The Forgotten Middle: Possible Solutions for Middle Income Senior Care

There is a cavernous gap in senior care options for the broad middle class.  For the truly, low income and low asset senior, Medicaid provides significant options for the senior.  For high income seniors, they can afford the services they want and need.  The majority in the middle struggle to afford the services, forcing seniors and families to stretch to meet their care needs. 

There is a business opportunity in all of this.  The question is how to put it together.  It’s doubtful that the solution is one thing. 

The solution to the problem likely lies with home and community-based senior care whether funded privately, by the government, or a combination of both.  It’s likely to include in home non-medical care, volunteer/unpaid family care, technology, home modifications, meal delivery services, and adult day services.  These are services that supplement existing housing options whether single family or multi-family housing.

The NIC study suggests building assisted living services for this group.  I’m sure there will be some properties who are able to figure it out if only because as the buildings age, they lose competitiveness.  Yet, the underlying cost of the institutional care (even just looking at personnel expenses) suggests that this is going to be difficult. 

There will be many creative solutions.  I’m looking forward to finding them and writing about them.

However, this senior care entrepreneur is focusing on and investing in adult day services to be the core solution to this dilemma of the booming care needs of the middle-class seniors.  I envision adult day centers to be a hub of services empowering seniors to remain in their homes and in their communities.  The adult day experience supplements current housing options whether in a traditional single family home, an apartment, a condo, a townhome, or in an independent living community. 

Adult day is a platform from which to provide the senior care services seniors need.  The center is a community hub.  Services emanate from the center into the community allowing for superior experiences at a lower cost.  The more expensive senior living options can be a supplement towards the end of life rather than a multi-year housing experience that drains financial resources.

I’m still working on the particulars, but when I envision the adult day center of the future it includes: 

  • Social, Recreational, and Spiritual Programming
  • Significant Health Care services to include chronic care services and engaging in the post-acute care and post-rehab spaces
  • Reaches into the home with sophisticated and expert home care services
  • Leverages Medicare funded services such as physical, speech, and occupational therapy, and medical social work services
  • Professional care management resources.

I’m still exploring the strategy.  I’m still trying to understand product market fit.  It’s clear that the middle market won’t be able to afford senior living in 10 years because they can’t afford it today.  The  middle really is forgotten.  We need a solution.  I’m betting on Adult Day.

What’s the solution for the forgotten middle?  Is it residential?  Is it community-based? Or a combination? 

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