Despite Staffing Challenges, HCBS Interest Remains Strong Among Senior Living Providers

In the last year, home- and community-based service offerings either stayed relatively flat or dipped among most of the largest nonprofit senior living providers. 

While senior living providers remain generally committed to these services, they have been tough to manage due to various factors, namely staffing woes.

That and other takeaways are according to the LZ 200, an annual report conducted by LeadingAge and Ziegler Healthcare Investment Banking that examines the nation’s 200 largest nonprofit senior living multi-sites, government-subsidized housing multi-sites and single campuses.


Of those senior living providers, 42% offered some sort of home- and community-based care. That could include home health care, home care, adult day care, continuing care at home (CCaH) programs and Programs for All-Inclusive Care for the Elderly (PACE).

“The overall commitment to HCBS has generally been stable in recent years – even with COVID’s impact,” Lisa McCracken, the director of senior living research at Zeigler, told Home Health Care News in an email. “However, we know that the staffing pressures have absolutely impacted the ability to grow these platforms.”

Staffing pressures have forced health care providers across the board to reconsider launching new service lines, or investing in existing ones, but “the numbers show a relatively steady commitment within the LZ 200 to home care and home health,” Katy Barnett, the director of home care and hospice operation and policy at LeadingAge, also told HHCN in an email.


The Washington, D.C.-based LeadingAge is an advocacy group comprised of nonprofit organizations that serve the aging population. Meanwhile, the Chicago-based Ziegler is a privately held investment bank specializing in home health care and senior living, among other areas.

The largest providers in this year’s LZ 200 included Trinity Health Senior Communities, Presbyterian Villages of Michigan, St. Paul Senior Services, Holland Home, Concordia Lutheran Ministries and Brio Senior Living Services.

While there are slight drops and upticks in the figure shown above, those can also be chalked up to respondent discrepancies on a year-to-year basis.

For instance, CCaH – which has been growing in popularity over recent years – fell from 10% to 8% among the providers. But that’s likely not indicative of a larger trend. In fact, the opposite trend is likely occurring.

“The composition of the LZ 200 varies slightly year over year depending on who moves off and who merged,” McCracken said. “I would say – even beyond CCaH within the LZ 200 – that we continue to see a commitment to that model within the nonprofit sector.”

In fact, LeadingAge has seen more nonprofits launch CCaH over the last year – and heard from others considering launching the program – according to Dee Pekhrun, the director of life plan communities services & policy at LeadingAge.

On the other end, the adult day model is still struggling. After serious COVID-19-related issues from early 2020 on, many providers had to start from scratch as the pandemic finally eased.

“Adult day providers are still navigating a number of unclear regulations around reopening of congregate settings,” Barnett said. “That, coupled with the reimbursement rates for these services from a Medicaid standpoint – a major issue – may make it hard for some providers to justify keeping these service lines open.”

In regards to home health care, experts at LeadingAge and Ziegler doubted that an uncertain rate environment would lead to less providers offering services.

Staffing can still be a challenge in home health care, though, which makes joint ventures popular in the space. Nearly 35% of the LZ 200 organizations are engaged in a formal JV with another provider, a health system or a home health or home care agency. That’s up compared to the 29% that were in such a partnership in 2021.

McCracken also mentioned that there are providers that may look towards technology in order to solve some of the staffing issues that they have faced.

“I think noting the role of technology in this space is significant,” she said. “It can help reach people to a greater extent than possible in the past. It can also assist with some of the staffing-related challenges. Technology and home-based services really do create some of the best platforms out there.”

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