Senior living residents and their families would like to have easy access to healthcare services. But owners and operators can find it challenging to make those services easily available.  

Medicare Advantage (MA) plans from private insurers align with the government’s move toward value-based care by replacing traditional fee-for-service payments with reimbursements based on quality outcomes. Senior living communities can improve resident care by partnering with a provider in a value-based care model. 

A panel of experts recently explored a case study of how MA health plans can be an ally of long-term care providers.  

The Q&A discussion, presented during the 2025 NIC Spring Conference, was moderated by Dr. Katy Lanz, Healthcare Advisor and Strategist at TopSight Partners, and a member of NIC’s Partnering for Health Focus Area Committee. She was joined by René Lerer, CEO at Longevity Health Plan, and Catherine Field, Senior Vice President & Medicare Division Leader West Division at Humana. 

What follows is a recap of the discussion, edited for length and clarity: 

Dr. Katy Lanz: The Centers for Medicare & Medicaid Services (CMS) has set a goal to have 100% of Medicare beneficiaries, and most Medicaid recipients, in a value-based care model by 2030. Senior living providers play a vital role in supporting the health and well-being of their residents and can actively engage in value-based care arrangements.  

The key is to focus on partnerships with Medicare Advantage (MA) plans and other CMS demonstration platforms, such as the ACO REACH program.  Assisted living and nursing communities are highly focused on Medicare Advantage Institutional Special Needs Plans (I-SNPs), which are growing quickly. I-SNPs are a type of MA plan designed to serve individuals who live in institutional settings or who need an institutional level of care. 

The alliance between Humana and Longevity represents a good example of a successful I-SNP partnership to provide healthcare to the residents of nursing care facilities.  

Catherine Field: Humana is the second largest MA carrier insuring 6.5 million lives and 1.5 million Medicaid lives. When senior living providers partner with a value-based care platform, we see better quality outcomes.   

René Lerer: I was a practicing doctor. Longevity is a clinical company with 700 employees. Our goal is to take care of people and their wellbeing. We are the largest independent I-SNP with 10,000 members.  We have developed a partnership with Humana. We started with skilled nursing facilities and are having conversations with assisted living and memory care communities. Our population is institutional. We bring clinical staff into the buildings to manage resident care. We have a true partnership with senior living communities to augment what they do.  

Lanz: What is Humana’s approach? 

Field: Humana is contracted with 16% of the skilled nursing facilities in the country. We’re seeing a transition to value-based care. Transactional relationships with the insurer are being replaced with end-to-end consumer care. Our job is to help people transition through the healthcare system. Every transition, say from hospital to home, is a time when care can get dropped. Our focus is on quality outcomes and getting people back where they live.  

Lanz: How do changes in Medicare rules affect your decisions? 

Lerer: Medicare is changing rapidly, growing quickly and impacting everyone. Over the last six years we’ve learned a lot about value-based care. The building staff have a big impact on resident outcomes. We need to educate the staff on value-based care. It’s a major change. We understand how the community works and how managed care works for the benefit of the residents. 

Lanz: What lessons have you learned? 

Lerer: We’ve found that scale matters. We formed a partnership with Humana which has a skill set focused on contracts and compliance. CMS has so many rules. The partnership has allowed us to focus on the clinical side and take care of our population. 

Lanz: Why did Humana partner with Longevity? 

Field: We spend much of our time serving the senior population, so it’s hard not to help people living in senior living facilities. We started talking to healthcare providers in 2018. But we didn’t understand the business complexities of nursing homes. We needed a knowledgeable partner and found Longevity. They needed our scale, and we needed them because they could speak the language of skilled nursing operators.  

Lerer: The skilled nursing world is unique. The average facility has 100 beds. We are in 500 buildings with 30-40 patients in each building. A partnership with the facility is the only way to achieve scale and succeed. 

Field: MA penetration in the I-SNP space is only about 13%. There are a lot of opportunities to bring more value to a forgotten population.  

Lanz: What’s the operator’s path to entry into value-based care?  

Lanz: What’s the next step from a value-based care perspective? 

Field: Develop a strategy. What are your values? What’s important? Test and learn is the name of the game in healthcare. Give it a try. You don’t have to do it alone or learn on your own. You can share the risk. Work with a partner that has the technology and data infrastructure. Find partners. 

Lanz: What MA benefits are most helpful? 

