartments
Definition. Senior apartments are multifamily residential rental properties restricted to
adults at least 55 years of age or older. These properties do not have central kitchen facilities
and generally do not provide meals to residents, but may offer community rooms, social activities
and other amenities. The apartments discussed in this section do not include subsidized
apartments such as HUD 202 or Section 8 properties.
The number of senior apartments built in the last five years has increased substantially,
particularly because this product has shown significant success across the United States.
Developers of senior apartments are attracted to this product for the following reasons:
Older renters have a longer tenure than younger renters;
Older renters have less impact (wear and tear) on the building than younger renters;
Senior apartments require fewer employees than service-enriched age-qualified
housing such as independent living;
Senior apartments, because they do not include a central kitchen and dining room,
are less expensive to construct than independent living communities; and
Senior apartments have enjoyed faster fill-up rates than independent living
apartments, probably because they are less expensive than communities that
include services in their monthly fees.
Part 2. Trends: Senior Apartments
23
Example of Senior Apartments in Prince George’s County
In 2001 a large number of senior apartments were
financed through the Low-Income Housing Tax Credit
program, while approximately one-fourth were bond
financed. The properties focused on in this report,
however, are market rate properties that do not rely on
subsidies.
There has been an increase in the number of
market rate senior apartments in the U.S. for several
reasons. Many service-enriched communities,
particularly those experiencing occupancy problems,
have begun to lease their apartments without services
to attract a younger clientele and to fill vacant units.
Senior apartments may compete significantly with
independent living residences. They are not likely to
have a strong impact on the market for single-family
homes among the 55+ market sector. Renting is not
an alternative for someone who wishes to purchase a
home. A senior apartment, on the other hand, is an
alternative to an apartment in an independent living
community when the household does not wish to pay
for additional services.
Part 2. Trends: Senior Apartments
24
Profile of Residents in Senior Apartments
Average Age: 77.6 years;
Gender: 73 percent are women, 27 percent are men;
Marital Status: 20 percent are married; 38 percent are widowed; 41 percent single or
divorced;
Race/Ethnicity: 91 percent are Caucasian.
Source: Understanding Seniors Housing: Demand, Choices and Behavior, 2003, National Investment Center for the
Seniors Housing & Care Industries.
Part 2. Trends: Senior Apartments
25
26
CCRCs Variation by Contract Type
CCRCs vary in the type of contracts that they have with their residents. These contracts differ
relative to the amount of money the resident pays when entering the community and subsequently
in monthly fees, and they vary relative to the types of services included in the contract.
Type A Contract: A resident typically pays an upfront fee and an ongoing monthly fee in
exchange for the right to lifetime occupancy of an independent living unit and certain services and
amenities. Residents who require assisted living or nursing care may transfer to the appropriate
level and continue to pay essentially the same monthly fee as they were paying for independent
living. This Type A contract is sometimes referred to as “Lifecare.”
Type B Contract: Under a Type B (Modified) contract, a resident typically pays an upfront fee
and an ongoing monthly service fee for the right to stay in an independent living unit and receive
certain services and amenities. A modified contract obligates a CCRC to provide the appropriate
level of assisted living or nursing care to residents of independent living units, as in a life care
contract, but only for a specified period of time at a specified rate that may or may not be tied
directly to the independent living rate.
Type C Contract: A fee-for-service contract requires an entrance fee but does not include
any discounted health care or assisted living services. Typically residents receive priority admission
or guaranteed admission for these services. Under this contract, residents who require assisted
living or nursing care pay the regular per diem rate paid by those admitted from outside the CCRC.
Source: American Seniors Housing Association, The State of Seniors Housing, 2004.
Part 2. Trends: CCRCs
27
Size of CCRCs in Number of Units/Beds
CCRCs range in size from fewer than 200
apartments or beds to more than 400
apartments or beds. The units are generally
counted as apartments in independent living
and beds in assisted living and nursing care.
The total count of units in CCRCs is the count of
apartments in independent living and beds in
assisted living and nursing care.
