Shaping the Future of Senior Living: Technology-Driven and Person-Centric Approaches

Abstract

By 2040, more than 80 million Americans will be aged ≥65, yet contemporary senior living communities still operate on a hospitality-first model developed for healthier cohorts three decades ago. This commentary argues that the next generation of senior living must pivot from hotel-style amenities to person-centric health platforms that proactively coordinate medical, functional, and social support. We outline four mutually reinforcing pillars. (1) Data infrastructure that stitches together clinical, functional, and social determinants of health enables continuous risk stratification and early intervention. (2) Ambient and conversational artificial-intelligence tools can extend sparse caregiving workforces while preserving resident autonomy. (3) Value-based contractual arrangements—for example, Medicare Advantage special-needs plans embedded within senior living sites—can realign financial incentives toward prevention rather than occupancy. (4) Targeted policy levers, including low-income housing tax credits for the “forgotten middle” and outcomes-based regulatory frameworks, can catalyze adoption at scale. Ultimately, re-architecting senior living around integrated technology, value-based financing and supportive regulation can transform these communities into preventive-care hubs that delay nursing home entry, improve quality of life, and reduce total cost of care.

1. Introduction

The United States faces an unprecedented challenge in elder care as its population ages, with projections indicating that the number of adults aged 65 and older will exceed 80 million by 2040 [1]. The current housing infrastructure for older adults, designed for a different era, struggles to meet the complex needs of this growing demographic (Figure 1). Traditional institutional settings often provide one-size-fits-all care solutions for deeply individualized problems, leading to suboptimal outcomes and diminished quality of life for many seniors [2]. This misalignment between available services and individual needs carries significant consequences, such as accelerated health declines, preventable hospitalizations, and mounting financial burdens for individuals, families, and healthcare systems [3].

Against this backdrop, assisted living illustrates how design and demand have diverged. Originally conceived as a hospitality-focused model, these facilities now struggle to address increasingly complex healthcare needs while avoiding the regulatory burden of formal healthcare designation. Current demographics underscore that approximately half of assisted living residents are over 85 years old, with a third managing cardiovascular disease or arthritis and four in ten experiencing moderate-to-severe cognitive impairment or dementia [4,5,6]. Most residents require support with activities of daily living, and a quarter face hospitalization annually [7]. While new care models attempt to build comprehensive support systems through collaboration among payers, providers, technologists, communities, and families, many facilities remain caught between their original design and current demands. However, in bridging the gap between the old and new, a critical barrier to systemic improvement lies in the lack of standardized data on healthcare needs and outcomes in senior living [8,9,10]. Current data collection methods vary widely across facilities and regions and, given minimal industry oversight, it remains difficult to evaluate care effectiveness or track population health trends. Without robust data, healthcare payers and senior living operators struggle to quantify risk and demonstrate cost savings, creating a cycle where innovation and investment are hindered by insufficient evidence of return on investment. Furthermore, with respect to human capital and operational challenges, chronic underinvestment, workforce shortages, and inadequate Medicaid reimbursement rates have created a system where many facilities struggle to maintain quality care [11].

National data highlight three housing-related root problems for older adults. First, affordability and insecurity are widespread: in recent national analyses, over half of renters aged 65+ are housing-cost burdened, and only about one-third of income-eligible older adults receive federal rental assistance; cost burdens among low- and moderate-income older renters are longitudinally associated with subsequent health decline [12,13]. Second, the existing housing stock is poorly matched to age-related needs—an NIH-linked review citing American Housing Survey data estimates that roughly one in ten U.S. homes are “aging-ready”, lacking basic accessibility features such as a step-free entry plus a first-floor bed and bath [14]. Third, inequities and variable oversight persist across residential care: national studies in assisted living and nursing homes document disparities by dual-eligibility/race and call for stronger, more consistent clinical and regulatory infrastructure [15,16].

This paper examines emerging solutions that address these systemic challenges through technological innovation, community-based approaches, novel payment models, and policy reforms, offering potential bright spots for transforming elder care to meet the demands of the 21st century.