Field: For this population, we think about transportation or over-the-counter items such as adult diapers. Our partnership with Longevity has helped us build our plans so members can access benefits. 

Lerer: The benefit people enjoy the most is music therapy. It wakes them up. They have an amazing response. We also have a hairdresser benefit. It’s not expensive and can make a big difference in the residents’ mental health. We have the ability to be flexible to meet the needs of this vulnerable and unique population.  

The following analysis examines broader occupancy trends, year-over-year changes in inventory, and same-store asking rent growth – by care segment – within 571 entrance fee Continuing Care Retirement Communities (CCRCs) and 488 rental CCRCs in the 99 NIC MAP Primary and Secondary Markets based on data through the first quarter of 2025. 

Regional Entrance Fee and Rental CCRC Occupancy: 1Q 2025 vs. Time Series High  

The exhibit below demonstrates regional occupancy rates for entrance fee and rental CCRCs across the 99 primary and secondary NIC MAP markets. Each bar represents occupancy as of the first quarter of 2025, while the markers above the bars indicate the highest occupancy recorded for each region since the first quarter of 2008. The difference between the current bar and its marker highlights the gap between present occupancy and each region’s historical peak.  

In the first quarter of 2025, entrance fee CCRCs continued to outperform rental CCRCs in occupancy rates across all regions. The Northeast led with the highest occupancy at 93.4% and is the region closest to reaching its time series high of 94.9%, with an occupancy difference of just 1.5 percentage points (pps). Meanwhile, the Southwest (88.8%) lags furthest behind its time series peak of 94.2%, with a difference of 5.4pps.  

For Rental CCRCs, the Northeast region recorded the highest rental occupancy at 91.7%, while the West North Central region reported the lowest at 86.7%. Compared to time series high occupancy, the Pacific region is closest, with a difference of 2.9pps, whereas the Mid-Atlantic shows the largest gap at 5.1pps.  

Across the combined 99 NIC MAP primary and secondary markets, entrance fee CCRCs posted an average occupancy of 91.6% in the first quarter of 2025, compared to 88.7% for rental CCRCs. Entrance fee CCRCs trail the time series peak by 1.5pps and rental CCRCs by 3.1pps. 

1Q 2025 Market Fundamentals by Care Segment – Entrance Fee CCRCs vs. Rental CCRCs 

The exhibit below compares the market performance of entrance fee CCRCs and rental CCRCs by care segment for the first quarter of 2025, highlighting year-over-year changes in occupancy, inventory, and asking rent growth.  

Occupancy. Entrance fee CCRCs continued to outpace rental CCRCs in occupancy rate across all care segments. The difference in the first quarter of 2025 occupancy rates between entrance fee CCRCs and rental CCRCs was largest in the independent living segment (2.6pps), followed by the nursing care segment (1.3pps), and the assisted living segment (0.4pps), with the smallest gap in the memory care segment (0.3pps).  

The highest occupancy in entrance fee CCRCs (93.0%) and rental CCRCs (90.4%) was seen in the independent living care segment. 

Asking Rent. The monthly average asking rent for entrance fee CCRCs across all care segments remained higher than rental CCRCs. Rental CCRCs showed higher year-over-year rent growth in memory care (3.6% to $8,021), and nursing care (4.6% to $403*) segments. Entrance fee CCRCs showed higher year-over-year rent growth in independent living (4.0% to $4,253) 

Note, these figures are for asking rates and do not consider any discounts that may occur. 

Inventory. Compared to year-earlier levels, assisted living inventory experienced the largest decline in rental CCRCs (2.8%) and the largest growth in entrance fee CCRCs (1.4%).  

Negative inventory growth can occur when units/beds are temporarily or permanently taken offline or converted to another care segment, outweighing added inventory. 

In early 2024, the NIC SHARK report – an in-depth analysis that issued a call to action following the disruption of the pandemic – laid out a forward-looking view of the senior housing sector, grounded in demographic momentum, constrained new supply, and a demand trajectory projected to push occupancy to new heights. A year later, the data is in, and the market is moving as anticipated. Senior housing occupancy momentum is not only tracking with projections made in our SHARK report, but occupancy growth is also outperforming other major commercial real estate (CRE) sectors for the first time in nearly two decades. 

Yet with momentum comes new challenges. Labor constraints, tightening immigration policy, and tariffs influencing construction inputs are creating friction that will shape development, staffing, and capital decisions in the years ahead. 

