Historically, the process of identifying a suitable home for a loved one has not been a consumer-driven process. Put simply, if an older adult can no longer live independently and does not require the level of support offered in skilled nursing, they are left to choose among the current supply of assisted living (or similar) facilities. In terms of care needs, this cohort accounts for the largest proportion of older adults needing supportive services. A combination of online research and touring of assisted living facilities close to one’s current residence is the basis for a decision. There is no shortage of checklists and online resources to select a home for an older adult (most sites appeal to the son or daughter of a loved one as opposed to the actual resident). Given that 60% of assisted living residents only relocate within a 10-mile radius from their home, and 80% relocate within a 25-mile radius, this is a very narrow range to find a suitable home. As such, one is likely to be subject to the geographical definitions of quality and amenity; given that although the industry has rapidly expanded since its inception in the late 1970s, there has been no establishment of a threshold at or below which an assisted living facility can provide adequate care without comprising resources and safety.

On the basis of gender, women dominates the market. More than two-thirds of geriatric population aged above sixty-five years require some kind of long- term care, among which mainstream are women. As per the New England Journal of Medicine, the probability that a man over 65 years of age, will require long-term care is 33% whereas, for a woman, it is 50%. Women are more prone to long-term care as they have increased life expectancy and are susceptible to developing chronic infections and ailments like Alzheimer’s disease. Women usually outlive men by five or more years. Women age sixty-five at present can anticipate to live around twenty more years and need an average of 3.7 years of prolonged long-term care provision. Thus, due to this increased need for assistance, nearly two-thirds of assisted living facility receivers are women.

Across the United States, 60% of assisted living administrators noticed an increase in legal claims; meanwhile nearly 75% noticed an increase in lawsuits and 71% noticed an increase in settlements. One of the reasons for the rise in legal pressure may be attributed to a higher proportion of residents with moderate to severe cognitive impairment in assisted living. More broadly, this also indicates that there is a lack of consumer choice and solutions for the elderly in need of long-term services. As a short-term option to mitigate the rise in legal pressure, long-term facilities could explore ways to work with residents in defining various thresholds of care that are safe, sustainable and economically sound whilst preserving certain aspects of residents’ desired lifestyles. Over the long term, the United States needs to develop innovative options for the provision of long-term care services with a focus on redesigning care for older adults with their input.