2. Emerging Solutions

The first step in transforming elder care will be to improve operational efficiency and data standardization, as accurate, comprehensive data is essential to tailor care models effectively and support preventive health measures. By adapting technologies from agile private sector offerings to enhance data-driven decision-making, providers can better address the specific health and social needs of residents, creating more personalized and effective care plans. Beyond the individual level of care, this foundation in turn must be scaffolded by stronger community-based approaches, wherein seniors can remain socially connected and embedded in familiar, culturally resonant environments, enhancing their quality of life and minimizing feelings of isolation. To support the implementation of these models, sustainable financing is necessary. As such, exploring novel payment strategies and value-based care arrangements will incentivize providers and payers alike to invest in long-term health outcomes for older adults. Finally, without supportive policies to reinforce these changes, efforts in technology, community-based care, and financing will be constrained by regulatory and financial limitations. Thus, policy reforms that foster innovation and enable flexible, sustainable elder care models are essential to catalyze sector-wide improvements.

2.1. Technologies

To understand pathways to innovating in older adult housing, it will be necessary to examine technological approaches—including data integration, artificial intelligence, and no-touch healthcare—that facilitate person-centered health platforms for elder care by improving safety, addressing social determinants of health, and supporting care continuity, especially in resource-constrained settings. In this context, person-centric health platforms may be defined as hybrid digital–physical systems that merge a resident’s clinical records, functional status metrics, and social context data into one continuously updated file accessible to the care team and the resident. Core elements often include a FHIR-compliant data layer, user-facing apps, device APIs, and a rules engine that triggers tailored prompts. Typical roll-out involves mapping data feeds, co-designing interfaces, and embedding alerts in existing workflows. Such platforms in turn, enable continuous risk stratification—leveraging multimodal data sources such as wearable or EHR data coupled with frequently retrained machine learning models.

Deploying such tools in the elder care ecosystem mandates an understanding of service quality and scope, yet a significant data deficit hampers decision-making—impeding public authorities and private payers from making informed investments. Studies indicate that at least 10% of older adults have unmet healthcare needs and up to 75% present to an emergency department (ED) experiencing activities of daily living (ADLs) decline. This highlights the need for comprehensive data to guide innovations [17,18]. Addressing both the social and health needs of older adults requires integrating diverse data sources—clinical, operational, and observational—into actionable insights, a complex yet essential endeavor [19].

At the provider level, innovative models like those from Centered Care focus on creating a unified, 360-degree view of each resident in assisted living facilities. By integrating clinical data with personal preferences and social engagement activities, Centered Care’s platform crafts wraparound patient profiles to enable predictive, personalized approaches to meeting social needs. This model aims to identify high-risk patients early, thus preventing health declines and avoiding unnecessary healthcare spending. Such approaches align with value-based care principles, emphasizing preventive measures and chronic condition management, which are essential for meeting the unique needs of aging populations.

Beyond access to data, the application of data through artificial intelligence is revolutionizing elder care by streamlining housing placements that are customized to the unique needs of older adults, leading to better individual outcomes and reduced costs for healthcare systems. Upside, for example, has partnered with health plans to match elderly patients with housing environments that meet their specific requirements, alleviating financial strains on the healthcare system. Their algorithm evaluates factors such as cost, location, available resources, tenancy requirements, and lifestyle preferences to provide personalized housing solutions. Housing Care Guides enhance this service by assisting residents with application processes and connecting them to essential community resources. This approach has supported 70% of participants in achieving stable housing, and 90% in gaining access to social determinant of health (SDOH) services (Personal Communication from Jake Rothstein, Upside, December 2024). With respect to health plan referrals, Upside reports a 13 min average response time and connection of over 90% of members within 24 h, positioning housing stabilization as a rapid, scalable intervention linked to reduced preventable utilization [20].

Integrating clinical, functional, and social determinants of health (SDOH) data is already producing measurable gains for older adults. Todd et al. showed that adding frailty indices and SDOH variables to routine electronic health record data improved the c-statistic of a 30-day readmission model from 0.68 to 0.78 in 56,308 Medicare beneficiaries [21]. Cornell et al. subsequently found that incorporating food insecurity, legal need, and neighborhood deprivation into prediction models decreased 30-day unplanned readmissions by 30% among 2038 older adults discharged from hospital [22]. Such studies underscore the statistical and clinical value of a unified data infrastructure that spans medical and social domains.

While technology is helping older adults find supportive environments tailored to their needs, advancements in no-touch healthcare technology are essential for ensuring safety and addressing workforce shortages in elder care. In institutional settings like assisted living, where staff shortages and high turnover make it challenging to provide continuous, wraparound support, passive monitoring technologies offer an efficient solution. Companies like Artisight use computer vision and machine learning to track older adults’ activities of daily living (ADLs) and detect unusual events, such as falls, without the need for wearable devices. By flagging anonymized video footage of potential incidents for human review, these systems can distinguish between harmless movements and situations requiring intervention, reducing staff burden and allowing for a safer environment even with limited personnel. This technology not only enhances safety but also fills critical gaps in workforce availability, where staff resources expended on 24/7 monitoring are often stretched thin (Personal Communication from Max Goncharov, Artisight, December 2024).

