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In any field, there's a difference between observing something and understanding it.
Data can tell you what's happening. The people doing the work can tell you why it matters.
For the second year running, we've asked clinical leaders directly about their priorities, their challenges, and the decisions they're making as they navigate this moment in senior living.
This year's findings, developed in partnership with ASHA, offer a nuanced yet decisive view of an industry at a crossroads.
When we can compare responses year over year, patterns become clearer. Some challenges are intensifying. Others are evolving. And in certain areas, we're seeing meaningful progress.
Read the full 2025 State of Senior Living Clinical Leadership Report →
What Clinical Leaders Are Telling Us
On Resident Acuity
Three-quarters of respondents report that acuity has increased over the past five years.
At the same time, 63% believe that documented acuity doesn't always reflect actual acuity.
The most common reasons include assessments falling behind schedule and staff under-scoring assessments to manage conversations with families about rate increases.
“We know our nurses and caregivers alike are very busy and there is often a delay between change in condition and it being memorialized in the resident assessment. And we know why this occurs. We know that when they’re splitting their focus and their time between tracking rate adjustments and billing and assessments and hands-on care and documentation and human resources management, they don’t always have the time in the day to record those changes of condition to trigger a new care plan.”
- Danielle Parker, RN
Chief Operations Officer, GenCare Lifestyle
On Staffing
Improving staff quality and retention continues to be the top challenge, with 65% of leaders identifying it as a priority (up from 57% in 2024).
Many communities are responding by adding caregivers and expanding the role of med techs.
When asked what would most improve resident care, 66% pointed to workplace culture and staff retention, reinforcing the direct connection between team stability and clinical outcomes.
On Value-Based Care
Two-thirds of organizations are actively operating in, joining, or evaluating value-based care arrangements.
To prepare, 74% are strengthening partnerships with primary care, therapy, or hospice providers, while 59% are working to improve care documentation and acuity tracking.
On Technology and Data
Leaders recognize the potential of predictive analytics and AI to identify at-risk residents earlier.
In fact, 88% see earlier risk detection as the most valuable outcome of these tools. However, only 36% are currently using or piloting these technologies.
When introducing new tools, the biggest barriers are staff adoption (65%) and integration into existing workflows (57%).
The Opportunity Ahead
Clinical leaders are managing more complexity than ever before. They're balancing higher acuity, evolving staffing models, increased regulatory requirements, and new partnership arrangements — all while trying to elevate quality of care and team morale.
Several themes emerge from their responses that point to the opportunities ahead:
Better visibility into clinical patterns.Many leaders wish they had clearer insight into rising-risk residents, frequent PRN services, and changes in condition between formal assessments. Point-of-care tools, integrated EHR workflows, and passive monitoring technologies are beginning to address these gaps in some communities.
Alignment between clinical and operational data.When acuity data informs staffing models and revenue planning, clinical leaders can make more strategic cases for the resources their teams need. Half of respondents report that care levels are a major factor in their staffing model, though there's room for this to become more systematic across the industry.
Thoughtful change management.The leaders who are successfully implementing new technologies emphasize the importance of involving frontline staff early, explaining the rationale clearly, and designing workflows that reduce burden rather than add to it. As one task force member observed, "Explaining the 'why' behind a decision matters, but you also need methodology for project management and ongoing support."
Our Research Approach
Clinical leadership is about more than patterns in a database. It's about judgment, context, and the ability to translate complex information into better care.
The data can show you that fall rates are changing or that acuity scores are climbing. Clinical leaders can tell you why. And, more importantly, what they're doing about it.
The 2025 State of Senior Living Clinical Leadership Survey was conducted in partnership with ASHA and includes responses from 68 clinical leaders across assisted living, memory care, independent living, and skilled nursing communities nationwide. Survey data was collected between September 16 and October 21, 2024.
Read the full 2025 State of Senior Living Clinical Leadership Report →
The 68 clinical leaders who participated in this year's survey are making decisions every day that affect resident safety, staff wellbeing, and organizational sustainability. They're piloting new care models, evaluating partnerships, and advocating for resources. Their perspectives, shaped by both the challenges they face and the solutions they're developing, deserve to be centered in conversations about the future of senior living.
What This Means for the Industry
Clinical leaders are clear about what they need:
- Better tools to capture and act on clinical data in real time
- Systems that reduce administrative burden while improving care documentation
- Recognition of their role as strategic partners in organizational success
The question is: are we listening to them?
"Our role requires emotional intelligence, leadership, and systems thinking, not just clinical expertise. When recognized as whole-community leaders rather than just clinical task managers, we're able to drive better clinical outcomes and stronger business performance."
As the industry continues to evolve, the voices of clinical leaders will be essential in shaping what comes next. We're grateful to the leaders who took the time to share their insights, and to ASHA for partnering with us to make this research possible.
Read the full 2025 State of Senior Living Clinical Leadership Report →