Percent of CCRCs by
Number of Units
0 to 200
22%
301 to
400
28%
401+
23%
201 to
300
27%
Source: American Seniors Housing Association, The
State of Seniors Housing, 2004.
Part 2. Trends: CCRCs
28
Example of a CCRC in Prince George’s County
(The Collington)
28
Part 2. Trends: CCRCs
29
Profile of Residents in CCRCs
Average age: 77.3 years.
Gender: 68.3 percent female, 31.7 percent male
Marital status: 47 percent married, 44 percent widowed, 9 percent single or divorced
Race/Ethnicity: 99 percent Caucasian
Work for pay (part-time or full-time)
0 percent full-time
2 percent part-time
Source: Understanding National Investment Center for the Seniors Housing & Care
Industries Seniors Housing: Demand, Choices and Behavior, 2003.
American Seniors Housing Association, The Independent Living Report, 2004.
Part 2. Trends: CCRCs
30
Independent Living (endorsed definition)
Congregate Care/Independent Living Communities
Definition. Age-qualified multifamily rental properties with central dining facilities that
provide residents, as part of their monthly fee, access to meals and other services such as
housekeeping, linen service, transportation, and recreational activities. Such properties do not
provide, in a majority of the units, assistance with daily living such as supervision of medication,
bathing, dressing, toileting, etc. There are no licensed skilled beds in the property.
Variation in Independent Living Communities. Independent living communities vary by
their size, whether or not they are freestanding structure or are combined with other services, their
amenities and services, and whether or not the resident may “age in place” and receive assisted
living services in their apartment.
Fees. The median monthly revenue from independent living apartments is $1,832. Fees
range from as low as $600 per month in a community with an entrance fee up to $7,500 for a two-
bedroom apartment in a luxury community.
Note: The term “congregate care” is used only infrequently.
Part 2. Trends: Independent Living
31
Independent Living Communities
Independent living properties range in
size from perhaps as small as a dozen
apartments (units) up to 1,500 or more. The
average (mean) number of independent living
apartments is 136 and the median is 108.
Source: American Seniors Housing Association, The
State of Seniors Housing, 2004.
Percent of Independent Livin
g
Communities
by Number of Units
29%
24%
18%
29%
Part 2. Trends: Independent Living
32
Variations in Independent Living Properties:
Type of Property
A freestanding independent living
community is one that provides only
independent living housing and services. In
contrast, there are properties that provide
both independent living and assisted living
housing and services.
There are two types of properties that
provide both independent living and assisted
living. One type segregates the independent
living from the assisted living residents in
separate buildings or wings. Most do not
intermingle the groups for activities and
dining. While this seems discriminatory, it is
usually at the request of independent living
residents. Contrary to what you might
expect, many older adults are intolerant of
other older adults with diminished capacities
and do not want to be in the same areas or
dining rooms with them. It is almost that
they fear the difficulties of the other person
are contagious, or if they are seen with other
people with diminished capacity, they will be
viewed the same.
Independent Living Community
Part 2. Trends: Independent Living
33
Variations of Independent Living: Aging in Place
Some independent living properties by plan or by default allow independent living residents to
continue living in their apartments, even though they cannot live independently any longer. Instead
of moving the resident to assisted living they provide assisted living services to the resident in
his/her independent living apartment. This is usually preferred by the resident receiving the services
because he/she is not required to move and is able to stay in the apartment to which he/she has
become accustomed.
Unfortunately, many independent living neighbors of individuals who are receiving assisted
living services in what used to be an independent living apartment are unhappy about the presence
of their neighbors with diminished capacities. Their unhappiness is often caused by two primary
circumstances. The first is that they must encounter the persons with diminished capacities in the
common areas of the community. The second, is that often they are called upon to assist residents
with diminished capacities.
From focus groups conducted with independent living residents living in an “aging in place”
community, ProMatura has documented many instances where a neighbor had to go to the rescue of
their frailer assisted living neighbor who had fallen, become ill, or who was disoriented and
wandering the halls, etc. While the independent living residents sympathize with the assisted living
neighbors, they do not believe that it is fair that they should be the ones to have to look out for their
frailer neighbors and be concerned about them. It is not the intention of the communities to have
the residents look out for one another relative to their health and safety; however, most independent
living residences are larger and not well-designed for closely monitoring residents 24 hours per day.