The literature supports the potential of ambient and conversational AI as frontline enablers of more independent aging. In hospitalized adults, an ambient computer vision system for continuous bedside monitoring reduced accidental falls compared with usual care, demonstrating benefit in an inpatient setting [23]. In community-dwelling older adults, a randomized controlled trial of an ambient-assisted-living platform (in-home sensors with AI-driven alerts) improved EQ-5D quality of life scores versus controls, showing benefit for aging-in-place [24].

While these technological advancements offer promising solutions, they also bring forth a range of ethical and practical considerations. The deployment of AI in elder services raises questions of privacy, autonomy, and the ethical use of data. AI health monitoring systems must be developed with careful consideration of their impact on users and other stakeholders, such as caregivers and family members. This includes understanding perceptions of risk and a senior’s tolerance for independent living, as well as balancing autonomy and well-being against the interests and preferences of family caregivers and healthcare professionals [25].

2.2. Community-Based Approaches

Beyond technological solutions designed to improve service delivery, programs supporting the psychosocial challenges of aging have emerged. These address key issues such as social isolation, the need for a supportive environment, and the importance of cultural and community integration. Such models highlight the evolving landscape of elder services, where the focus is increasingly on creating living spaces that are not only safe and supportive but also enriching and empowering for seniors [26,27].

Community- and culture-centered wraparound approaches demonstrate measurable benefits. The community-integrated PEARLS trial, delivered via senior service agencies, doubled remission from depression at 12 months in chronically ill, often low-income older adults [28]. Intergenerational engagement through Experience Corps improved executive function and, over two years, increased hippocampal and cortical volumes in older adult volunteers, suggesting neurocognitive benefits from social role integration [29]. Complementing these trials, reviews of Naturally Occurring Retirement Community supportive service programs report strengthened social capital and support for aging-in-place, though rigorous trials remain limited [30,31].

Priya Living exemplifies a community-based approach that reduces social isolation and enhances quality of life for older adults. This model, initially based on the concept of a shared duplex for seniors, has expanded into a vision of community-centered living. Priya Living’s communities, centered around South Asian culture, are strategically located near ethnic grocery stores, temples, and specialty restaurants. Offering a la carte services, the model allows residents the flexibility to select services as needed, fostering mutualism in community life and reducing the associated costs of isolation.

“Dementia Villages” offer another new approach, specifically catering to individuals with cognitive impairments [32]. Designed to provide a sense of normalcy and autonomy alongside necessary care and support, these villages feature amenities like shops, cafes, and gardens, enabling residents to partake in everyday activities within a traditional community setting. These care programs aim to create a supportive and familiar environment for residents, promoting a sense of belonging and community integration. These models pair environment and social design (community pillar) with data-informed screening and navigation (technology pillar) to support aging-in-place.

Broadly, by creating environments that promote engagement and inclusion, these models not only improve the quality of life for seniors but also lead to better health outcomes and overall well-being.

2.3. Novel Payment Models

To drive meaningful reform and foster more holistic services, innovative payment and policy models are essential. By aligning financial incentives with comprehensive care goals, these approaches can encourage senior living facilities and healthcare providers to integrate health, housing, and supportive services, creating a foundation for sustainable, person-centered care.

The partnership of senior living communities with health plans offers a strategic opportunity to enhance the health and well-being of older adults. By partnering with health plans, housing can more effectively integrate plan benefits and value-based offerings. Lifespark and Juniper Communities, for example, are partnering with payers in value-based arrangements. Lifespark, a complete senior health company, focuses on recentering health around people in their homes by integrating an entire continuum of services to meet their needs. A key focus is managing complex health issues by deploying to the home a combination of responsive and preventive measures. For example, Lifespark’s value-based offering called Lifespark COMPLETE provides a single point of contact, geriatric medical care, and in-home urgent response services that work within the context of existing senior living architecture (Personal Communication from Meaghan Puglisi, LifeSpark, November 2024).

In another model, the Connect4Life program by Juniper Communities integrates healthcare and care coordination for seniors, using electronic health records and a medical concierge model to reduce hospital readmissions and improve well-being. The program is designed to be part of the broader care continuum for seniors with significant healthcare needs post-hospital discharge (Personal Communication from Lynne S. Katzmann, Juniper Communities, November 2024).

