​In this Q&A with LaShuan Bethea, executive director of the National Center for Assisted Living (NCAL), Bethea reviews the accomplishments of 2023 and forecasts what 2024 will hold for the assisted living sector.

Q. How were assisted living providers successful in 2023?
A. Assisted living providers have continued to deliver the high-quality care that residents depend on in their communities. They—like all long term care providers—have faced myriad challenges since the pandemic, and yet they continue to meet residents’ needs day-in and day-out. These providers are passionate about what they do, and they do this work because they genuinely care about their residents. Despite challenges like labor shortages, quality care and resident safety have always been and remain top priorities.

That commitment shines bright through the results of the AHCA/NCAL National Quality Award Program in 2023. We saw a record number of assisted living communities (as well as nursing home providers) declare their interest in applying for a Quality Award since the beginning of the pandemic. This is a tremendous reflection of their dedication, and they should be proud to display their impressive quality journey through this program. I am so proud of each and every one.

Q. What were some of NCAL’s biggest accomplishments in 2023?
A. NCAL works hard to ensure our members have the resources they need to be able to do their important work. One of the many important resources we developed last year was a toolkit to help members determine if and how they can offer more affordable assisted living. This is important right now, especially given the changing needs of a growing senior population. The NCAL team developed a white paper outlining the issue, challenges, and proposed solutions. We also created materials to assist providers in exploring the viability of expanding affordable assisted living options, including state-specific data, the Assisted Living Operating Proforma and Financial Feasibility Analysis Model, and a user guide for the financial model.

We also created the assisted living regulatory resource center especially for our members. This includes state survey data and a state bill tracker. These resources are something that our members enjoy and utilize, and our team is excited to continue expanding the resource center in 2024. 

I previously mentioned the importance and value of the Quality Awards. One thing NCAL completed in 2023 was a study with Brown University analyzing Silver and Gold Quality Award (QA) winners compared with those who are not awardees. The goal was to determine the outcomes of the QA journey. Do communities who have received a Quality Award have better resident outcomes? This important research suggests exactly that—Silver and Gold awardees may have better outcomes compared to non-awardees. For example, the data showed a greater than 5 percent lower relative risk of emergency department use for awardees vs non-awardees. This data is tremendous and supports the value of participating in this program.

Q. What are the top issues facing assisted living providers in 2024?
A. Many of these issues have been ongoing for many years. We continue to face a labor shortage, which—as mentioned—impacts access to care and not quality of care. This is especially true in rural areas, where there are fewer people in general. Assisted living providers are having to compete with other health care organizations for qualified staff or even making the tough decision to limit admissions.

This will only be made worse by the Biden Administration’s proposed staffing mandate. While many health care settings have nearly rebuilt their workforce back to pre-pandemic levels, a federal minimum staffing mandate threatens to take the essential staff on which assisted living communities depend. We will continue to make our voice heard on this issue and focus on various strategies to help strengthen the workforce in the new year.

Q. What is NCAL planning to focus on in 2024?
A. I believe 2024 is going to be an exciting year for assisted living. NCAL will maintain a focus on rebuilding the workforce and how we can best support our members—from working with other health care groups to best practices and idea sharing. As mentioned, we will continue to develop the assisted living regulatory resource center. We will continue to advance health care visa legislation to increase the supply of workers in long term care. 

Another area where NCAL will continue to focus in 2024 is population health management. This is the future, and assisted living providers need to be ready. We will continue to develop and offer education on this both through webinars and at our events, such as the Population Health Management Summit in May. 

Quality will also be a priority for NCAL next year. We may have achieved a record number of communities interested in applying for the Quality Award this year, but we won’t stop there. We will continue to educate about the significance of the program, the value (supported by the Brown University study), and why more providers should become involved. The quality improvement journey is ongoing, and this is a valuable way to ensure providers are on the path to success.