Part 2. Trends: Independent Living
34
Profile of Independent Living Residents
Average age: 82.6 years
Gender: 69 percent female, 31 percent male
Marital status: 31 percent married, 52 percent widowed, 16 percent single or divorced
Race/Ethnicity: 99 percent Caucasian
Work for pay (part-time or full-time)
0 percent full-time
2 percent part-time
Source: Understanding National Investment Center for the Seniors Housing & Care
Industries Seniors Housing: Demand, Choices and Behavior, 2003.
American Seniors Housing Association, The Independent Living Report, 2004.
Part 2. Trends: Independent Living
35
Assisted Living (endorsed definition)
Assisted Living Residence
Definition. State-regulated rental properties that provide the same services as
independent living communities, but also provide, in a majority of the units, supportive care from
trained employees to residents who are unable to live independently and require assistance with
activities of daily living, including management of medications, bathing, dressing, toileting,
ambulating and eating. Many of these properties include wings or floors dedicated to residents
with Alzheimer’s or other forms of dementia.
Size of Residences. Assisted living residences range in size from a few units to up to 300
apartments. The median size of assisted living residences is 54 units (apartments).
Fees. The median monthly fee charged by assisted living residences in the U.S. is $2,695.
This fee usually pays for the room and board and personal care services (as listed above). There
are variations in the way assisted living communities charge for their services. Some have a
single all inclusive price. Other assisted living residences charge a base price for room and board
and charge separately for each additional service such as medication management, bathing,
assistance with toileting, escort service to meals. And some assisted living properties have tiered
pricing based on the amount of service (or assistance) provided.
Part 2. Trends: Assisted Living
36
Variations in Assisted Living: Type of Property
Assisted living services are
provided in freestanding
properties where only assisted
living care is provided in
properties where other services
are provided. Many assisted
living properties include
separate areas or wings where
residents with Alzheimer’s
disease or some other form of
dementia are provided care.
Some assisted living
Alzheimer’s care centers are
freestanding and only serve
persons with this disorder.
Assisted living is often
provided in communities that
also offer nursing care, and is
usually provided in continuing
care retirement communities.
Assisted Living Morningside House at Laurel
Part 2. Trends: Assisted Living
37
Profile of Assisted Living Residents
Average age: 85 years
Gender: 79 percent female, 21 percent male
Race/Ethnicity: 99 percent Caucasian
Assisted Living Residents’ Needs for Assistance
Need help with medications 86 percent
Need help with bathing 72 percent
Need help with dressing 57 percent
Need help with toileting 41 percent
Need help with transferring 36 percent
Need help with eating 23 percent
National Center for Assisted Living, Facts and Trends: The Assisted Living Sourcebook, 2001.
Part 2. Trends: Assisted Living
38
Nursing Care: Skilled and Unskilled
(endorsed definition)
Nursing Home. A licensed daily rate or rental property that is technically referred to as a
skilled nursing facility or nursing facility where the majority of individuals require 24-hour nursing
and/or medical care. In most cases, these properties are licensed for Medicaid and/or Medicare
reimbursement. These properties may contain a minority of assisted living units.
Skilled Nursing Facility (SNF). These state-licensed long-term care facilities offer
24-hour medical care provided by registered nurses (RN), licensed practical nurses (LPN) and
certified nurse assistants (CNA). They also are required to have house physicians. This facility
cares for the very frail residents who are totally dependent on nursing care. This facility typically
has a short-term rehabilitation unit for residents needing rehab between hospital and home.
Nursing care properties vary in the level and type of care they provide. Some provide
intermediate care that has limited nursing care and provides personal care services. Skilled
nursing facilities provide higher levels of care and many may offer special services.
Some nursing care providers have short-term stay facilities and cater to individuals
recovering from injury, surgery or illness. Others serve a broader range of nursing care needs
and may offer palliative care for persons near death.