The integration of value-based care models in senior living reflects a potential industry evolution, wherein providers now have greater access to partner with primary care networks, accountable care organizations (ACOs), and Medicare Advantage (MA) networks. Importantly, early experience with value-based payment models in senior care settings demonstrates meaningful efficiency gains. For long-stay nursing home residents enrolled in Medicare Advantage Institutional Special Needs Plans that provide on-site advanced practice clinicians, emergency department use was 51% lower, hospitalizations 38% lower, and 30-day readmissions 45% lower than in matched fee-for-service residents across 13 states [33]. In community-based comprehensive care, the Program of All-Inclusive Care for the Elderly (PACE) controlled hospital use to 0.2 days per enrollee per month alive versus 0.8 days in matched controls [34]. Complementing these plan- and provider-level models, the CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents reported promising reductions in potentially avoidable transfers when nurse practitioners or registered nurses were embedded to provide on-site clinical management [35]. Implementing these models requires a mindset shift. Given their proximity to residents, operators can have a substantial impact on outcomes and the ultimate cost for their residents. This approach underscores the need for forward-thinking leadership and the adoption of the right tools and metrics to achieve better health outcomes more proximal to the resident—i.e., where they live.

2.4. Policy Actions

Policy actions serve as an umbrella for comprehensive reform, enabling scalable solutions and ensuring that elder care programs remain accessible, sustainable, and aligned with broader public health goals. For example, a quasi-experimental study of 12 Low-Income Housing Tax Credit (LIHTC) senior housing projects across five states reported a 15% increase in assisted-living availability and a 5.8% reduction in Medicaid long-stay nursing-home days over five years [36]. Additionally, Hua et al. showed that Oregon’s outcomes-based assisted-living licensing reform was associated with a 19% decline in injurious falls per 1000 resident-months relative to neighboring states [37]. Here, we briefly outline key policy opportunities that can bolster services for older adults by incentivizing innovation, supporting integration, and reducing financial barriers for individuals and families.

Tax incentives represent a critical government action to reduce the financial strain on individuals and families seeking elder care services. These incentives are particularly important for the “forgotten middle”—16 million middle-income older adults who do not qualify for Medicaid yet lack the resources to afford necessary housing and care options [38]. By offering tax credits, the government can facilitate access to appropriate care environments, ensuring that financial barriers do not impede the adoption of more effective and personalized care models.

Beyond addressing financial access, policy should also shift the industry’s focus toward improving resident outcomes rather than adhering to rigid process measures like staffing ratios. Over-reliance on such ratios may unintentionally hinder the adoption of technology and stifle continuous innovation aimed at enhancing health and wellness. To foster progress, subsidies or grants could be allocated to support the integration of technology, such as telehealth and remote monitoring systems, into care delivery. Additionally, regulatory reforms could incentivize partnerships between assisted living facilities and healthcare providers, ensuring more comprehensive and coordinated care for older adults. Finally, policies promoting continuous education and training for caregivers—focusing on the latest research and technologies—would further ease workforce challenges and improve the overall quality of care.

Thus, while innovative care models, technology, and community-based approaches provide critical pieces of the elder care puzzle, policy reform is necessary to create an overarching framework that supports these initiatives.

2.5. Integrated Framework

Collectively, the four pillars form a virtuous cycle (Figure 1). Technology—combining rich, multisource data with ambient and conversational AI—enables earlier risk detection and personalized supports; community-based approaches (e.g., home-delivered acute care, home-based primary care, and home modifications with coaching) translate those insights into timely, in-home interventions; novel payment models capture resultant savings and reinvest them into scale staff, tools, and services; and policy actions (e.g., targeted housing and licensing reforms) accelerate diffusion and align incentives toward equity. In addition, this integrated approach helps address systemic challenges such as workforce strain by shifting routine surveillance and documentation to ambient systems and using savings from novel payment models to reinvest in wages, training, and career ladders, mitigating burnout and turnover. To our knowledge, no prior senior living framework explicitly situates this feedback loop.

3. Conclusions

Reimagining the housing industry for older adults will require synthesizing these models and scaling solutions appropriately to meet the diverse needs of the aging services sector. The ongoing housing crisis for the elderly underscores the urgent necessity for systemic change, with a range of potential pathways forward—including technological innovations and policy reforms—available to improve outcomes. We present a call to action for stakeholders to engage in further research, policy development, and the advancement of technological solutions, with the collective goal of creating a more efficient and compassionate elder care ecosystem.