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Industry shift: fewer new CCRCs, more expansions, mergers and for-profit growth, panelists say
Summary
Panelists told the commission that since the 2008 financial crisis and again after COVID-19, new continuing-care retirement community campuses have sharply declined nationwide; growth now is driven by expansions, mergers and acquisitions, and for-profit providers concentrating on rental and standalone segments.
Panelists advising the Commission on Aging and Independence described a long-term shift in how continuing-care retirement communities grow and operate: new campuses are rare, and growth comes predominantly from smaller expansions, acquisitions and for-profit activity.
An industry presenter summarized the sector'wide trend: before the 2008 financial crisis, the sector averaged about 12 to 14 new campuses a year nationwide; post'COVID, that has fallen to roughly one to two new campuses a year. The presenter said many nonprofit CCRCs curtailed campus construction after the 2008 real estate downturn and instead pursued expansions of existing campuses (typically 25'to 75 units) or growth through affiliations, mergers and acquisitions.
Panelists described differences between nonprofit and for'profit operators. The presenter said roughly 24'25% of CCRCs nationwide are for'profit; many for'profit operators prefer rental or standalone assisted-living and memory-care models rather than the traditional entrance-fee CCRC life-care model. LeadingAge and Mass Senior Care representatives highlighted nonprofit activity, including purchases of skilled-nursing facilities in Massachusetts aided by MassHealth policies and support for greater transparency about refund provisions.
Speakers also discussed whether CCRCs must include the full continuum of care (including on-site skilled nursing) to be considered CCRCs. Participants noted the definition varies by state and by organization. One participant cited Zingler tracking that of 45 proposed new campuses Zingler followed, only 13 included on-site skilled nursing. Several panelists said many newer communities are built without skilled nursing and instead rely on assisted-living services or off-site affiliations and in-home care arrangements to deliver higher-acuity services.
Speakers pointed to zoning and community affluence as factors that affect where nonprofit CCRCs can grow, and they emphasized that board governance, occupancy and liquidity remain central to long-term viability. The group did not take formal action; panelists and commissioners asked staff to circulate past slides and a spreadsheet identifying CCRCs that do and do not report on-site skilled nursing.
Ending: Commissioners said they will use the sector trends and data shared at the meeting to inform future policy work and the June 16 public listening session on entrance fees and disclosure.