Services. Nursing homes provide personal care and nursing care services. They vary in
the amount and depth of nursing care provided.
Fees. The median per diem rate for a private nursing care bed in metropolitan areas in
the U.S. is $190 or approximately $5,795 per month.
Part 2. Trends: Nursing Care
39
Nursing Care: Change on the Horizon
Nursing homes have long been dreaded by everyone. One fears spending the end of life there, and family
members suffer guilt when placing their loved ones in nursing centers. Most even fear having to visit someone in a
nursing home. Since, 1991, Dr. Bill Thomas has led a small but progressively growing movement to change nursing
homes. Called the Eden Alternative, his movement focuses on making sure that despite their health and/or physical
condition, residents of a nursing home have an opportunity for growth.
THE EDEN ALTERNATIVE TEN PRINCIPLES
1. The three plagues of loneliness, helplessness, and boredom account for the bulk of suffering among our elders.
2. An elder-centered community commits to creating a human habitat where life revolves around close and
continuing contact with plants, animals, and children. It is these relationships that provide the young and old alike
with a pathway to a life worth liv
ing.
3. Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal
companionship.
4. An elder-centered community creates an opportunity to give as well as receive care. This is the antidote to
helplessness.
5. An elder-centered community imbues daily life with variety and spontaneity by creating an environment in which
unexpected and unpredictable interactions and hap
penings can take place. This is the antidote to boredom.
6. Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential
to human health.
7. Medical treatment should be the servant of genuine human caring, never its master.
8. An elder-centered community honors its elders by de-emphasizing top-down bureaucratic authority, seeking
instead to place the maximum possible decision-making authority into the hands of the elders or into the hands of
those closest to them.
9. Creating an elder-centered community is a never-ending process. Human growth must never be separated from
human life.
10. Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.
Part 2. Trends: Nursing Care
40
Nursing Care: A New Alternative, the Green House
Dr. William Thomas initiated another
innovation in nursing home care with
Mississippi Methodist Services. The first
four Green Houses in the nation have
been housing elders since May 2004 in
Tupelo, Mississippi. Conceived as part of a
movement to change the culture of long-
term care in America, they are designed
to feel more like home than today's
typical nursing home and to blend easily
into their community or surroundings.
The Eden Alternative is a way to
humanize existing nursing homes that
were designed to the institutional
standards in existence when they were
built. The Green House is a new design
for the physical plant of a nursing home
and a new form for the delivery of service
to residents.
Source: www.thegreenhouseproject.com
Part 2. Trends: Nursing Care
41
Nursing Home: Trends and Innovation
The Green House is a small intentional
community for a group of elders and staff and
is intended to be a vessel for the enactment
of the most positive elderhood possible. It is
a place that focuses on life, and its heart is
found in the relationships that flourish there.
A radical departure from traditional skilled
nursing homes and assisted living facilities,
the Green House alters facility size, interior
design, staffing patterns, and methods of
delivering skilled professional services.
Developed by Dr. William Thomas
and rooted in the tradition of the Eden
Alternative, a model for cultural change
within nursing facilities, the Green House is
intended to de-institutionalize long-term care
by eliminating large nursing facilities and
creating habilitative, social settings. Its
primary purpose is to serve as a place where
elders can receive assistance and support
with activities of daily living and clinical care,
without the assistance and care becoming the
focus of their existence.
Source: www.thegreenhouseproject.com
Part 2. Trends: Nursing Care
42
Nursing Home: Trends and Innovation
Each elder enjoys a private room with
a private bath which they decorate with their
own belongings. There is easy access to all
areas of the house including the kitchen and
laundry, outdoor garden and patio. Safety
features are built into the house to minimize
injury. The small size of the Green House
promotes less use of wheelchairs.
The elder is free from the limitations of
an institutional schedule and lives a
comfortably daily life - sleeping, eating, and
engaging in activities as they choose. Meals
are prepared in the kitchen and served at a
large single dining table where staff and
elders and visitors enjoy a pleasant dining
experience called -CONVIVIUM. This is
characterized by good fresh food, a well-set
table, music and flowers, and good
conversation with people who care about one
another. Meal times can last over an hour
and appetites are good.
