By Steve Moran 

I was looking back on some notes from the NCAL day of the ACHA/NCAL conference this past October (2023). There was a fireside chat where a number of leaders were talking about regulation and senior living. They addressed three big topics:

  • The ongoing efforts to keep senior living regulation at the state level
  • The role of improving the quality of senior living and how that will help to keep regulation at the local level
  • Success strategies for senior living operators today and in the future

We Are the Experts … Assisted Living

One of the emerging themes was that when it comes to senior living — and largely to creating great living experiences for older people — we are the experts. We know how to provide care, how to create good living experiences, how to hire and manage staff, how to improve quality of life and increase longevity.

And we do all of that at a reasonable price.

And Yet …

We mostly end up letting regulators and media push us around. I was talking to a friend of mine who has been an interim executive director for an assisted living community that had a series of citations. Even though the violations were cleared months ago and there was only minimal harm to residents, the regulators keep coming back and coming back and coming back. This in spite of the fact that the regulators’ own rules require them to wrap up an investigation in 90 days.

I get why they don’t push back. It would require attorney fees; it would would create a very real risk of a retaliatory response by those same regulators. And there is always the added risk of negative press, which would inevitably swing against the community.

Taking Control

You would never know that senior living operators are the experts if you were in the wilds of the general public. It mostly looks like we are this industry that is sort of a necessary evil, that only cares about profits and needs regulation.

Right now, when we see positive stories about older people in senior living, they are mostly “cute” stories about something residents did, or children visiting residents or residents falling in love late in life. The other stories that we see on rare occasions are about what people accomplished early in life. That’s it!


A few weeks ago, I spent close to an hour on the phone with one of the Washington Post reporters who was involved in the one-sided attack on senior living. One of the things I suggested to him was that if they wanted to do an investigation into a kind of care that was doing real harm, they should be looking at hospitals.

The best estimates suggest there are somewhere between 48,000 and 98,000 unnecessary deaths in U.S. hospitals each year — the equivalent of a jumbo jet crashing and killing all souls on board every single day.

And talk about making money. Take a look at the salaries of the senior leadership in your hospital system. It will make you blush with envy … and yes, I am talking about not-for-profit hospitals.

And yet …

Most Americans have a very positive view of hospitals, and they are much less regulated than nursing homes for sure — and only slightly more regulated than assisted living.

The Hospital Narrative

Take a look at a sampling of press release headlines from the Sutter Health system in Northern California:

“Sutter Health Invests More than $300,000 to Support Community Food Banks”

“Sutter President & CEO Warner Thomas Honored Among Nation’s 100 Most Influential People in Healthcare”

“Sutter Hospitals Recognized as Best-In-State by Newsweek”

“Sutter Announces Innovation Center to Revolutionize Patient Care”

“AMA Honors Sutter Physician Groups for Promoting Well-Being of Healthcare Workers”

You might look at that and think, “Wow, I wish that was my hospital system.” Trust me, it is no great shakes. It is the system I am a part of and don’t change only because the alternatives are no better or worse.

On top of that, you see ads coming out of the system about how they have saved lives, given people a new lease on life, and more. All of this is designed to control the narrative and make people love something that may not be all that loveable.

In my family we have a rule. If we have a loved one who is in a life critical situation and hospitalized, a family member will stay overnight with them, simply because we don’t trust the system to be effective in monitoring their safety.

They have more money, so it is perhaps easier for them to control the narrative, but one of the reasons they have more money is because they are more lightly regulated and because they are controlling the narrative.

We need to do a much better job of this. We need to be telling bigger stories about how we are, in fact, transforming the lives of residents, their families, and our team members. When we do, life for senior living will get much, much better.