The Daily Realities of Clinical Care in Senior Living
Resident acuity is climbing, yet most communities don’t have a clear view of it.
In communities where acuity is underreported, it’s largely due to overdue assessments and intentional under-scoring.
Assessments are
not updated on time
Intentionally under-scoring
assessments by staff
to manage care rates
PRN care services are provided but
are not triggering reassessments
Technology or
system limitations
Training or knowledge gaps
Operational
staffing constraints
Assessments take too long
to complete
Limited visibility into
resident condition changes
between assessments
Needing to have conversations with families about care rates is likely one reason for intentional underscoring. Most nurses aren’t equipped or comfortable with this type of financial conversation related to care rates and this shouldn't be a nursing responsibility.
Staffing models are evolving to support rising acuity.
When asked what they wish they could do more of to improve resident care, a majority of respondents cited workplace improvements, indicating a direct relationship between staffing and quality of resident care.
We’re all battling for the same people and it’s great to see there’s a huge focus on workplace culture. The churn and burn is real, so I’m not surprised by the results we’re seeing in terms of staff retention being a key challenge. It’s an accurate depiction of what’s happening.
One-third of respondents are operating in value-based care systems that involve financial risk.
Strengthening external partnerships, in addition to closer tracking of resident acuity and clinical quality metrics, are among the primary ways operators are equipping themselves for success in value-based care.
Strengthening partnerships with primary care, therapy, or hospice
Increasing consistency in care
documentation and/or acuity tracking
Investing in internal dashboards
to track quality metrics
Implementing VBC-enablement technology
platforms (e.g., EHRs, analytics, fall prevention, etc.)
Piloting new staffing models
or workflows
Leveraging fully or partially-owned primary care,
therapy, or hospice providers
Developing risk-based
contracting capabilities
No specific preparation at this time
Clinical leaders see clear benefits in predictive analytics and AI, but adoption remains slow.
I’ve been in this field for 20 years and in my experience, assisted living tends to be behind on adopting new technologies. With fall detection and fall prevention technology, more people are starting to move forward with it but it took a long time for companies to see the benefit of the investment.
Effective change management remains a major barrier to improving clinical workflows and care, with time-consuming trainings and slow uptake among the top barriers to adopting new technologies
Explaining the “why” behind a decision matters, but you also need to ensure that there’s some methodology for project management.
More communities are monitoring change in condition via passive monitoring and point of care apps, while fewer are relying on paper charting (compared to 2024).
On paper
Electronic charting
(EHR, point of care app, or kiosk)
A combination of paper
and electronic
Paper documentation doesn’t allow you to capture everything that happens during a shift. Things like extra showers become routine, so when caregivers are asked about changes, they don’t think of that as a change [...] They just think of it as being part of their standard care for that resident.
Clinical leaders are pushing toward proactive care, but fragmented data holds them back.
“I wish more people knew that clinical care extends far beyond medication management. It requires critical thinking, communication, and regulatory expertise.”
“Nurses are not a cost center, they’re a core value driver and the reason residents choose our communities”
“My role directly influences quality of care, staffing models, and operational outcomes. Integrated data would allow for better forecasting and collaboration between Clinical and Finance.”
“Our biggest challenge is overlapping priorities around clinical excellence, hospitality, and wellness in care settings that have traditionally adhered to a medical model.”
“I want to see the industry shift toward a focus on data and analytics, but buy-in isn’t always there and teams are slow to leave behind paper processes.”
“We need better resident risk data to drive early interventions and prevent hospitalizations.”
Methodology
Clinical leaders at senior living operators across the United States were invited to participate in this survey via email outreach and LinkedIn messages. Sixty-eight clinical leaders elected to complete the survey. Data was captured via anonymized online survey between September 16, 2025 and October 21, 2025.
See last year’s reportSurvey task force
Download the report
Get the PDF to save and share survey results and to see the complete appendix.