Source: www.thegreenhouseproject.com
Part 2. Trends: Nursing Care
43
Profile of Nursing Home Residents
Average age: 76.5 years
Gender: 55 percent female, 45 percent male
Race/Ethnicity: 92 percent Caucasian; 3 percent African American, 5 percent other.
Source: Understanding National Investment Center for the Seniors Housing & Care
Industries Seniors Housing: Demand, Choices and Behavior, 2003.
Part 2. Trends: Nursing Care
44
Number of Senior Housing Units Under Construction
The senior housing industry experienced a
significant increase in supply between the years
1997 and 1999. This growth was predominantly led
by the development of hundreds of assisted living
communities at the behest of Wall Street investors.
The rapid influx of assisted living product impacted
negatively all facets of the industry.
This chart shows the significant boom in
development of assisted living properties that
occurred in the late 1990s. This over-building
affected occupancies in assisted living, independent
living and nursing care properties.
Growth in the number of assisted living and
independent living properties has remained steady
over the past three years, while that of senior
apartments and CCRCS has shown an increase in
numbers.
0
5000
10000
15000
20000
25000
30000
35000
1997 1998 1999 2000 2001 2002 2003 2004 2005
Units
Seniors Apartments Independent Living
Assisted Living CCRCs
Source: American Seniors Housing Association, Seniors Housing Statistical Handbook, October 2004.
American Seniors Housing Association, Seniors Housing Construction Report, 2005
Part 2. Trends: Industry Growth
45
Age-Qualified Units (Apartments) Under Construction
June 2003 and June 2004
The number of senior
apartment units under
construction increased 17 percent
and the number of independent
living units increased by 43
percent between 2003 and 2004.
In contrast, there were 2 percent
fewer units of assisted living and
7 percent fewer units in
continuing care retirement
communities under construction
in 2004 as compared to 2003.
43%
17%
-7%
-2%
0
2000
4000
6000
8000
10000
12000
Seniors Apt Independent Living Assisted Living CCRC
Number of Units Constructed
-10%
0%
10%
20%
30%
40%
50%
Percent Change 2003 to 2004
2003 2004 Change
Part 2. Trends: Industry Growth
46
Median Occupancies by Senior Housing Product Type
Source: National Investment Center for the Seniors Housing and Care Industries, Inc. (NIC), Key Financial
Indicators, www.nic.org
Occupancies of service-enriched age-qualified housing have only begun to show a slight growth
since the overbuilding in the late 1990s. Independent living occupancies at 90 percent have not
returned to the level of 93 percent seen in 2000. The median occupancies of assisted living
properties of major providers that have been open for more than two years is 88 percent, the
highest level in more than six years. Nursing home occupancies at 87 percent are at their highest
level since 2000. Occupancies of CCRCs remain stable at 91 percent.
Median Occupancies of Stabilized (Open 24+ Months)
Age-Qualified Properties of Major Providers
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
Mar 31 2000 Mar 31 2001 Mar 31 2002 Mar 31 2003 Mar 31 2004 Mar 31 2005
Percent
Independent Living Assisted Living
Nursing Home CCRCs
Part 2. Trends: Industry Growth
47
Growth in Active Adult Housing in the United States
There are no censuses of active adult housing in the United States, with the exception of age-
qualified senior apartments that are tracked by the American Seniors Housing Association. It is
difficult to determine the number of active adult housing units and to monitor the growth of this
sector of the industry for a variety of reasons.
1. Active adult housing developments that provide single-family homes are not monitored by any of
the trade associations and are not required to register with any governmental agency.
Consequently, there is not a central repository for information about active adult housing in the
U.S.
2. Active adult housing developments range in size from as few as a dozen or so homes up to as
many as 23,000 homes. Small builders of active adult properties often do not advertise and
simply sell their age-targeted homes by word of mouth.