Key Takeaways – One Year After the Inaugural NIC SHARK Report 

1. Occupancy is on track with SHARK projections and is expected to surpass peak levels not seen since 2008. 

2. Senior housing occupancy growth is now outperforming other CRE asset classes, which has the potential to attract additional capital inflows from investors.  

3. Investor interest is increasing, but labor constraints, immigration policy shifts, and tariffs continue to pose operational and development challenges. 

4. Occupied unit levels continue to grow steadily, with no signs of a demand cliff, but the market is entering a new phase. 

5. Senior housing projects will likely continue to be built at above-replacement cost in 2025, pushing transaction volumes and per-unit pricing higher. 

6. Approaches to greater construction efficiency are emerging but need greater scale and adoption. Meeting rising demand requires building and designing smarter, with different approaches than in the past. 

1. Occupancy is Right on Track 

As projected in the first segment NIC SHARK report, senior housing occupancy levels across most regions have reached or exceeded 2024 benchmarks. Behind this rise is the broad-based demand across both needs-based and lifestyle-choice property types, limited inventory growth, and the continued strength of the absorption-to-inventory-growth velocity (AIV) ratio. In 2024, the AIV ratio stood at 27:10 across the 99 NIC MAP Primary and Secondary Markets, well above the threshold needed to drive continued occupancy gains. 

The exhibit below shows that by the end of 2026, senior housing occupancy in most regions is projected to surpass the peak levels recorded since 2008. Notably, the Secondary Markets, East North Central, Mountain, and Southwest regions are the closest to reaching those historic highs, with the gap ranging from 1.0pps in the Mountain region to 1.6pps in the Southwest. 

2. Senior Housing Occupancy Growth Outperforms Other CRE Sectors 

In a notable shift and for the first time in nearly two decades, senior housing occupancy growth is now outperforming traditional commercial real estate (CRE) sectors such as apartment, strip malls, office, and industrial.  

In today’s higher-interest rate environment with tighter capital availability, senior housing’s resilience, reflected in stronger occupancy growth in recent years has attracted growing attention from institutional and private investors. With its stable, forward-looking, and demographically anchored growth, senior housing stands out in the broader CRE arena. In fact, in an October 2024 ULI poll, senior housing ranked second only to data centers in projected risk-adjusted returns over the next three years. 

3. Investor Interest Is Rising, But So Are Friction Points 

The uptick in investor interest is real. Many debt lenders, brokers active in the space, and entities raising funds for senior housing investment, all observe an increase in the volume of new investor entrants into the market. Transaction volume picked up in 2024 and capital is increasingly looking toward ground-up development again. However, labor availability remains a top concern, now exacerbated by immigration policy shifts. Operators are contending with limited pipelines of frontline and clinical staff, a challenge that could limit the pace of new move-ins and elevate wage pressure. 

Additionally, tariffs and supply chain issues have the potential to continue to influence construction timelines and costs, further contributing to the likelihood that new projects will remain above replacement cost through at least 2025, and development activity will be limited. 

4. Occupied Unit Growth Continues at a Disciplined Pace 

Occupied unit growth continued at a measured and disciplined pace with no sign of a demand cliff on the horizon. As projected, occupied penetration rates continued to rise steadily across regions, reflecting a healthy alignment between the number of aging households and the supply of available senior housing units. But with most new projects taking years from planning to delivery, today’s steady and strong absorption signals a clear need to start building now to meet the demand rooted in long-term population trends. 

5. Supply Remains Moderate, but Pressure is Building 

Construction activity remains subdued, and the market is not at risk of being oversupplied. However, with occupancy rising and new projects facing multi-year timelines, senior housing is approaching a new phase. By 2026, stronger demand, combined with a potential undersupply of new inventory, is expected to drive upward pressure on pricing, and developers will need to take a thoughtful approach aligning rising development costs with affordable rent. 

6. Construction Efficiency* will Emerge out of Necessity 

Rising costs and prolonged timelines are prompting more developers to explore modular construction, off-site fabrication, and smarter design strategies. While still early in adoption, these approaches reflect a growing recognition that meeting future demand will require building smarter, not just building more.  

As senior housing stakeholders look ahead to 2026 and beyond, the next phase will require translating accurate forecasts into strategic action, balancing optimism with realism, and growth with discipline. 

*Learn more about construction efficiency. 

