The senior care industry is currently navigating a complex landscape marked by contentious corporate governance battles, significant legislative changes impacting funding, persistent challenges in patient care outcomes, and a strong drive towards technological innovation. Stakeholders across the sector are grappling with these multifaceted issues, each presenting unique pressures and opportunities.

A notable proxy fight continues to unfold between Brookdale Senior Living and Ortelius Advisors, now in its fourth month, ahead of Brookdale’s annual shareholder meeting on July 11. Both parties are leveraging reports from proxy advisory firms to bolster their positions regarding control of Brookdale’s board of directors. Glass Lewis & Co. LLC and Institutional Shareholder Services have recommended that shareholders not grant control of the board to Ortelius, citing Ortelius’s poor engagement record and lack of operational knowledge. Glass Lewis specifically noted that Ortelius failed to provide a ‘clear, persuasive and measurable framework for execution.’ While Brookdale agreed with these firms on denying Ortelius control, it 'strongly' disagreed with their suggestion to vote for any Ortelius nominees, asserting they are 'not additive or relevant' to the business. Brookdale maintains that its own slate of nominees is 'uniquely suited' to oversee the company, emphasizing a 'thoughtful refreshment process' that balances fresh perspectives with institutional knowledge. The company believes electing Ortelius nominees could jeopardize strategic execution and the CEO search. Concurrently, Brookdale has appointed Mark Fioravanti and Joshua Hausman as independent directors. Conversely, Ortelius cites Glass Lewis’s recommendation to vote for its nominees as validation for its push for change, highlighting the firm’s credit to Ortelius for driving change and questioning Brookdale’s governance. Ortelius also garnered support from Egan-Jones Ratings Company, which recommended all six of its nominees and recognized the need for significant board renewal, criticizing Brookdale’s underperformance and 'unsustainable debt burden.' Egan-Jones also supported voting for Brookdale’s new incumbents, Fioravanti and Hausman, as they were not responsible for past missteps.

Legislatively, the Senate recently passed a $3.3 trillion budget reconciliation bill, which includes $4.5 trillion in tax cuts and $1.2 trillion in spending cuts, notably impacting Medicaid. These cuts involve work requirements, co-pays, and a 3.5% cap on state provider taxes, with the bill now moving to the House. Industry advocates, including LeadingAge and Argentum, are assessing the 'significant negative impacts' of the bill. LeadingAge highlighted concerns about reduced state flexibility, leading to lower provider Medicaid reimbursement rates or closures, and reductions in optional benefits like home- and community-based services (HCBS), including assisted living waivers. While the bill proposes a new HCBS program, advocates fear states’ budget constraints will hinder its success. Argentum has focused on ensuring Medicaid assisted living waiver programs are unaffected and pushing for tax policy to increase access and affordability, noting the inclusion of tax deductions for older adults ($4,000 in House, $6,000 in Senate version) and a permanent expansion of the low-income housing tax credit. Despite these efforts, several senators, including Amy Klobuchar (D-MN) and Susan Collins (R-ME), expressed strong opposition, calling the bill a 'betrayal' of older adults and low-income families due to its harmful effects on Medicaid and Medicare. Worker and older adult advocacy groups, such as SEIU, Justice in Aging, Caring Across Generations, Robert Wood Johnson Foundation, and Alliance for Retired Americans, echoed these concerns, describing the bill as an 'assault on working people' and a 'staggering betrayal' that threatens healthcare access and deepens inequality.

Beyond policy, new research highlights long-term health problems for older adults following hospitalization for community-acquired pneumonia (CAP). A study published in BMC Infectious Diseases, tracking 296 adults aged 50 and older, found that CAP’s impact extends far beyond the initial infection, affecting employment, daily functioning, cognitive ability, and overall well-being for months post-discharge. Among employed patients, 59% experienced job loss within six months. Significant declines were also observed in basic and instrumental daily activities, and cognitive impairment affected 42% of patients, including those under 60 without prior dementia. Risk factors for worse outcomes included lower pre-illness functioning, poor baseline quality of life, less education, and tobacco use. Patients with delirium during hospitalization faced particularly poor functional outcomes, underscoring the need for strategies to prevent or mitigate these adverse effects.

Adding to healthcare challenges, older adults in the United States are experiencing increasingly longer stays in emergency departments (EDs), often exceeding federal guidelines. A national analysis of hospital data from 2017 to 2024 revealed that in 2024, 20% of older patients spent over eight hours in the ED, up from 12% in 2017. For those admitted, more than one-third (36%) waited over three hours after admission decisions, a phenomenon known as 'boarding.' These benchmarks are part of the new Age-Friendly Hospital Measure introduced by the Centers for Medicare & Medicaid Services (CMS), effective January 2025. Delays were most severe in academic hospitals. Emergency physicians emphasize that these prolonged stays expose vulnerable older adults to complications like delirium and loss of mobility. Contributing factors include financial incentives and reduced inpatient bed capacity, prompting calls for broader reforms, including increased access to telehealth, mobile care teams, and hospital-at-home programs to reduce unnecessary ED visits.

Amidst these challenges, innovation and technology are increasingly pivotal in senior living. A new survey from Argentum and A Place for Mom, titled 'The State of Technology Adoption,' reveals increased optimism about artificial intelligence (AI) and heightened concerns about interoperability. Based on surveys of nearly 1,000 senior living operators, executives, and technology leaders, the report outlines how the $475 billion sector is responding to rising demand, workforce shortages, and changing expectations. Key themes include prioritizing compatibility and interoperability with existing systems, securing funding for tech investments, enhancing operational efficiency and resident care through AI, and co-innovation with vendors. AI adoption is widespread, with 70% using it for predictive analytics, and 50% for staff efficiency and chatbots. Enthusiasm for AI jumped from 58% in 2023 to 76% in 2024. The report identifies technology silos, vendor challenges, delayed value-based care participation, and a lack of quality data as key issues. While 58% of executives collect health and wellness data, only 7% have a comprehensive view across all datasets, though most expect to implement such systems within 18-36 months. The industry's 'vast data resources' remain locked in incompatible systems, hindering informed decision-making and value-based care. The report also highlights that 84% of respondents view collaboration with vendors as essential for long-term success, and 76% believe AI will have a positive or transformative effect. Despite this, lack of funding (63%) and demonstrable ROI (74%) remain top barriers to technology adoption. This report, an evolution of Argentum's 2023 'Innovation Roadmap,' aims to track technology trends and progress, reinforcing a 'shared commitment' to enhancing older adults’ lives through innovation and policy.