3. Many developers do not use terms such as, active adult, 55+, age-qualified, or retirement
community when promoting their product.
4. Age-targeted housing communities avoid using terms that define them as being for persons who
are 55 years of age and older, even though that is the market they are trying to attract.
Sometimes these developments can be identified via the words used to market them, such as
carefree living, maintenance-free housing, ranch-style homes and lifestyle communities.
5. Often when many, if not most, of the active developments sell all of their homes, the central
amenities are deeded to the homeowners association and the builder no longer markets the
property. Thus, there is often not a central telephone number associated with the community,
the community is not listed in the yellow pages directory for the area, and homes are sold by
individual realtors or by the homeowners.
Part 2. Trends: Industry Growth
48
Directories of Active Adult Housing
There are two directories of active adult housing in the US that are fairly complete relative to
the properties that are presently selling homes. These directories are:
The National Directory of Lifestyle Communities, 2005, published by Parks Development
Consulting, Inc., 8912 East Pinnacle Peak, Suite 459, Scottsdale, AZ 85255. This directory lists
1,263 communities and includes all of the active adult properties in Prince George’s County that have
been identified. The National Directory lists all of the active adult properties in Prince George’s
County.
The Active Adult Living Directory, available at www.activeadultlivingdirectory.com. This on-line
directory lists 865 active adult communities.
Part 2. Trends: Industry Growth
49
Growth in Number of Builders Targeting 50+ Households
Source: NAHB, 1999, Builder Member Survey on Seniors Housing; and NAHB, 2003, 2003
Builder Survey: An Industry Update of Current Trends of Age-Restricted, Age-Targeted and
Independent Living Communities.
The National Association of Home Builders has
conducted two surveys of home builder members,
one in 1998 and one in 2002, that asked the
proportion of the builder’s construction that was age-
targeted or age-qualified. While these studies are
not representative of the entire builder market, the
results suggest growth in the number of builders
targeting mature households.
In 1998, 19 percent of the 1,010 builder
survey respondents said they built active adult
housing within the previous two years and 26
percent planned to build it in the next two years. In
2002, significantly fewer builders completed the
survey (500 respondents). Among these
respondents 56 percent said they built age-restricted
single-family housing in 2002 and 58 percent said
they planned to build it in the future.
While these two studies do not allow an apples
to apples comparison, they suggest that the number
of builders targeting 50+ households grew by at
least 9 percent per year between 1998 and 2002.
Percent of NAHB Member
Survey Respondents
Building Age-Targeted
Housing
19
58
26
56
0
10
20
30
40
50
60
70
Built Plan to Build
Percent
1998 2002
Part 2. Trends: Industry Growth
50
Conclusions about Senior Housing Trends and Their
Effect on Prince George’s County
1. The age-qualified service-enriched industry is shifting from solely a rental or entrance fee
product line, to forms of true ownership where the owner (condominium or cooperative) may
receive the benefits of appreciation and tax deductions. Additionally, many people have a
greater sense of control and satisfaction if they own their homes. It is anticipated, that with
the opportunity to own their residences, a greater proportion of the 55+ market will choose
age-qualified housing.
2. Adding active adult housing to a market area often will reduce the proportion of households
who move to independent living, and even to a smaller extent, assisted living. Residents of
active adult communities often develop supportive networks and access to home-based
services and may reside in their homes longer and avoid moving to independent living or
assisted living care until later stages of their lives, if at all.
3. The age-qualified housing industry has served Caucasians and national averages suggest that
at least 95 percent of the households in age-qualified housing are Caucasian. The brief survey
of properties located in areas where African-American households make up 20 percent or more
of the population, suggest that this market sector is receptive to active adult housing.
4. Prince George’s County is underserved relative to independent living, assisted living and
Alzheimer’s care. This is likely to be directly related to the racial composition of the county.
Developers have not yet tapped the African-American market and consequently have not built
in market areas where African Americans form the predominant market sector.
5. Prince George’s County has a high volume of existing nursing care stock, consequently
innovations in nursing care may be slow to materialize until older structures are retired.
Part 2. Trends: Conclusions