Senior housing posted a positive total return of 1.87% in the first quarter of 2025, the highest NCREIF property type return for the quarter. Senior housing outperformed the broader Expanded NPI by nearly 60 basis points, with the index posting a total return of 1.29%. Senior housing capital appreciation in the first quarter was positive with valuations increasing 0.54%. The capital appreciation return is the change in value net of any capital expenditures incurred during the quarter. Senior housing income in the first quarter was also positive, yielding 1.34%. For the broader NPI in the first quarter, both capital appreciation (+0.11%) and income yield (1.18%) were positive.  

By senior housing property subtype, independent living (+2.58%) outperformed assisted living (+1.25%) in the first quarter. In recent years, independent living has also outperformed assisted living over the one-, three-, and five-year periods. This outperformance may be driven by higher margins typically generated in lower acuity settings such as independent living, which require less staffing and labor expenses than higher acuity settings such as assisted living. Additionally, independent living has had higher occupancy rates during this period. Over the longer run, since NCREIF began tracking returns data for these subtypes roughly a decade ago, both assisted living and independent living posted similar returns averaging more than 5% annually. 

Annualized Total Returns by NCREIF Property Subtype
As of 3/31/2025; Unlevered

Compared to other NCREIF property types over the 10-, 15-, and 20-year periods, senior housing was the strongest property type except for industrial and self storage, outperforming the NPI on an annualized basis by 37, 23, and 275 basis points, respectively. Since the 2003 inception of NCREIF’s senior housing historical series, income yield drove roughly 60% of senior housing total returns, while price appreciation contributed roughly 40%. These performance measures reflect the returns of 214 senior housing properties valued at $12.03 billion in the first quarter. Overall, the number of senior housing properties tracked within the NPI has grown significantly from the 56 properties initially tracked in 2003. 

Annualized Total Returns by NCREIF Property Subtype
As of 3/31/2025; Unlevered

Senior housing market fundamentals remained positive in 2025, with the occupancy rate for the 31 NIC MAP Primary Markets increasing 0.3 percentage points to 87.4% in the first quarter, driven by net absorption of senior housing units outpacing the number of new units arriving online. By property type, occupancy rates for independent living have made slightly higher gains in recent quarters than assisted living, which is a reversal of trends in 2022 and 2023. In the first quarter, independent living increased to an average occupancy rate of 89.0%, while assisted living increased to 85.8%.  

The inaugural NIC Growth Conference was more than a convening of 300+ senior housing and care industry stakeholders, it was a rallying cry for action. With operators, capital providers, technologists, and strategists all under one roof, the event offered a deep dive into the real-world challenges and opportunities facing senior housing growth. If there was one unifying theme throughout the sessions, it was this: We are at a pivotal moment in the senior housing industry, and the time to act is now.  

A Historic Demand Cycle is Here  

A staggering 28% growth in the 80+ population over the next five years signals what NIC called a “historic demand cycle.” As Arick Morton, chief executive officer (CEO) at NIC MAP, succinctly put it, “Senior housing demand growth is durable and long lasting.” The tone throughout the conference was clear—operators and investors who prepare now will be best positioned to capitalize.  

Yet, growth for growth’s sake won’t cut it. It must be strategic, as emphasized by Dennis Murphy, chief investment officer (CIO) at Priority Life Care. The call to “take off our blinders of survival” and start planning ahead” (Andy McDonald, chief finance officer (CFO) at HumanGood) was echoed throughout the conference, reinforcing that the next two years are critical for repositioning portfolios, investing in people and operational infrastructure, and building capacity.  

Data as the Foundation for Smart Growth  

The conference leaned heavily into the role of data as the engine of operational excellence and strategic expansion.   

“I love how data allows me to be in the weeds without being in the weeds,” said Stephanie Harris, CEO of Arrow Senior Living. Whether improving NOI, labor statistics, employee satisfaction, or informing site selection, operators were encouraged to leverage analytics to navigate market dynamics and make decisions grounded in reality, not assumptions.  

As Sevy Petras, CEO and co-founder at Priority Life Care, put it: “Trust but verify. That’s where our data comes in handy.”  

Organizational Structure: Culture, Clarity, and the Right People  

Growth was discussed not just as an external ambition, but as an internal discipline. Learning from your mistakes and learning how to better serve the essential drivers of success (your people), are critical. Several sessions focused on building scalable organizations that don’t lose sight of their mission as they expand. Quintin King, president and principal at Brightwater, reminded attendees that, “Culture is in our DNA… we need to keep creating DNA in our organization as our foundation.”  

