Overview The total U.S. nursing care industry is estimated at $99 billion, reflecting a 0.1% decline in 2011. The industry includes about 40,095 businesses including skilled nursing care facilities, home health care services, continuing care retirement communities, social services, and assisted living facilities. Though the recent economic downturn has slowed growth, the eldercare and nursing care industry is expected to increase due to an aging population, driven primarily by the baby boomers.

Overview Nursing homes will need to evolve in order to compete with other, more popular assisted living options and the current trend of aging in place. As government insurance programs Medicare and Medicaid largely control revenue per patient, the profitability of nursing facilities depends on efficient operations. Nursing homes may choose to participate in Medicare and/or Medicaid. A Skilled Nursing Facility (SNF) is certified to participate in and be reimbursed by Medicare, while a Nursing Facility (NF) is certified to participate in and be reimbursed by Medicaid.

Overview SNFs and NFs are subject to federal and state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (along with the nuclear power industry). Large companies have some economies of scale in administration and purchasing, but smaller operators can compete effectively by offering better service.

Major Players Most of the major eldercare companies offer a variety of facilities, from retirement communities to skilled nursing homes. With 548 communities in 35 states and the ability to serve over 51,800 residents, Brookdale is the largest operator of U.S. senior living communities. It offers independent living, personalized assisted living, Alzheimer’s and dementia care, rehabilitation, and skilled nursing and continuing care retirement communities. Sunrise Senior Living is the largest eldercare facility with 394 facilities and over 26,500 resident capacity.

Major Players Emeritus Corporation is another large eldercare company with 308 communities in 36 states with capacity for over 32,300 residents. ManorCare has more than 500 locations in 32 states focused on skilled nursing and rehabilitation centers. Other large skilled nursing facility companies include Genesis HealthCare and Trans Healthcare.

Demographics By 2030, 20% of the U.S. population—72 million Americans—will be age 65 or older and need senior care options, some with nursing care.   Women still live longer, but men are catching up. Males aged 60-74 increased by 35% while their female counterparts increased by 29%. The mortality gap between men and women at older ages has also narrowed. There are now subgroups, of the “old” and “very old,” who have very different needs than the younger seniors. The need for nursing home care increases with age.

Demographics According to AARP, nearly 20% of Americans provide unpaid care for loved ones age 50 and older. This is a crucial target demographic for nursing homes as caregivers are often also decision makers. The typical family caregiver (and often decision-maker) is a 46-year-old woman caring for her widowed mother who does not live with her. The adult daughter is married, employed, and pressed for time.

Marketing & Advertising A healthy spouse or adult child often researches care options for the patient so, with the prevalence of the internet, an informative website is necessary. Online partnerships with senior living directories and referral sites can be an effective element of the marketing mix. Solid lead generation and management are keys to success as the decision to enter a facility, more often than not, takes time. Successful managers will give families time and space to make this important decision. No pressure sells!

Marketing & Advertising Some nursing homes are part of larger retirement communities that offer care for life, whereby residents in these entry-fee communities have access to multiple lifestyle and care options for every life stage. These flexible options are great to advertise, especially considering the positive psychological impact they can have on patients going through difficult transitions. Many baby boomers express a preference for aging in place, meaning staying in homes for the long run. Nursing home facilities should advertise the benefits of familiarity with a space and early-intervention care for the elderly.

Trends and Challenges Positive trends include: a growing aging population with more financial assets than prior generations, the use of long-term health care insurance, and the mobility of extended families and their inability to care for aging family members. Facility trends will likely lean toward assisted-living and retirement communities, as they offer more independence and lower costs. Assisted living services generally cost 30-55% less than skilled nursing facilities.

Trends and Challenges While Medicare is the largest payment source for eldercare services, as a greater number of adults utilize long-term care insurance, private insurance payments are expected to become more common. A recovering economy should also allow more elderly people to be able to afford eldercare living arrangements.

The Future There’s no doubt the number of aging people who will need living assistance is growing. Nursing homes can be perceived as the option of last resort. They often do not have a positive reputation in the marketplace relative to other assisted-living options.   Eldercare comes in many forms and settings; companies that determine and meet the needs of consumers will be more successful.

Advertising Strategies Elder care organizations should use advertising to highlight their specialty, whether it's active lifestyle, Alzheimer's and dementia care, or long-term treatment. Focus on your expertise, compassion, and reliability. Clearly mention any certifications or organizational memberships in all ads. Elder care services should target both seniors (average age 74) and their caregiver children (average age 50) through advertising efforts. Use the emotional aspect of media: Depict an elder with his or her adult child talking about the challenges they share; or, include the major concerns of both demographics separately, but in the same ad.

Advertising Strategies Highlight the importance of elder care services as preventive measures. Once seniors become too ill to live independently, it is harder for them to adapt to new environments and lifestyles. This makes the transition to elder care more complicated. However, when seniors start elder care services while they are still relatively healthy, they are more likely to benefit. Consider hosting an event on-site. Serve coffee and cookies. Develop a presentation or panel discussion to enlighten people about the benefits of elder care. Leave plenty of time for questions at the end and send attendees home with an information packet that contains your contact information. Increase awareness of your event by including detailed information in ads.