For an older adult with a steady retirement income and some home equity, finding housing and care can still mean confronting a difficult gap: too much income to qualify for assistance, but insufficient resources to sustain traditional senior housing costs. Closing that gap requires models designed around what consumers can afford and what providers can sustainably deliver. 

The 2026 NIC Fall Conference session, “It’s Time to Make Middle Market Housing & Care a Reality,” explored that challenge through three distinct approaches. Building on NIC’s Forgotten Middle research, and subsequent NIC-sponsored work examining the combined burden of housing and care and exploring financing and care models that could expand access, the discussion focused on the economics and partnerships needed to turn individual examples into options available to more older adults. 

Different Consumers Require Different Models 

The middle market spans a broad range of financial circumstances and care needs. Some older adults have current needs that are largely related to housing and social connection while others require services and increasing levels of care. Serving that range calls for different products, with clear expectations about what residents receive and how costs may change. 

Bre Grubbs, with Leisure Care, described a mixed-income community in Livermore, California, where market-rate and income-qualified residents co-exist and share programs and amenities. The model combines bond-financing expertise, local government support, and sufficient density to make lower-priced housing possible within a high-income market. 

Laura Lamb from Episcopal Retirement Services takes a different approach in Ohio, offering independent living without an entrance fee and connecting residents with outside service providers as they age. Its patio-home model relies on manageable land and construction costs and an unlicensed independent living structure.  

At Mainstay Senior Living, Tod Petty emphasized reducing the cost basis through selective development, repositioning existing properties, and controlling construction costs, supported by a vertically integrated model, long-term ownership, and investors seeking ongoing income. 

Affordability Begins Before the Monthly Bill 

Across these approaches, the economics behind the residents’ price deserve as much attention as the price itself. Land costs, construction decisions, service arrangements, and capital expectations determine what a community must charge. Each model depends on a particular combination of those factors; expanding access requires understanding which elements can be adapted to another market. 

Financing remains a notable obstacle to middle market senior housing. A product can meet a clear consumer need yet struggle to secure funding because it falls outside familiar lending categories. For capital providers, the opportunity is to assess these models through their cash flows, operating evidence, and risks, with financing terms that support expansion. Local governments also influence feasibility through land-use decisions, density, and their willingness to work with developers and operators. 

Scaling Middle Market Senior Housing is the Next Challenge and Opportunity 

The panelists emphasized sharing what they have learned so others can build on it. Greater visibility into development costs, financing structures, and operating assumptions would help providers and capital partners distinguish a promising concept from a model they can adapt. Successful replication will require an honest account of each approach’s limits alongside its strengths. 

Affordability must also hold up over time. NIC’s Senior Housing Affordability Calculator reinforces the importance of understanding how long an older adult’s resources can sustain housing and care. A manageable starting rent is only part of the journey when residents’ needs and expenses may increase.  

The progress of middle market solutions needs to be measured by how many older adults gain access to housing and care they can sustain. That will depend on providers, capital partners, and governments carrying these ideas into actual projects. The three models discussed offer places to begin; the work ahead is to make their underlying economics and partnerships possible in more communities.