The need to build the next bench of leadership was stressed. Panelists emphasized the key to success as you grow is to have the next level of talent in place who are all aligned. Chris Guay, founder and CEO of Vitality Living, underscored the importance of operational transparency: “Plans are no good if they’re just in your head. Everyone needs to understand the plan to drive to the same goal.”  

Capital Partnerships: Alignment is Everything  

One of the most powerful discussions centered on how operators and capital providers can build aligned, long-term partnerships. Susan Barlow, co-founder and managing partner at Blue Moon Capital Partners, and NIC Board chair, made it clear: “We look at people first.” It’s not just about margins and occupancy, but whether operators have a strategic vision and a trustworthy team.  

Capital partners emphasized the importance of data integrity, operational transparency, as well as shared decision-making. As Matthew Ruark, senior vice president of KeyBank, said, “Be visible in ways you haven’t been. Strong operators can be creative partners in building a capital stack.”  

Revenue Strategy: Beyond 100% Occupancy  

In a candid and practical series of marketing and sales sessions, the message was loud and clear: stop losing money at the front door.  

With 92% of inquiry calls going unanswered, there is an immense opportunity to improve by evaluating current operating procedures. Traci Bild, chief visionary officer at Bild and Co and BILDX, emphasized the importance of “working on the business, not just in the business.” She noted how websites lacking pricing transparency or lead engagement features lead to many operators missing out on warm leads.   

Several panelists recommended calling your properties as a potential lead to identify whether calls are going unanswered. “Utilize a checklist to check your website from the customer/user experience,” suggested Sanela Graziose, CMO at Atria Senior Living. Understanding the customer’s experience at your property is paramount in understanding acquisition and retention.  

Pricing integrity is also key—but it must be grounded in operational capability. “Rate integrity is a function of operations, not of sales,” reminded Jennifer Saxman, CEO at Bild & Co and BILDX. If the product doesn’t match the pricing, no sales strategy will fix the gap.  

Automation, AI, and Smarter Staffing  

From dashboards to data lakes, operators discussed how technology and automation can reduce inefficiencies and free up talent. The power of automation lies in turning complex data sets into actionable insights. “We’ve got to do more with less,” was a repeated refrain. Operators shared how starting small—automating reporting or care coordination—can create quick wins without overwhelming internal teams.  

Staffing, unsurprisingly, was another hot topic. As one leader noted, “We’re constantly going to be asked to do more with less. In a competitive market, how will you win at attracting and retaining staff?” The answer? Smarter tools, better onboarding, and clear benchmarks.  

A City That Welcomed Us In  

Indianapolis offered the perfect setting: a walkable city with fantastic restaurants, welcoming spaces, and a warm Midwestern energy. With attendees from all across the country, the city became a vibrant hub of connection, learning, and hope.  

Closing Thoughts: We Are All In on Growth at All Levels  

From keynote to closing remarks, the energy was electric. Everyone—from first-time attendees to industry veterans—seemed to share the same sentiment: This is our moment.  

The conference didn’t shy away from the tough topics—transitioning management contracts, risk management, and litigation pitfalls were all on the table. Whether discussing elopement risks or resident fall expectations, speakers stressed transparency, communication, and realistic expectations as key to protecting trust.  

Above all, this is a people business. NIC co-founder and strategic advisor, Bob Kramer, reminded attendees: “It’s the people in the buildings that deliver what we do every day.”  

Or as David Mills, president and chief operating office of AgeWell said, “Don’t be afraid. Do what others won’t do. If you’re going to grow, you need to plan your fear—but do it.”  

What We Learned and Where We Go from Here  

The NIC Growth Conference wasn’t about pie-in-the-sky ideas. It was about tactical, strategic, people-powered growth—and the data to back it up. Attendees walked away with inspiration, and practical tools, to help on their growth journey.  

When maximizing growth opportunities, it’s important to invest in yourself and your business. Attendees dove deep into strategies they could apply directly and gained opportunities to connect with like-minded leaders with the same goals. As Meredith Benedict, principal at Clifton Larson Allen, noted, “if you’re not at the table…you’re probably on the menu.”  

For anyone serious about scaling their senior living business in the next 24 months, this was the place to be.  

And we’re thrilled to share that we’ll be returning to Indianapolis in May 2026!  

Thank you to all members of the NIC Growth Conference Program Committee for curating such an informative and impactful event!